Rheumatoid Arthritis (RA)
What is rheumatoid arthritis (RA)?
RA is a chronic (long-term) disease that causes pain, stiffness, swelling and limited motion and function of many joints. While RA can affect any joint, the small joints in the hands and feet tend to be involved most often. Inflammation sometimes can affect organs as well, for instance, the eyes or lungs.
Who gets rheumatoid arthritis?
RA is the most common form of autoimmune arthritis. Overall prevalence is approximately 1%, of these, about 75% are women. In fact, 1–3% of women may get rheumatoid arthritis in their lifetime. The disease most often begins between the fourth and sixth decades of life. However, RA can start at any age.
3. How common is the disease?
How is rheumatoid arthritis diagnosed?
RA can be hard to detect because it may begin with subtle symptoms, such as achy joints or a little stiffness in the morning. Diagnosis of RA depends on the symptoms and results of a physical exam, such as warmth, swelling and pain in the joints. Some blood tests also can help confirm RA.
X-rays can help in detecting RA, but may not show anything abnormal in early arthritis. Even so, these first X-rays may be useful later to show if the disease is progressing. Often, MRI and ultrasound scanning are done to help judge the severity of RA.
There is no single test that confirms an RA diagnosis for most patients with this disease. (This is above all true for patients who have had symptoms fewer than six months.) Rather, a doctor makes the diagnosis by looking at the symptoms and results from the physical exam, lab tests and X-rays.
How is rheumatoid arthritis treated?
Therapy for RA has improved greatly in the past 30 years. Current treatments give most patients good or excellent relief of symptoms and let them keep functioning at, or near, normal levels. With the right medications, many patients can achieve “remission” — that is, have no signs of active disease.
There is no cure for RA. The goal of treatment is to lessen your symptoms and poor function. Doctors do this by starting proper medical therapy as soon as possible, before your joints have lasting damage. No single treatment works for all patients. Good control of RA requires early diagnosis and, at times, aggressive treatment. Thus, patients with a diagnosis of RA should begin their treatment with disease-modifying antirheumatic drugs — referred to as DMARDs. Ask your rheumatologist about the need for DMARD therapy and the risks and benefits of these drugs. Patients with more serious disease may need medications called biologic response modifiers or “biologic agents.” FDA-approved drugs of this type include Abatacept, Adalimumab, Anakinra, Certolizumab, Etanercept, Golimumab, Infliximab, Rituximab and Tocilizumab. Most often, patients take these drugs with methotrexate, as the mix of medicines is more helpful.
The best treatment for RA needs things other than medicines alone. Patient education, such as how to cope with RA, is also important. Proper care requires the expertise of a team of providers, including rheumatologists, primary care physicians, and physical and occupational therapists.
What is the broader health impact of rheumatoid arthritis?
Research shows that people with RA, mainly those whose disease is not well controlled, have a higher risk for heart disease and stroke and die early.
Living with rheumatoid arthritis
It is important to be physically active most of the time, but sometimes to scale back activities when the disease flares. In general, rest is helpful when a joint is inflamed, or when you feel tired. At these times, do gentle range-of-motion exercises, such as stretching. This will keep the joint flexible.
When you feel better, do low-impact aerobic exercises, such as walking, and exercises to boost muscle strength. This will improve your overall health and reduce pressure on your joints. A physical or occupational therapist can help you find which types of activities are best for you, and at what level or pace you should perform them.
Points to remember
- Newer treatments are effective. RA drugs have greatly improved outcomes for patients. For most people with RA, early treatment can control joint pain and swelling, and lessen joint damage.
- Start treatment early. Studies show that people who receive early treatment for RA feel better sooner and more often, and are more likely to lead an active near normal life. They also are less likely to have the type of joint damage that requires joint replacement.