What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which the body’s immune system, which normally protects against bacteria and viruses, mistakenly attacks the lining of the joints. The lining is called the synovium and is a specialized connective tissue that lines the inner surface of the joint capsules and tendon sheaths. 

Rheumatoid arthritis leads to chronic inflammation of joints, especially in the hands, wrists, shoulders, feet, hips, knees and elbows. Because this is a systemic condition, it can also affect the skin, eyes, lungs, heart and blood vessels. The course of RA may vary from progressive to periods of remission and exacerbation. 

Baptist Health is known for advanced, superior care for patients with orthopedic conditions and the diagnosis, treatment and management of rheumatoid arthritis. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Left untreated, rheumatoid arthritis can harm bones and cartilage, and cause irreversible damage to the joints. If you’re experiencing any of the symptoms associated with this condition, it is critical that you see a rheumatologist – a physician that specializes in joint diseases – for proper diagnosis and care.

Rheumatoid Arthritis Symptoms 

Signs and symptoms of rheumatoid arthritis can include:

• Ongoing fatigue
• Low-grade fever
• Loss of appetite
• Stiffness, especially after a period of inactivity or upon waking, progressing to loss of joint mobility
• Pain, swelling and warmth of the joints that occurs usually on both sides of the body at the same time
• Tenderness with pressure
• Weight loss
• Deformities of the fingers

Pain, swelling and stiffness in the smaller joints first tend to be the first signs of rheumatoid arthritis. Some people may also experience:

• Anemia
• Eye dryness, pain, redness, sensitivity to light and/or vision problems
• Inflammation of blood vessels, leading to skin, nerve or organ damage
• Mouth dryness and gum irritation or infection
• Rheumatoid nodules – small lumps under the skin over bony areas
• Shortness of breath due to lung damage
• Rash

Rheumatoid Arthritis Diagnosis and Tests

No single test can confirm rheumatoid arthritis. To make a proper diagnosis, the physician will ask questions about personal and family medical history, perform a physical exam and order diagnostic tests. Common diagnostic procedures for rheumatoid arthritis include:

Blood tests: Blood tests for rheumatoid arthritis will evaluate for elevated substances in the blood such as:

• Erythrocyte sedimentation rate (ESR, or “sed rate”), a marker of inflammation.
• C-reactive protein (CRP) level, a marker of inflammation.
• Rheumatoid factor (RF), an antibody found in about 80 percent of people with RA. Because RF can occur in other inflammatory diseases, it’s not a definite sign of having RA. 
• Anti-cyclic citrullinated peptide (anti-CCP), which occurs primarily in patients with RA. While anti-CCP is more diagnostic of RA than the RF antibody, it is found in only 60 to 70 percent of people with RA and can exist even before symptoms start. 

A high ESR or CRP is not specific to RA, but when combined with other clues, such as increased levels of antibodies and symptoms, helps confirm the rheumatoid arthritis diagnosis.

Imaging studies: Imaging studies may be done to assess joint damage, such as erosions – loss of bone within the joint – and narrowing of the joint space. If the imaging tests don’t show joint damage that doesn’t rule out RA. It may indicate that the disease is in an early stage and hasn’t yet caused joint damage. Imaging studies may include:

• X-rays to detect signs of RA.
• Ultrasound, which plays a major role in diagnosis and monitoring the response to treatment.
• Magnetic resonance imaging scan (MRI) which uses a large magnet, radio waves and a computer to produce pictures of bone and soft tissues, including cartilage.

Rheumatoid Arthritis Causes

The cause of rheumatoid arthritis is not fully understood. The immune system goes awry causing inflammation and joint damage, but no one knows why. There is scientific evidence that genetics, hormones and environmental factors are involved in the disease process.

Preventable conditions or behaviors that can contribute to rheumatoid arthritis include:

• Obesity
• Smoking

There is scientific evidence that several factors are involved in the disease process:

• Genetic: A number of genes appear to correlate with the development of rheumatoid arthritis, including HLA, STAT4, TRAF1, C5, PTPN22. 
• Infectious agents: Certain bacteria and viruses may help trigger the disease.
• Hormones: Female hormones in particular may play a role; women comprise the majority of all persons with rheumatoid arthritis. 
• Trauma: Arthritis may be one aspect of a body’s response to physical or psychological trauma. 

Rheumatoid Arthritis Risk Factors

Risk factors that can contribute to rheumatoid arthritis include:

Age: RA can occur at any age, but it most commonly begins between the ages of 40 and 60.

Environmental exposure: Exposure to certain substances, like asbestos or silica, bacteria, viruses, air pollution, insecticides and/or mineral oil may increase the risk for developing RA. 

Gender: 70 percent of people with RA are women.

Genetics: In some cases, RA runs in families.

Physical/emotional trauma: The body’s response to stressful events such as physical or emotional trauma can increase the risk for RA.

Rheumatoid Arthritis Prevention 

There is no known way to prevent rheumatoid arthritis, but there are things you can do to reduce your risk or minimize joint damage and severe rheumatoid arthritis symptoms, including:

Protect yourself from pollution: Limit your exposure to environmental pollutants whenever possible.

