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What is RA? | by heidi


 


Rheumatoid arthritis (RA) is a chronic, progressive, and disabling autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and can affect other body organs.


RA usually affects the hands and feet first, but it can occur in any joint. It usually involves the same joints on both sides of the body.


Common symptoms include stiff joints, especially when getting up in the morning or after sitting down for a while. Some people experience fatigue and a general feeling of being unwell.


The Rheumatoid Arthritis Support Network estimates that RA affects up to 1% of the world’s population and over 1.3 million people in the United States.


What is rheumatoid arthritis?

RA is an autoimmune disease. It is also a systemic disease, which means it can affect the whole body. It occurs when a person’s immune system mistakes the body’s healthy tissues for foreign invaders.


As the immune system responds, inflammation occurs in the target tissue or organ. In the case of RA, this can be the joints, lungs, eyes, and heart.



Signs and symptoms

Signs and symptoms of RA usually occur in the wrists, hands, or feet and include:


pain or achiness in more than one joint

stiffness in more than one joint that lasts longer than 30 minutes

swelling in more than one joint

symmetrical joint involvement

a general feeling of being unwell

low-grade fever

appetite loss

weight loss

weakness

joint deformity

loss of function and mobility

unsteadiness when walking

According to the Centers for Disease Control and Prevention (CDC)Trusted Source, people do not typically receive a diagnosis of RA until they are in their 60s. Symptoms may start slowly and often get worse gradually over time.


People with RA usually experience periods when symptoms get worse, known as flares. RA symptoms may flare up due to stress, overactivity, or stopping medications.



Flares are followed by remissions when symptoms go away or are mild. Most people continue to experience flares and remissions throughout their lives.



RA usually affects the same joints on both sides of the body. Pain and stiffness tend to get worse after sleep or periods of inactivity.


Severe RA can lead to other complications throughout the body and cause joint damage that may lead to disability. Treatment can help manage the severity of symptoms and may reduce the likelihood of experiencing complications.


How does RA affect different parts of the body?



Pictures

The images below show how RA can appear in different parts of the body.




Treatment

If a person has a diagnosis of RA, the doctor may refer them to a specialist known as a rheumatologist, who will advise on treatment options.


Treatment will aim to:


prevent flares and reduce their severity if they occur

reduce inflammation to the joints

relieve pain

minimize any loss of function caused by pain, joint damage, or deformity

slow down or prevent damage to the joints and organs

Options include medications, physical therapy, occupational therapy, counseling, and surgery.



Medications to manage symptoms

Some drugs can help to relieve symptoms and slow disease progression.


Nonsteroidal anti-inflammatory drugs (NSAIDs) are available over the counter (OTC) from pharmacies. Examples include Motril, Advil, and Aleve. Long-term use and high doses can lead to side effects. These include:


bruising

gastric ulcers

high blood pressure

kidney and liver problems

Corticosteroids reduce pain and inflammation and may help slow joint damage, but they cannot cure RA. If NSAIDs do not work, a doctor may inject a steroid into the joint. Relief is usually rapid, but the effect is variable. It can last a few weeks or months, depending on the severity of symptoms.


Corticosteroids can help with acute symptoms or short-term flareups. However, a doctor will limit these injections to no more than three times per year because of their impact on the soft tissue structures in the joints. More frequent injections can potentially damage these structures or cause them to tear off where they attach to the bone.


Learn more about steroid injections here.


Disease-modifying antirheumatic drugs (DMARDs)

The American College of Rheumatology (ACR) recommends treatment with disease‐modifying antirheumatic drugs (DMARDs), either alone or with other treatments, in people with moderate to severe RA. Methotrexate (Rheumatrex, Trexall) is an example of a DMARD.


DMARDs affect how the immune system works. They can slow the progression of the RA and prevent permanent damage to the joints and other tissues by interfering with an overactive immune system. A person usually takes a DMARD for life.


These types of medications are most effective if a person uses them in the early stages of RA, but it can take several weeks to a couple of months to fully experience the benefits. Some people may have to try different types of DMARDs before finding the most suitable one.


Side effects can include:


liver damage

immune-related disorders

increased risk of infections

hair loss

mouth ulcers

nausea, stomach upset, and loose stool

abnormal blood counts

Learn more about the stages of RA here.


