Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that develops when certain cells of the immune system are not working properly and begin to attack healthy joints. Rheumatoid arthritis is the most common inflammatory arthritis cause by an autoimmune condition, affecting an estimated 3.25 million individuals in the United States. Prompt diagnosis and appropriate treatment can prevent severe joint damage. 

Causes and Risk Factors

The cause of rheumatoid arthritis is not fully understood, however there are certain risk factors that play a role:

  • Rheumatoid arthritis can develop at any age and affects women more than men. Roughly 75% of patients with rheumatoid arthritis are women.
  • Genetics can play a role in the development of rheumatoid arthritis. Those with a family history of RA have a slightly higher risk, about 5%, of developing RA compared to individuals without a family history.
  • Smoking is a significant risk factor for developing RA.

Symptoms

The most common symptoms of rheumatoid arthritis (RA) are pain, stiffness, and swelling in your joints.  The smaller joints are typically the most affected, such as your knuckles, and the joints in your feet, however, larger joints such as shoulders and knees can also be involved. Other symptoms include:

  • Decreased energy
  • Low grade fever
  • Development of bumps or nodules near the joints (this does not usually occur until you have had RA for some time)

Diagnosis

Rheumatoid arthritis can sometimes be difficult to diagnose as it can begin with easy-to-miss symptoms – such as subtle aching and stiffness in the morning. Additionally, many other diseases – particularly in the beginning – can have similar symptoms.

Because diagnosis of rheumatoid arthritis can be difficult, it is important to have a complete evaluation by a rheumatologist who has the special expertise in complex bone and joint disorders.  Along with warmth, swelling, and pain in the joints, certain blood tests can help in establishing the diagnosis.

Signs of rheumatoid arthritis include: 

  • Anemia (low blood count)
  • Detection of rheumatoid factor, which is an antibody found in 80 percent of patients with the disease
  • Antibodies to cyclic citrullinated peptides
  • Inflammation in the joints caused by an elevated sedimentation rate or C-reactive protein in the blood

X-rays can also be used to help diagnose rheumatoid arthritis, but abnormalities might not show up in the first three to six months of the disease. In these early stages of rheumatoid arthritis, there is no single test that can confirm a diagnosis. Generally, the diagnosis comes after evaluating the symptoms from a physical exam, lab tests, and X-ray.

In early disease and in cases which there may be a question of diagnosis, magnetic resonance imaging (MRI) and ultrasound may be helpful in demonstrating inflammation and damage in the joints. 

Treatment 

An important goal of the treatment therapy is to help slow down or stop damage to the joints, which is why early intervention and aggressive treatment are necessary. While there is no cure for the disease, newer therapies have been developed for rheumatoid arthritis that block the body’s signals to attack its own immune system.

The most common therapies are disease-modifying anti-rheumatic (DMARD) medications which can lessen or prevent joint damage.  The first line DMARD treatment is methotrexate, however depending on your symptoms and other medical issues, your rheumatologist may recommend that you start with another DMARD. Since these DMARDs can take weeks to take effect, they are often prescribed in conjunction with treatments that can more quickly reduce inflammation, such as non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, such as prednisone. It is important to realize that while NSAIDs and steroids provide symptom relief, they are not able to prevent joint damage like the DMARDs.

Another class of DMARDs, called biologic DMARDs, are used in patients in whom drugs such as methotrexate are not totally effective. These therapies target specific parts of the immune system that lead to inflammation and joint damage. 

Not all patients respond to therapy in the same manner, which is why it is important to work with your rheumatologist to determine the best course of treatment. Over time, therapies may need to be adjusted. Additionally, coordinated care among all of the patient’s physicians, physical therapy and occupational therapy are important components of proper rheumatoid arthritis care. 

RA treatment has advanced greatly over the past 25 years, and the treatments available today provide most patients with dramatic symptom relief, enabling them to function at near normal or normal capacity.

Contact Us

To learn more about our services or to make an appointment with a Brigham and Women’s Hospital rheumatologist, contact one of our trained coordinators at 1-800-294-9999 to get connected with the best doctor for your needs.

Michael E. Weinblatt, MD, Co-Director, Clinical Rheumatology, and R. Bruce and Joan M. Hickey Distinguished Chair in Rheumatology, Division of Rheumatology, Immunology and Allergy at Brigham and Women’s Hospital (BWH), discusses rheumatoid arthritis treatment along with an overview of promising research being conducted at BWH. Read the Advancing Rheumatoid Arthritis Treatment video transcript.

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