What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a disease that causes pain, stiffness, swelling, and loss of movement in your joints. It happens most often in the wrists, knuckles, knees, and feet. It can also affect other parts of your body.
RA is a lifelong problem that usually starts in early adulthood or middle age. You may have just one attack, but more often the symptoms come and go. Repeated attacks can lead to permanent joint damage. You can relieve symptoms and prevent or slow down joint damage by following your healthcare provider’s treatment plan and taking good care of yourself.
What is the cause?
Rheumatoid arthritis is an autoimmune disease. This means that your body's defenses against infection attack your body's own tissue. When you have rheumatoid arthritis, the attack is mostly against the tissues that line the joints. The tissues get inflamed, causing pain, swelling, and stiffness. The inflammation also damages bone and cartilage (the cushioning in joints) and can change the shape of your joints.
Things that may cause or contribute to rheumatoid arthritis are:
- Genes you have inherited. Genes are inside each cell of your body and are passed from parents to children. They contain the information that tells your body how to develop and work.
- Infection, such as infection with the Epstein-Barr virus or rubella (measles) virus
- Levels of female hormones. RA is more common in women. The symptoms tend to get better with the higher hormone levels that happen during pregnancy. Then the symptoms often come back after delivery, when hormone levels return to normal.
- Smoking, which may trigger an auto-immune reaction
- Long-term exposure to chemicals, like silica or asbestos
What are the symptoms?
Symptoms may include:
- Joints that are red, tender, warm, and swollen, usually on both your right and left sides
- Joint pain and stiffness that lasts 1 hour or longer, especially in the morning or after a rest
- Joint pain on both sides of your body but that may be more severe on one side
- Changes in the shape of your joints over time
- Mild fever, feeling tired, or generally not feeling well
- Small lumps under the skin near affected joints (called rheumatoid nodules)
How is it diagnosed?
Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:
- Blood tests (The most precise blood tests are the rheumatoid factor test and a test for substances called CCP antibodies.)
- Joint aspiration, which uses a needle to take fluid from a joint for testing
You may have other tests or scans to check for other possible causes of your symptoms.
Your provider may refer you to a rheumatologist, a doctor who specializes in treating diseases like rheumatoid arthritis.
How is it treated?
There is no cure for rheumatoid arthritis, but treatment can help:
- Relieve pain and stiffness
- Reduce swelling
- Keep the shape of the joints more normal so they move well and you can do your usual activities
- Stop or slow down damage to the joints
There are many ways to treat rheumatoid arthritis.
Many drugs are used to treat the symptoms of rheumatoid arthritis. For example:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, can help relieve pain and swelling. NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
- Steroid medicine may be prescribed to decrease pain and swelling. It can be given as a pill, cream or ointment, or shot. Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.
- Disease-modifying antirheumatic drugs (DMARDs) slow down or stop damage to the joints. They can help lessen pain and inflammation in the joints. Your healthcare provider will check you regularly to see how these medicines are working. DMARDs may cause infection or other serious side effects.
- Hyaluronic acid may be injected into your knee if you have arthritis in your knee. It helps your knee move more easily.
Some RA medicines can hurt an unborn baby. Whether you are a man or a woman, talk to your healthcare provider if you are thinking of having a child. You may need to stop certain medicines if you want to have a child. Make sure you ask about using birth control methods to prevent pregnancy so you can prevent birth defects from the medicines you are taking. Tell your provider right away if pregnancy occurs while one of the parents is taking medicine for rheumatoid arthritis.
Three types of exercise may help:
- Range-of-motion exercises are gentle stretching exercises that help you move each joint as far as possible. Examples include low-speed bike riding, tai chi, and yoga. Range-of-motion exercises help you keep or improve your flexibility and relieve stiffness.
- Strengthening exercise, such as weight training, makes muscles and tendons stronger. Strong muscles and tendons support joints better. You will be able to move more easily and with less pain.
- Aerobic or endurance exercise at a moderate pace, such as walking or bicycle riding, improves your overall health and helps control your weight. Exercising in a warm swimming pool is another option. The water supports your weight while you move, and the warmth helps improve joint movement.
Talk with your healthcare provider before you start an exercise program. Too much exercise too soon or even at the wrong time of day may make arthritis worse. Your provider may refer you to a physical therapist to design a program that is right for you.
Your provider may advise arthroscopy, which is a type of surgery done with a small scope inserted into your joint. Your provider can look directly at your joint and sometimes do small repairs of the joint without having to cut open the joint.
If your joints are severely damaged, surgery may be done to remove inflamed joint tissue or realign or replace a joint.
- Your healthcare provider may recommend physical or occupational therapy to treat pain and help you have better use of your joints.
- Sometimes it may help to use a splint or brace to rest a joint and protect it from injury.
How can I take care of myself?
- Follow the full course of treatment prescribed by your healthcare provider.
- Rest your body often during the day, as well as at night.
- Rest your joints, especially when they are warm, swollen, or painful.
- Learn how to move in ways that are easier on your joints. Be open to using devices to help you. Helpful devices include canes and walkers; bath seats and grab bars for the bathtub; and larger grips on tools, eating utensils, pens, and pencils. Velcro fasteners on clothes and shoes can be very useful, too.
- Eat a healthy diet. Ask your provider about the benefits of talking to a dietician to learn what you need in a healthy diet.
- Try to keep a healthy weight. If you are overweight, lose weight. Losing some weight can reduce the pain and stress on your joints.
- Stay fit with the right kind of exercise for you. Talk with your healthcare provider before you start an exercise program.
- If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
- Try to get at least 7 to 9 hours of sleep each night.
- Join a support group or take classes on how to manage your arthritis.
- Learn ways to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks. Try deep breathing exercises when you feel stressed.
- Be sure to let all of your healthcare providers know what medicines you are taking, especially if you are going to have surgery.
- Ask your healthcare provider:
- How and when you will hear your test results
- What activities you should avoid and when you can return to normal activities
- What symptoms or problems you should watch for and what to do if you have them
- Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.
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