Biologic treatments

Biologic treatments, such as tumor necrosis factor-alpha (TNF-alpha) inhibitors, also change how the immune system works. When the human body faces an infection or other threat, it produces TNF-alpha, an inflammatory substance. TNF-alpha inhibitors suppress this substance and help prevent inflammation.


TNF-alpha inhibitors can reduce pain, morning stiffness, and swollen or tender joints. People usually notice an improvement 2 weeks after starting treatment.


Examples include:


adalimumab (Humira)

certolizumab pegol (Cimzia)

etanercept (Enbrel)

golimumab (Simponi

infliximab (Remicade)

Possible side effects includeTrusted Source:


a higher risk of infection

lupus

congestive heart failure

demyelinating diseases, which damage the myelin sheath that normally protects nerve fibers

lymphoma

skin reactions

Learn more about DMARDs and biologic drugs for RA.


Occupational or physical therapy

An occupational therapist can help a person learn new and effective ways of carrying out daily tasks. This can minimize stress to painful joints. For example, a person with painful fingers might learn to use a specially devised gripping and grabbing tool.


A physical therapist can advise people about using assistive devices, such as a cane, and help individuals develop a suitable exercise plan.


Which exercises can help people with RA?


Surgery

In some cases, a doctor may recommend surgery to:


repair damaged joints

correct deformities

reduce pain

The following procedures are possible:


arthroscopic surgery, a procedure to remove inflamed joint tissue

surgery to release tendons responsible for unusual bending in the fingers

carpal tunnel release to relieve nerve compression in the hand and wrist

arthroplasty, or total joint replacement

Learn why RA affects the hand joints.


Home remedies

Several strategies can help a person manage RA. Examples include:


rest, especially during an RA flare

low-impact exercise, such as swimming, to boost overall health and mobility and strengthen the muscles around a joint

managing weight, which can prevent additional stress on the joints

applying heat or cold packs

meditation, guided imagery, deep breathing, or muscle relaxation to relieve stress

A healthcare professional can help a person make a plan that incorporates dietary advice, suggestions for exercise, and other tips.


Learn about other natural remedies for RA here.



Diet

A varied, balanced diet can help control the inflammation that causes RA symptoms. It also helps a person to manage their weight, which reduces stress on the joints.


A Mediterranean diet is a good option for many people with RA. This diet focuses on inflammation-fighting foods, such as:


plenty of fresh fruits and vegetables, which are rich in antioxidants

fatty fish, such as salmon or tuna, which are high in omega-3 fatty acids

olive oil, which has heart-healthy monounsaturated fat

nuts, which are also a great source of monounsaturated fats and other nutrients

whole grains, which have fiber and antioxidants to help boost heart health

legumes, including peas and beans, which are a healthy source of protein

People with RA should additionally eat calcium-rich foods to support strong bones, as some RA medications can increase the risk of osteoporosis. Good sources include low fat dairy and dark leafy green vegetables.


Because anemia can occur during RA flare-ups, causing fatigue, it’s a good idea for a person to incorporate iron-rich foods into their diet, including:


lean meats

leafy greens

fortified breakfast cereals

legumes

eggs

What is the best diet for people with RA?


Causes

Nobody knows what causes the immune system to malfunction, leading to RA.


Some people appear to have genetic factors that make developing RA more likely. One theory is that bacteria or a virus triggers RA in people who have this genetic feature.


In RA, the immune system’s antibodies attack the synovium, the smooth lining of a joint. When this happens, pain and inflammation result.


Inflammation causes the synovium to thicken. Eventually, if left untreated, it can invade and destroy cartilage — the connective tissue that cushions the ends of the bones.


The tendons and ligaments that hold the joint together can also weaken and stretch. The joint eventually loses its shape and configuration. The damage can be severe.



Rheumatoid arthritis vs. osteoarthritis

RA is an autoimmune disease that causes inflammation in the joints, leading to pain, stiffness, and swelling. Osteoarthritis leads to many of the same symptoms as RA but is due to normal wear and tear of the joints.


While RA usually affects the same joints on both sides of the body, osteoarthritis may only affect one side.


Although other symptoms can help a person figure out if they’re experiencing RA or osteoarthritis, only a doctor can diagnose these conditions.



Risk factors


60 years or older

are female

have specific genetic traits

have never given birth

have obesity

smoke tobacco or whose parents smoked when they were children

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