Rheumatoid Arthritis Foundation

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.

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.

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.

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.

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.

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.

Skin.

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.

Eyes.

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.

Heart.

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.

Nervous System.

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.

Lungs.

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.

Blood.

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.

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.

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.

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.

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

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.

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.

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.

Therapy

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.

Surgery

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.