Rheumatoid Arthritis FAQs
What is RA?
What are RA signs and symptoms?
Signs and symptoms of Rheumatoid Arthritis may include:
- Tender, warm, swollen joints
- Morning stiffness that may last for hours
- Firm bumps of tissue under the skin on your arms (rheumatoid nodules)
- Fatigue, fever and weight loss
Early Rheumatoid Arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.
As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.
Rheumatoid Arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, Rheumatoid Arthritis can cause joints to deform and shift out of place.
Is there a cure for RA?
We know a great deal about how to control RA and its symptoms. While we still cannot cure it at present, joint damage can now be prevented — with early use of disease-modifying drugs that are essential in order to avoid joint erosion and limitation in function.
What are causes of Rheumatoid Arthritis?
The actual cause of RA is unknown, but it is thought to be triggered by environmental factors, such as infections with viruses or bacteria, in people with a genetic predisposition to the disease.
However, while some patients do remember a viral-type illness when RA began, most do not. To date, no specific infectious agent has been found. (Some antibiotics may improve RA a bit, but their benefits seem to come from their anti-inflammatory action, not their bacteria-killing actions.)
Genetic factors appear to play as much as a 50% role in the development of RA. But it is the contact with an environmental agent in the genetically-predisposed person that seems to initiates the self-perpetuating inflammation characteristic of RA.
While it is clear that genetics are important, if you have RA, this does not at all mean that your child or grandchildren will develop it. Actually, the risk is very small.
Will dietary changes help with RA?
An appropriate and healthy diet plays a major role for patients with RA. For most, a well-balanced diet is the correct prescription and will ease inflammatory pain by reducing the swelling of infected joints.
RA patients should keep a diary to determine whether eating one type of food is commonly associated with a flare of RA.
If that is the case, a trial of avoiding that food is reasonable. Optimal weight is always appropriate, especially for patients with joint inflammation in legs, knees and feet.
What role does stress play in RA?
Patients commonly report that stress, either physical or emotional, was present or severe when their RA began. This is true in other autoimmune disorders as well. Since the mind-body connection is real, most physicians appreciate the linkage between stress and disease onset or exacerbation.
Because there are clear interactions between the nervous, immune and endocrine systems, the impact of stress on disease presentation and severity is explainable in physiologic terms. Obviously, life is stressful. Thus, how to employ stress reduction in a therapeutic regimen is up to the individual patient, in concert with the physician.
Why is RA called an autoimmune disease?
The immune system plays a major role in development of joint inflammation and damage, fatigue, and the feeling that you have a chronic viral illness.
The immune system is made up of body-protecting cells and antibodies. In normal people, these help to fight off invading infectious agents.
In RA, however, something goes awry, and the immune system appears to be directed against the person’s tissue. In autoimmune diseases, like RA, the immune system mistakenly attacks healthy parts of the body.
Can RA affect internal organs?
Rheumatoid Arthritis does not limit itself to joint deterioration. It can adversely affect almost any organ in the body. Specifically the skin, eyes, heart, nervous system, lungs, and blood are all potential victims of Rheumatoid Arthritis complications.
Rheumatoid Nodules develop in between 25 and 50% of Rheumatoid Arthritis patients. Rheumatoid Nodules are firm, subcutaneous nodules frequently found on pressure points like the elbow, fingers, and other joints. They are one of the most visual indicators of Rheumatoid Arthritis deformity.
Rheumatoid Arthritis patients may also develop:
- Keratoconjunctivitis sicca, or dryness of the eyes due to decreased tear production.
- Episcleritis or scleritis; inflammation of the connective tissue in the eye that gives it a red-eye appearance similar to conjunctivitis; however, there is no tearing.
These conditions can cause painful symptoms including increased light sensitivity, redness, and even vision loss.
Almost 50 % of RA patients develop pericardial effusion, or an abnormal accumulation of fluid around the heart. Although clinical symptoms are rare, fluid accumulation can cause increased pressure around the heart and adversely affect its function. Rheumatoid Arthritis may also lead to myocarditis, or inflammation of the heart muscle. Both pericardial effusion and myocarditis can lead to congestive heart failure.
Two disorders of the nervous system may also develop as a result of Rheumatoid Arthritis:
- Peripheral nerve entrapment; results in pain and/or loss of nerve function as a result of chronic compression.
- Mononeuritis multiplex; eventual loss of sensory and motor function of individual peripheral nerves.
Interstitial lung disease is an increasing scarring of the lungs that eventually disturbs your ability to breathe and get enough oxygen into your bloodstream. While patients may be asymptomatic, this condition is quite common in Rheumatoid Arthritis patients.
It is very common for Rheumatoid Arthritis patients to develop anemia or other problems stemming from this condition. A patient with Rheumatoid Arthritis also carries the dangerous possibility of developing Rheumatoid Vasculitis, or inflammation of the blood vessels. Potentially life-threatening, it can cause:
- skin ulcerations and infections
- nerve disorders that cause pain, numbness, or tingling
- bleeding stomach ulcers
Additionally, vasculitis can affect the brain, nerves, and heart, which can lead to stroke, heart attack, or heart failure. Naturally products have been shown to help greatly with Rheumatoid Arthritis.
Is there a link between RA and heart disease?
According to studies people with Rheumatoid Arthritis have a greater risk of heart disease than the general population. During the two years before diagnosis of RA, persons with this disease were three times more likely to have had a heart attack requiring hospitalization and five times more likely to have an unrecognized heart attack.
After diagnosis, arthritis patients were twice as likely to experience unrecognized heart attacks and sudden cardiac death. Persons with RA are often less likely to have a history of chest pain, possibly due to pain relieving medications being used to treat their RA symptoms. A significant increase in stroke has not been found.
