There are many types of
arthritis (disease of the joints). This topic is about
rheumatoid arthritis. If you are looking for information about how juvenile
idiopathic (rheumatoid) arthritis affects young children, see the topic
Juvenile Idiopathic Arthritis. If you are looking for
information on the most common form of arthritis in older adults, see the topic
Rheumatoid arthritis (RA) causes
joints to become
swollen, stiff, and painful (inflamed).
Over time, this
inflammation may destroy the joint tissues. This can limit your daily
activities and make it hard for you to walk and use your hands.
Rheumatoid arthritis is more common in women than in men. It often
begins between the ages of 40 and 60.
The exact cause is not known. But rheumatoid arthritis is an
autoimmune disease. This means that the body's natural
defense system attacks the joints. The disease may run in some families.
The main symptoms of rheumatoid arthritis are pain, stiffness, and
swelling in the joints of the hands, wrists, elbows, feet, ankles, knees, or
neck. The disease usually affects both sides of the body at the same time. In
rare but severe cases, it may affect the eyes, lungs, heart, nerves, or blood
Sometimes the disease
can cause bumps called nodules to form over the elbows, knuckles, spine, and
lower leg bones.
There is no single test for rheumatoid
arthritis. Your doctor will do a physical exam and look at your joints for signs of swelling or
tenderness. He or she will also ask about your symptoms and past health.
You may have blood tests,
X-rays, and other tests to find out if another problem
is causing your joint pain.
Treatment for rheumatoid arthritis continues throughout your life. It includes medicine,
exercise, and lifestyle changes. Getting treatment early may control the condition or keep it from getting worse.
the medicines used to treat rheumatoid arthritis have side effects. So it is
important to have regular checkups and talk with your doctor about any
problems. This will help your doctor find a treatment that works for you.
At home, there are things you can do to relieve your symptoms.
If you try medicine, exercise, and lifestyle changes for at least a few years but pain and disability get much worse, surgery may be an option. Total joint replacement of the hip and knee are the most successful.
It can be hard to live with a long-term
illness that can limit your ability to do things. It is common for people with
rheumatoid arthritis to feel depressed. Your mood can affect how you feel and how well you cope with pain. Be sure to seek the help and
support you need from friends and family members. Professional counseling can also help.
Health Tools help you make wise health decisions or take action to improve your health.
Learning about rheumatoid arthritis:
Living with rheumatoid arthritis:
The cause of
rheumatoid arthritis (RA) is not fully understood.
Genes play a role, but experts
don't know exactly what that role is. For most people with RA, the disease
doesn't run in their families and they don't pass it along to their children.
One or more genes may make it more likely that the body's
immune system will attack the tissues of the
joints. This immune response may also be triggered by
bacteria, a virus, or some other foreign substance.
Other causes of joint pain include osteoarthritis, lupus, and gout.
Joint pain can be an early symptom of many
different diseases. In
rheumatoid arthritis, symptoms often develop slowly
over a period of weeks or months. Fatigue and stiffness are usually early
symptoms. Weight loss and a low-grade fever can also
Joint symptoms include:
In addition to specific joint symptoms, rheumatoid arthritis can cause
symptoms throughout the body (systemic). These include:
Some of the symptoms of rheumatoid arthritis may be similar
to symptoms of
other health conditions.
The course of
rheumatoid arthritis is hard to predict. It usually progresses slowly, over months or years. In some people it doesn't get worse, and symptoms stay about the same. But in rare cases, symptoms come on rapidly, within days.
Symptoms can come and go. You may have times in your life when joint pain goes away on its own for a while. This is called remission.
If the disease progresses, joint pain can
restrict simple movements, such as your ability to grip, and daily activities,
such as climbing stairs. It is a common cause of permanent
disability. But early treatment may control the disease and keep it from getting worse.
Rheumatoid arthritis is more likely to get worse when:
The ongoing inflammation caused by rheumatoid arthritis affects the tissues that line joints. It causes a breakdown in cartilage and loosens ligaments and tendons that support the joints. The resulting joint destruction can lead to deformed joints.
The pain, stiffness, fatigue, and
whole-body (systemic) symptoms of rheumatoid arthritis can be
disabling. Over time, the deformity caused by the disease can lead to difficulty with daily activities.
Specific joint problems may also occur later in the course of the
The hands and wrists and feet may be deformed. The hands are the most common location for
Inflammation of the knees, if not controlled by
treatment, can cause erosion of cartilage and can later lead to the need
for knee replacement surgery.
Rheumatoid arthritis can also damage the cervical spine, or neck. This damage can limit how easily you can move your neck. In rare cases, the
damage can pinch a nerve or affect the spinal cord and cause numbness, pain, weakness, or paralysis in the arms or legs.
In a small number of severe cases, the disease may damage other organs, such as the eyes and lungs.
