Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than the joints in the body. The condition can cause joint pain, swelling and deformity.
It is also an autoimmune disorder, which means the immune system mistakenly attacks the body's tissues. The membrane that lines the joints (synovial membrane) becomes inflamed and thickened, fluid builds up, resulting in pain, and the joints erode, degrade and become deformed and shift out of place.
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. Over time the inflammation associated with rheumatoid arthritis can also damage other parts of the body and other body systems, including the skin, eyes, lungs, heart, and blood vessels.
Joint stiffness that is usually worse in the mornings and after inactivity
Fatigue, fever and loss of appetite
Early signs of rheumatoid arthritis tend to affect the smaller joints first — particularly the joints that attach fingers to hands and toes to feet. Make an appointment with a doctor if a person has persistent discomfort and swelling in their joints that comes and goes.
About 40% of people with rheumatoid arthritis also experience signs and symptoms that don't involve the joints. Affected areas include:
Skin
Eyes
Lungs
Heart
Kidneys
Salivary glands
Nerve tissue
Bone marrow
Blood vessels
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.
Causes
Rheumatoid arthritis is an autoimmune disease. Normally, the immune system helps protect the body from infection and disease. In rheumatoid arthritis, the immune system attacks healthy tissue in the joints. It can also cause medical problems with the heart, lungs, nerves, eyes and skin.
Doctors don't know what starts this process, although a genetic component appears likely. While your genes don't cause rheumatoid arthritis, they can make you more likely to react to environmental factors — such as infection with certain viruses and bacteria — that may trigger the disease.
Risk factors
Factors that may increase your risk of rheumatoid arthritis include:
Gender. Women are more likely than men to develop rheumatoid arthritis.
Age. Rheumatoid arthritis can occur at any age but most commonly begins in middle age.
Family history. If a member has rheumatoid arthritis, a person may have an increased risk of the disease.
Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if there is a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
Excess weight. People who are overweight appear to be at a higher risk of developing rheumatoid arthritis.
Rheumatoid arthritis increases the risk of developing:
Osteoporosis. Rheumatoid arthritis and some medications used for treating rheumatoid arthritis can increase your risk of osteoporosis — a condition that weakens your bones and makes them more prone to fracture.
Falls risk. A person with rheumatoid arthritis is a falls risk as their condition progresses.
Rheumatoid nodules. These firm bumps of tissue most commonly form around pressure points, such as the elbows. However, these nodules can form anywhere in the body, including the heart and lungs.
Dry eyes and mouth. People with rheumatoid arthritis are much more likely to develop Sjogren's syndrome, a disorder that decreases the amount of moisture in the eyes and mouth.
Infections. Rheumatoid arthritis and many medications used to combat it can impair the immune system, leading to increased infections. Protect yourself with vaccinations to prevent diseases such as influenza, pneumonia, shingles and COVID-19.
Abnormal body composition. The proportion of fat to lean mass is often higher in people with rheumatoid arthritis, even those with a normal body mass index (BMI).
Carpal tunnel syndrome. If rheumatoid arthritis affects your wrists, the inflammation can compress the nerve that serves most of your hands and fingers.
Heart problems. Rheumatoid arthritis can increase your risk of hardened and blocked arteries and inflammation of the sac that encloses your heart.
Lung disease. People with rheumatoid arthritis have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.
Lymphoma. Rheumatoid arthritis increases the risk of lymphoma, a group of blood cancers that develop in the lymph system.
Medications
Medications play an important role in managing the symptoms of RA. While new medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.
Abatacept (brand name Orencia), Anakinra (brand name Kineret), Etanercept, Golimumab (brand name Simponi), Hydroxychloroquine (brand name Plaquenil, Plaquenil Sulfate), Infliximab (brand name: Remicade(r), Rituximab (brand name Mabthera), Tocilizumab (brand name Actemra) and Certolizumab (brand name Cimzia) belong to a new class of medicines called biological disease-modifying antirheumatic drugs (biological DMARDs or bDMARDs). These medicines block natural substances called cytokines, which are found in excessive amounts in the blood and joints of people with rheumatoid arthritis and juvenile arthritis.
Azathioprine (brand names: Azamun(r), Azapin(r), Imuran(r), Thioprine(r)) is a medicine used to treat immune and inflammatory diseases such as vasculitis, systemic lupus erythematosus (SLE/lupus), polymyositis (muscle inflammation), rheumatoid arthritis and other rheumatic conditions.
Azathioprine (brand name: Imuran, Azamun, Azapin) and Hydroxychloroquine (brand name: Plaquenil), Mycophenolate mofetil (brand name: Cellcept, Myfortec) are medicines used to treat certain childhood rheumatic conditions (diseases which may affect kidneys, joints, muscles, skin, gut or eyes). This can include lupus (also known as SLE), inflammatory bowel disease, uveitis and scleroderma. Azathioprine is a medicine that works by suppressing your immune system. It reduces the damage done by inflammation rather than just reducing pain.
Baricitinib (brand name Olumiant®), Upadacitinib (brand name: Rinvoq®) and Tofacitinib (brand name: Xeljanz®) are medicines that belong to a class of medicines called Janus Kinase (JAK) inhibitors. JAK inhibitors work by blocking signals involved in inflammation. Blocking these signals in rheumatoid arthritis reduces pain, stiffness, swelling and damage in the joints.
Cyclosporin (brand names Cicloral, Neoral and Sandimmun) is a medicine used to treat rheumatoid arthritis and other rheumatic conditions such as systemic lupus erythematosus (lupus/SLE), polymyositis (muscle inflammation) and pyoderma gangrenosum. Cyclosporin is used in rheumatoid arthritis when other treatments have been unsuccessful.
Cyclophosphamide (brand name: Cyclonex(r) Endoxan(r) is used in rheumatoid arthritis when there are serious complications involving organs other than the joints, such as the lungs, eyes or skin.
Leflunomide (brand names Arabloc, Arava), Sulfasalazine (brand names Pyralin EN, Salazopyrin EN) are medicines used to treat rheumatoid arthritis and psoriatic arthritis. It is an immunosuppressive medicine that reduces the immune system's activity. In rheumatoid and psoriatic arthritis, this action helps to reduce inflammation and thus reduces pain and swelling in the joints. It also limits damage to the joints and helps to prevent disability in the long term.
Methotrexate (brand name Methoblastin or injectable methotrexate (Hospira, Methacord, Methotrexate Accord & Trexject) is a well-established, effective treatment for several different types of inflammatory diseases such as rheumatoid arthritis, psoriatic arthritis, Crohn’s disease, SLE (Systemic Lupus Erythematosus) and severe psoriasis. It may also be used for other conditions.
Non-steroidal anti-inflammatory drugs, or NSAIDs, are common medicines used to treat the symptoms of arthritis. The name means they reduce pain and stiffness due to inflammation of the joints without using steroids. There are many different NSAIDs. Some can be bought over the counter (OTC), e.g. ibuprofen (Nurofen). Others, such as ketoprofen (Orudis) are only available with a prescription.
Prednisolone and prednisone are man-made corticosteroids (also called steroids for short). Man-made corticosteroids treat inflammatory diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE/lupus) and other inflammatory diseases. They have a strong anti-inflammatory effect and reduce swelling and pain in joints and other organs.
Note Medical conditions MUST always be diagnosed by a medical professional. The above has been structured to provide basic information to HWH Support Workers and Clinical Care Managers.
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