(RA; Arthritis, Rheumatoid)
Rheumatoid arthritis (RA) is a disorder that results in pain, swelling, stiffness, and loss of function in the joints.
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RA happens when the immune system attacks healthy tissue. It is not clear what makes this happen.
Some causes may be:
- A specific genetic defect
- Problems with the immune system may stop immune cells from recognizing the body’s own tissues
- Infection with specific viruses or bacteria may start an abnormal immune response
- Chemical or hormonal imbalances in the body
RA is more common in women. It often starts in people who are between 30 to 60 years of age.
Other things that may raise the risk are:
- Having other family members with RA
- Heavy or long-term smoking
Pain and swelling usually happens in smaller joints, such as the hands, wrists, and feet. It affects similar joints on both sides of the body, such as both hands or wrists.
Other problems may be:
- Pain, stiffness, and swelling in the morning and after inactivity that lasts more than 30 minutes
- Red, warm joints
- Deformed, misshapen joints
- Lack of energy
- Weight loss
- Muscle aches
- Small lumps under the skin
The doctor will ask about symptoms and health history. A physical exam will be done. There are many diseases that have symptoms that are similar to RA. Tests will be done to rule out other health problems.
Blood tests may be done to look for inflammation and blood proteins linked to RA.
Samples may be taken of fluid and tissues to look for signs of RA. This can be done with:
- Arthrocentesis—the removal and testing of fluid from a joint
- Synovial biopsy—the removal and testing of a piece of the lining of a joint
There is no cure for RA. The goal is to manage the disease by slowing damage, easing pain, and improving movement. Choices are:
There are no guidelines to prevent RA.
Medicine can help to stop or slow inflammation that causes damage to the joints. It may change over time and include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and COX-2 inhibitors
- Disease-modifying anti-rheumatic drugs (DMARDs) that suppress inflammation caused by immune system
- Corticosteroids (less common)
- Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA. 2018 Oct 2;320(13);1360-1372.
- Fraenkel L, Bathon JM, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol 2021;73(7):1108-1123 https://doi.org/10.1002/art.41752.
- Radu A-F, Bungau SG. Management of Rheumatoid Arthritis: An Overview. Cells. 2021; 10(11):2857. https://doi.org/10.3390/cells10112857
- Rheumatoid arthritis. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/rheumatoid-arthritis-ra.
- Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: niams.nih.gov/health-topics/rheumatoid-arthritis.
- Rheumatoid arthritis: causes, symptoms, treatments, and more. Arthritis Foundation website. Available at: https://www.arthritis.org/diseases/rheumatoid-arthritis.
- Rheumatoid arthritis (RA). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/rheumatoid-arthritis-ra.
- Singh JA, Saag KG, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68(1):1-26.
- Laura Lei-Rivera, PT, DPT
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