People who have rheumatoid arthritis seem to develop plaque deposits in arteries (atherosclerosis) earlier than people who do not have rheumatoid arthritis. Inflammation may play a role in speeding up plaque development. When plaque develops in the arteries in the heart, it is called coronary artery disease (CAD) and it increases the risk of a heart attack. When plaque develops in the arteries in the neck, it increases the risk of stroke.
It is common for people with rheumatoid arthritis to feel depressed. These feelings may be caused by pain and
Most women with rheumatoid arthritis can become pregnant and have a healthy baby.
Other factors that may increase
your risk for rheumatoid arthritis include:1
Call your doctor immediately if you have:
Call your doctor within the next few days if
is a wait-and-see approach. It is reasonable to try home
treatment for mild joint pain and stiffness. If there is no improvement after 6
weeks, or if any other symptoms are present, call your doctor.
Early treatment can slow and sometimes prevent significant joint damage.
So if you have symptoms similar to rheumatoid arthritis, see
your doctor to find out if you have rheumatoid arthritis.
Early diagnosis and treatment allows for possible reduction of joint pain,
slows joint destruction, and reduces the chance of permanent disability.
Early arthritis symptoms can be
Rheumatoid arthritis can be treated by:
Supportive treatment can be provided by:
No single lab test can diagnose
rheumatoid arthritis. Instead, doctors look at symptoms and physical signs and then rule out other diseases that
can cause similar symptoms.
medical history and physical exam are usually
done to help find the cause of joint pain. The pattern and nature of
joint symptoms are the most important clues
to the diagnosis.
Diagnosis is based on a set of
classification criteria. The criteria include the results of these tests:
following tests may also be done:
Other tests may be done to check for side effects of
treatment. These tests may include:
Because rheumatoid arthritis can lead to severe joint
destruction and disability over time, regular checkups are important to see if treatment is working or
needs to be adjusted.
Rheumatoid arthritis is most often treated with medicine, exercise, and lifestyle
changes. Treatment may help relieve symptoms and control the disease, but there
is no cure. Treatment for rheumatoid arthritis usually continues throughout
your life, but it will vary depending on:
The goal of treatment is to help you maintain your
lifestyle, reduce joint pain, slow joint damage, and prevent disability.
rheumatoid arthritis should start with education about
the disease, the possibility of joint damage and disability, and the risks and
benefits of potential treatments. A long-term treatment plan should be
developed by you and your team of doctors.
Early and ongoing treatment of
RA with medicines called disease-modifying antirheumatic
drugs (DMARDs) can slow or sometimes prevent joint
destruction.2 Other medicines may be combined with DMARDs to relieve symptoms. These medicines include:
For more information, see Medications.
rheumatoid arthritis usually continues throughout your
life. Your doctor will want to closely monitor your condition. A
rheumatologist should evaluate you regularly. Depending on your symptoms and
treatment, this could be done as often as every 2 to 3 months or every 6 to 12 months. Testing, such as blood tests, may be done
During each follow-up visit, your doctor will assess:
In some cases, the disease does not respond to
the first several treatments. When this happens, the disease may be
treated with much higher doses of medicines or with different combinations of
Surgery may be considered when the joints—especially the hips,
knees, or feet—are severely damaged or deformed and are causing extreme pain.
Surgery may include total joint replacement or other techniques to improve
joint function. For more information, see Surgery and Other Treatment.
Exercise, physical therapy, and lifestyle
changes can help relieve joint pain. Many people with RA
benefit from self-care plans that balance rest and activity. You can take steps at home to relieve your symptoms and help control your disease. For more information, see Living With Rheumatoid Arthritis.
rheumatoid arthritis often means making changes to
your lifestyle. You can do things at home, such as staying active and taking
medicines, to help relieve your symptoms and prevent the disease from getting
You can also plan for those times when the disease symptoms
may be more severe. It is important to work closely with your health
professionals, who may include a
physical therapist or counselor, to find ways to
The disease itself causes fatigue. And the
strain of dealing with pain and limited activities also can make you tired. The
amount of rest you need depends on how bad your symptoms are.
You may need to change the way you do certain activities so that you are not
overusing your joints. Try to find different ways to relieve your joint
Keep moving to
keep your muscle strength, flexibility, and overall health.
People with rheumatoid arthritis have an increased risk of plaque in the arteries (atherosclerosis). Smoking increases this risk even more. Smoking may also lower your response to treatment.3 So, if you're a smoker, quit. For more information on how to quit, see the topic Quitting Smoking.
Try to eat a healthy, balanced diet. It should be low in saturated fat, cholesterol, and salt and high in fiber and complex
carbohydrate (whole grains, beans, fruits, and vegetables). According to some studies, fish oil may improve your symptoms.4
For more information, see:
People who have rheumatoid arthritis tend to get gum disease. Some experts think that infection that enters the body through the mouth may make rheumatoid arthritis worse, although this has not been proved. You can help prevent gum disease through good basic dental care.
Medicines are the main treatment for
rheumatoid arthritis. The types of medicines used
depend on how severe your disease is, how fast it is progressing, and how it
affects your daily life.