Can you decrease the risk of heart disease having RA?
People with RA should be screened and treated for cardiac risk factors including high cholesterol. It is important that people with RA recognize the traditional risk factors for heart disease and the other risk factors that are associated with the disease and seek medical care.
There are many things that can be done to reduce the risk for heart disease such as: not smoking, a healthy diet, getting plenty of regular physical activity, keeping weight under control, getting regular medical checkups, managing stress, and controlling blood pressure and cholesterol.
What are complications of RA?
Rheumatoid Arthritis increases your risk of developing:
Carpal tunnel syndrome. If Rheumatoid Arthritis affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers.
Anemia. This is a low level of hemoglobin, a protein in the blood that carries essential oxygen to cells and tissues. Symptoms include weakness, low energy, pallor, and shortness of breath.
Scleritis. This is a serious inflammation of the blood vessels in the white portion (sclera) of the eye that can damage the eyes and impair vision.
Infections. People with Rheumatoid Arthritis have a higher risk for infections. This is due partly to the abnormal immune system in RA and partly to the use of immune-suppressing medications for treatment.
Digestive tract problems. Many people experience stomach and intestinal distress. Again, this is more often a side effect of medications used to treat RA.
Osteoporosis. Osteoporosis, or the loss of bone density, is more common in women with RA than in women in general. The hip is particularly affected. The risk for osteoporosis also appears to be higher than average in men with RA who are older than 60 years.
Lung disease. Certain conditions involving inflammation of the lungs seem to be more common in people with RA than in the general population.
Heart problems. Rheumatoid Arthritis can increase your risk of hardened and blocked arteries, as well as inflammation of the sac that encloses your heart.
Sjögren’s syndrome. This is another autoimmune rheumatic disease, like Rheumatoid Arthritis. It causes extreme dryness of certain body tissues, especially the eyes and mouth. Dryness of the eyes is common in people with RA.
Lymphoma and other cancers. The risk for lymphoma, a cancer of the lymph nodes, is higher than normal in people with RA. This is thought to be a result of abnormalities in the immune system.
Macrophage activation syndrome. This is a life-threatening complication of Rheumatoid Arthritis. It is diagnosed by bone marrow testing and requires immediate treatment. Symptoms include persistent fever, weakness, drowsiness, and lethargy.
Overall, the rate of premature death is higher in people with Rheumatoid Arthritis than in the general population. The most common causes of premature death in people with RA are infection, vasculitis, and poor nutrition. Fortunately, the manifestations of severe, long-standing disease, such as nodules, vasculitis, and deforming are becoming less common with optimal medical treatments.
When should you see a doctor?
Joint pain or stiffness or swelling around a joint that lasts more than two weeks warrants a visit to a health-care professional.
Someone who experiences symptoms that he or she thinks may be caused by RA should talk to a doctor. A doctor can explain the treatment options.
How to prepare for a doctor visit?
While you might first discuss your symptoms with your family doctor, he or she may refer you to a Rheumatologist — a doctor who specializes in the treatment of arthritis and other inflammatory conditions — for further evaluation.
What you can do
Write a list that includes:
- Detailed descriptions of your symptoms
- Information about medical problems you've had in the past
- Information about the medical problems of your parents or siblings
- All the medications and dietary supplements you take
- Questions you want to ask the doctor
What to expect from your doctor
Your doctor may ask some of the following questions:
- When did your symptoms begin?
- Have your symptoms changed over time?
- Which joints are affected?
- Does any activity make your symptoms better or worse?
- Are your symptoms interfering with daily tasks?
How to diagnose RA?
Rheumatoid Arthritis can be difficult to diagnose in its early stages, because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis.
During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she will also check your reflexes and muscle strength.
People with Rheumatoid Arthritis tend to have an elevated erythrocyte sedimentation rate (ESR, or sed rate), which indicates the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinate peptide (anti-CCP) antibodies.
Your doctor may recommend X-rays to help track the progression of Rheumatoid Arthritis in your joints over time.
What is the treatment for RA?
There is no cure for Rheumatoid Arthritis at present. Medications can reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage.
Occupational and physical therapy can teach you how to protect your joints. If your joints are severely damaged by Rheumatoid Arthritis, surgery may be necessary.
Many drugs used to treat Rheumatoid Arthritis have potentially serious side effects. Doctors typically prescribe medications with the fewest side effects first. You may need stronger drugs or a combination of drugs if your disease progresses.
NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include Ibuprofen (Advil, Motrin IB) and Naproxen (Aleve). Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems, and liver and kidney damage.
Steroids. Corticosteroid medications, such as Prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include Methotrexate (Trexall), Leflunomide (Arava), Hydroxychloroquine (Plaquenil) and Sulfasalazine (Azulfidine).
Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes Abatacept (Orencia), Adalimumab (Humira), Anakinra (Kineret), Certolizumab (Cimzia), Etanercept (Enbrel), Golimumab (Simponi), Infliximab (Remicade), Rituximab (Rituxan) and Tocilizumab (Actemra). Tofacitinib (Xeljanz), a new, synthetic DMARD, is also available in the U.S.
These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections.
Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as Methotrexate.
Your doctor may send you to a therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, if your fingers are sore, you may want to pick up an object using your forearms.
If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities.
Rheumatoid Arthritis surgery may involve one or more of the following procedures:
- Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.
- Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
- Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.
Is it possible to prevent RA?
There is no known way to prevent Rheumatoid Arthritis, although progression of the disease usually can be stopped or slowed by early, aggressive medical treatment.
If you have any specific questions, please feel free to contact us.