Rheumatoid Arthritis

 

What is RA?

Rheumatoid Arthritis is a disease that affects the joints. Long-term inflammation causes pain and swelling most commonly to the small joints in hands, wrists, and feet. Changes to the joint linings (synovium) can over time result in bone changes and deformity. Traditional arthritis (osteoarthritis) is different from RA because it generally consists of wear and tear damage to the joints.

Causes

The exact cause of RA is unknown. The immune system in a healthy person fights bacteria and unknown substances to protect the body. In RA, the immune system appears to attack and damage its own body tissues.

Who gets RA?

The reason certain people get RA and others do not is not completely known. There does appear to be a genetic factor. It is also possible that hormones and environmental factors (viruses and bacteria) play a role. Women are more likely than men to develop RA. Also, smoking increases the risk of developing RA. 

Symptoms

RA symptoms vary from person to person and may come and go. Initial symptoms develop slowly and usually begin with smaller joints. The initial symptoms also may be more generalized and include fatigue, general pain, numbness, and tingling.

The most common joint symptoms include pain, stiffness, and swelling. Stiffness is most common in the morning or after sleeping. Hand joints can be tender to the touch and weaker than normal. Hard bumps, known as rheumatoid nodules, can develop under the skin near the joints. The wrist is the most commonly affected joint in the arm.

Managing RA

Rheumatoid Arthritis is a lifelong disease. Managing RA can include both non-drug and drug therapies. The goal is to decrease symptoms and joint damage, and to maintain quality of life. Non-drug measures include occupational and physical therapy. A healthy lifestyle that includes rest and exercise may be part of the treatment plan. Surgery may be required for severe joint damage.

It is important to work with your healthcare provider to understand your condition and develop a long-term plan.

Medications

There are many different medications used to treat RA. Most people with RA take some sort of a medication. Treatment early after diagnosis may help reduce symptoms and improve quality of life.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to decrease inflammation. Examples include ibuprofen and naproxen. These products are available over the counter and by prescription. Nonsteroidal anti-inflammatory drugs help with pain and swelling but do not slow joint damage. Corticosteroids are another type of medication that works against inflammation. Examples include prednisone and prednisolone, which may be used to treat flares. Non-anti-inflammatory medications that treat pain include acetaminophen, some topical products, and opioids such as hydrocodone and oxycodone. 

Disease-modifying antirheumatic drugs (DMARDs) can reduce inflammation, joint damage, and maintain quality of life. These medications are usually taken orally. Examples include methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide. The choice of DMARDs depends on the individual person and possible side effects.

Biologic agents (Biologics) are medications that target specific types of molecules that cause inflammation. These medications are usually used if a person did not tolerate DMARDs or if they did not provide a person enough relief from the symptoms of RA. There are several different types of biologics. Most biologic agents are injectables. Tumor necrosis factor (TNF) inhibitors bind TNF, which is an inflammatory substance. Examples include Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), Simponi (golimumab), and Cimzia (certolizumab). These medications can be used in combination with anti-inflammatory drugs and DMARDs. Other medications that target other sources of inflammation include Actemra (tocilizumab), Kineret (anakinra), Orencia (abatacept), Rituxan (rituximab), and Xeljanz (tofacitinib).

Resources

American College of Rheumatology
Arthritis Foundation
National Institute of Arthritis and Musculoskeletal and Skin Diseases