If your symptoms ease, you and your
doctor will decide if you can take less medicine or stop taking medicine.
If your symptoms get worse, you will have to start taking medicine again.
Medicines are used to:
Medicines called disease-modifying antirheumatic drugs
(DMARDs) can slow or sometimes prevent joint destruction. Starting treatment early with DMARDs can reduce the severity of the disease.2 DMARDs are also called immunosuppressive drugs or
slow-acting antirheumatic drugs (SAARDs). These medicines are usually taken over a long period to help control the disease.
DMARDs can be thought of as nonbiologic or biologic, depending on how they are made and how they act in the body. But they are all used to block harmful responses from the body's immune system. DMARDs are sometimes combined with one another or with other medicines. By combining medicines, you may be able to take lower doses of individual medicines. This may reduce your risk of side effects.
Some medicines for rheumatoid arthritis may cause birth defects. If you
are pregnant or are trying to become pregnant, talk with your doctor about your medicines.
Disease-modifying antirheumatic drugs
(DMARDs) are usually started within 3 months of your diagnosis. They are used to
control the progression of RA and to try to prevent joint
damage and disability. DMARDs are often given in combination with other
There is a newer biologic drug called tofacitinib (Xeljanz) for adults who have moderate to severe rheumatoid arthritis. This medicine is for people who have not responded well to methotrexate or who cannot take it. Tofacitinib is taken by mouth. It reduces the symptoms of rheumatoid arthritis and allows people to be more active. But the long-term safety of this medicine is still being studied.5, 6
Surgical treatment for
rheumatoid arthritis is used to relieve severe pain
and improve function of severely deformed joints that don't respond to
medicine and physical therapy.
Total joint replacement
(arthroplasty) can be done for many different joints in the body. Its success
varies depending on which
joint is replaced.
Surgeries considered for people
who have severe rheumatoid arthritis include:
Joint surgery often restores
near-normal movement in a person who has
osteoarthritis in just one or two joints. But this is
not the case for people affected by rheumatoid arthritis.
Before you decide to have surgery, consult with an
orthopedic surgeon who is experienced in joint surgery
for rheumatoid arthritis.
Other types of treatment that may
help you control some of the symptoms of
rheumatoid arthritis include:
Although not proved in scientific studies, complementary therapies are
used by many people to relieve symptoms and
improve their quality of life. These therapies include:
The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members.
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
The Arthritis Foundation provides grants to help find a
cure, prevention methods, and better treatment options for arthritis. It also
provides a large number of community-based services nationwide to make living
with arthritis easier, including self-help courses; water- and land-based
exercise classes; support groups; home study groups; instructional videotapes;
public forums; free educational brochures and booklets; the national, bimonthly
consumer magazine Arthritis Today; and continuing
education courses and publications for health professionals.
The National Center for Complementary and Alternative Medicine
(NCCAM) at the National Institutes of Health (NIH) explores complementary and
alternative healing practices in the context of rigorous science, trains
complementary and alternative medicine researchers, and gives out authoritative
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
Harris ED Jr, Firestein GS (2009). Clinical features of rheumatoid arthritis. In GS Firestein et al., eds., Kelley’s Textbook of Rheumatology, 8th ed., vol. 2, pp. 1087–1118. Philadelphia: Saunders Elsevier.
Kwoh CK, et al. (2002). Guidelines for the management
of rheumatoid arthritis. Arthritis and Rheumatism,
O'Dell JR (2012). Rheumatoid arthritis. In L Goldman, A Schafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 1681–1689. Philadelphia: Saunders.
Genovese MC (2009). Treatment of rheumatoid arthritis. In GS Firestein et al., eds., Kelley’s Textbook of Rheumatology, 8th ed., vol. 2, pp. 1119–1143. Philadelphia: Saunders Elsevier.
Fleischmann R, et al. (2012). Placebo-controlled trial of tofacitinib monotherapy in rheumatoid arthritis. New England Journal of Medicine, 367(6): 495–507.
Von Vollenhoven RF, et al. (2012). Tofacitinib or adalimumab versus placebo in rheumatoid arthritis. New England Journal of Medicine, 367(6): 508–519.
Cameron M, et al. (2011). Herbal therapy for treating rheumatoid arthritis (Review). Cochrane Database of Systematic Reviews (2).
Murray MT, Pizzorno JE Jr (2006). Rheumatoid
arthritis. In JE Pizzorno, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 2, pp. 2089–2108. St. Louis:
Churchill Livingstone Elsevier.
Other Works Consulted
Singh JA, et al. (2012). 2012 update of the 2008 American College of
Rheumatology recommendations for the use of
disease-modifying antirheumatic drugs and
biologic agents in the treatment of
rheumatoid arthritis. Arthritis Care and Research, 64(5): 625–639.
Steultjens EEMJ, et al. (2009). Occupational therapy for rheumatoid arthritis. Cochrane Database of Systematic Reviews (1).
August 5, 2013
Anne C. Poinier, MD - Internal Medicine
& Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
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