Lose weight: Eat a healthy diet and get regular exercise.

Stop smoking: Smoking can contribute to RA.

See your doctor: Seek treatment from a Baptist Health provider as soon as you notice rheumatoid arthritis symptoms.

Rheumatoid Arthritis Prognosis: 

There is no known cure for rheumatoid arthritis. It is a chronic disorder and prognosis varies from patient to patient. In recent years, a shift in strategy toward the earlier institution of disease modifying drugs and the availability of new medications have greatly improved the outcomes for most patients.

The goal of rheumatoid arthritis treatment now aims toward achieving the lowest possible level of arthritis disease activity and remission if possible, minimizing joint damage, and enhancing physical function and quality of life. Treatment and regular monitoring of the condition will help reduce pain and disability and improve quality of life. 

Rheumatoid Arthritis Treatment and Recovery

Rheumatoid Arthritis treatment depends on symptoms and the condition’s progression and also requires a comprehensive program that combines medical, social and emotional support for the patient. At Baptist Health, patient and family education about the nature and course of the disease is a crucial component of the treatment program. Common treatment and recovery options for rheumatoid arthritis are: 

Decrease Joint Stress

• Maintain your ideal body weight. 
• Rest inflamed joints because of the danger of injuring structures weakened by inflammation. Resting the joint is important, but patients should maintain a modest level of activity to prevent loss of muscle tone and/or joint laxity. 
• Splinting involved joints at night and the use of assistive devices (such as cane or walker) when walking help decrease stress on specific joints. 

Alternative Medicine for Rheumatoid Arthritis

• Fish oils and plant oils: These help relieve pain and stiffness in some people. 
• Exercise: Tai chi and/or yoga, which combines adoption of specific bodily postures, gentle movements, meditation with deep breathing, have shown favorable results such as stress relief, reduced disability and improved mood and vitality.

Rheumatoid Arthritis Medications 

Medications will depend on the severity of rheumatoid arthritis signs and symptoms and how long a person has had RA. They may include:

• Immunomodulators: These medications are used to help regulate or normalize the immune system and helps prevent structural joint damage.
• Antimalarial: These modulate or change the way the immune system works.
• Biologics: These new class of drugs can target parts of the immune system that trigger inflammation, but they also increase the risk of infections.
• Disease-modifying antirheumatic drugs: These can slow the progression of rheumatoid arthritis and save joints and other tissues from permanent damage.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These over-the-counter or prescription-strength medications that can relieve pain and reduce inflammation.
• Steroids: These are medications that reduce inflammation and pain and slow joint damage, but they often cause side effects including weight gain, bone damage or even diabetes.

Surgery for Rheumatoid Arthritis

Surgery may be recommended if there is a lot of joint damage or pain. Different types of surgery used to treat rheumatoid arthritis include: 

• Joint replacement surgery (especially hips and knees): This is the most common type of surgery for people with RA. In this procedure, also known as arthroplasty, a surgeon removes damaged joint surfaces and replaces them with plastic and metal parts. These artificial joints may need replacement over time.
• Arthroscopy: This type of procedure uses a fiber-optic telescope that can be inserted into a joint (commonly the knee, shoulder and ankle) via a small incision to evaluate and treat a number of conditions. Tiny instruments can be utilized to trim/repair damaged cartilage and even do ligament and tendon reconstruction.
• Joint Fusion: Surgically fusing a joint may be recommended to stabilize it and reduce pain when joint replacement is not possible.
• Synovectomy: Surgery to remove the inflamed joint lining (synovium) can be performed on knees, elbows, wrists, fingers and hips.
• Tendon Repair: If inflammation and joint damage cause tendons around a joint to loosen or rupture, a surgeon may be able to repair them either with an incision (called an open repair) or by utilizing the arthroscope which involves a smaller incision.

Therapy Options for Rheumatoid Arthritis

Physical therapy can help strengthen muscles around the joint, increase flexibility and reduce pain. Additionally, occupational therapy can help people with RA do everyday tasks with less pain and less stress on an affected joint.

Rheumatoid Arthritis Complications

Complications of rheumatoid arthritis may include:

• Carpal tunnel syndrome: If RA affects the wrists, inflammation can compress the nerve serving the hand and fingers.
• Dry mouth and eyes: People who have RA are also likely to have Sjogren’s syndrome, a disorder that decreases moisture in the eyes and mouth.
• Heart and vascular problems: RA can increase the risk of hardened or blocked arteries and inflammation of the lining surrounding the heart (endocarditis).
• Infections: RA itself, as well as many of the medications used to treat it, can impair the immune system, making the person more susceptible to infection.
• Lung disease: People with RA have an increased risk of inflammation and scarring of lung tissues.
• Lymphoma: RA increases the risk of these blood cancers that develop in the lymph system.
• Osteoporosis: RA itself, as well as some of the medications used to treat it, can weaken the bones, increasing a person’s risk of fracture.
• Rheumatoid nodules: Firm lumps of tissue can form at pressure points, such as the elbows, and throughout the body.
• Immobility: This can lead to self-care deficits.