Is this topic for you?
There are many types of
arthritis (disease of the ). This topic is about
rheumatoid . If you are looking for information about how juvenile
idiopathic ( affects young children, see the topic
Juvenile Idiopathic Arthritis. If you are looking for
information on the most common form of in older adults, see the topic
What is rheumatoid arthritis?
Over time, this
may destroy the joint tissues. This can limit your daily
activities and make it hard for you to walk and use your hands.
begins between the of 40 and 60.
What causes rheumatoid arthritis?
The exact cause is not known. But rheumatoid
autoimmune disease. This means that the body's natural
defense system attacks the . The disease may run in some families.
What are the symptoms?
The main symptoms of rheumatoid
swelling in the of the hands, wrists,
neck, feet, ankles, knees, or. The disease usually affects both sides of the body at the same time. In
rare but severe cases, it may affect the eyes, , heart, nerves, or blood
Sometimes the disease
can cause bumps called nodules to form over the elbows, knuckles, spine, and
lower leg bones.
How is rheumatoid arthritis diagnosed?
There is no single test for rheumatoid
. Your doctor will do a and look at your for signs of swelling or
tenderness. He or she will also ask about your symptoms and past health.
You may have blood tests,
, and other tests to find out if another problem
is causing your joint pain.
How is it treated?
Treatment for rheumatoid
exercise, and lifestyle changes. Getting treatment early may control the condition or keep it from getting worse.
the medicines used to treat rheumatoid 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.
- Rest when you are tired.
your from injury by using devices like special kitchen tools or
- Use splints, canes, or walkers to ease pain and take
stress off your if your symptoms are severe.
- Eat a
- Exercise regularly.
- Stay at a healthy
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 to feel depressed. Your mood can affect how you feel and how well you cope with pain. Be sure to seek the and
support you need from friends and family members. Professional can also help.
Health Tools help you make wise health decisions or take action to improve your health.
Frequently Asked Questions
Learning about rheumatoid:
Living with rheumatoid:
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 , or some other foreign substance.
Other causes of joint pain include osteoarthritis, lupus, and.
Joint pain can be an early symptom of many
different diseases. In
rheumatoid , symptoms often develop slowly
over a period of weeks or months. Fatigue and stiffness are usually early
symptoms. Weight loss and a low-grade can also
Joint symptoms include:
- Painful, swollen, tender, stiff
joints. The same on both sides of the body
(symmetrical) are usually affected, especially the
hands, wrists, ,
feet, ankles, knees, or neck.
stiffness. Joint stiffness may develop after long periods of sleeping or
sitting. It usually lasts at least 1 hour and often up to several
- Bumps (nodules). ranging in
size from a pea to a mothball develop in nearly one-third of people who have
Nodules usually form over pressure points in the body
such as the elbows, knuckles, spine, and lower leg bones.
In addition to specific joint symptoms, rheumatoid
symptoms throughout the body (systemic). These include:
- Weight loss.
- Mild .
Some of the symptoms of
to symptoms of other health conditions.
The course of
rheumatoid 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.
Rheumatoidis more likely to get worse when:
- A rheumatoid factor blood test is
- A blood test for the
peptide) is positive. CCP (cyclic citrullinated
- The disease fails to respond to
- Bumps (nodules) form rapidly.
joints are affected.
of bone or
cartilage. show early
The ongoing inflammation caused by rheumatoid joint destruction can lead to deformed .affects the tissues that line joints. It causes a breakdown in cartilage and loosens ligaments and that support the . The resulting
The pain, stiffness,
whole-body (systemic) symptoms of rheumatoid 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
of the knees, if not controlled by
treatment, can cause erosion of and can later lead to the need
damage can pinch a nerve or affect the spinal cord and cause numbness, pain, weakness, or 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 atherosclerosis) earlier than people who do not have rheumatoid . may play a role in speeding up plaque development. When plaque develops in the arteries in the heart, it is called (CAD) and it increases the risk of a . When plaque develops in the arteries in the neck, it increases the risk of .seem to develop plaque deposits in arteries (
Rheumatoid osteoporosis.and some of the medicines used to treat it can increase the risk of
It is common for people with rheumatoid depressed. These feelings may be caused by pain and
Most women with rheumatoidcan become pregnant and have a healthy baby.
What Increases Your Risk
Things that may increase
your risk for rheumatoid include:
- Being female. Rheumatoid
women 2 to 3 times as often as men. affects
middle-aged. Rheumatoid can begin at any , but
it most often begins in adulthood.
- Smoking cigarettes.
When to Call a Doctor
Call your doctor immediately if you have:
- Sudden, unexplained swelling and pain in any
joint or .
- Joint pain associated
with a fever or rash.
- Pain that is so severe that you cannot use
- Back or along with weakness in your arms or legs.
- of bowel or bladder control.
Call your doctor within the next few days if
- Joint pain that continues and
has not improved for over 6 weeks.
- Side effects that occur with
large doses of
nonsteroidal anti-inflammatory drugs (NSAIDs) or other
medicine used to treat your . NSAIDs include ibuprofen (Advil) and naproxen (Aleve).
Watchful waiting 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 , see
your doctor to find out if you have rheumatoid .
Early diagnosis and treatment allows for possible reduction of joint pain,
slows joint destruction, and reduces the chance of permanent disability.
Who to see
Early arthritis symptoms can be
Rheumatoidcan be treated by:
- A rheumatologist.
- A family medicine doctor or an who consults with a .
Supportive treatment can be provided by:
Exams and Tests
No single lab test can diagnose
rheumatoid . Instead, doctors look at symptoms and physical signs and then rule out other diseases that
can cause similar symptoms.
medical history and 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:
- Anti-cyclic citrullinated peptide antibody (ACPA or anti-CCP) test (helps confirm diagnosis and may
show your risk of having severe symptoms)
- C-reactive protein (may help to assess disease activity)
- Erythrocyte sedimentation rate
(may help to assess disease activity)
- Rheumatoid factor
Other tests are used to help monitor and manage rheumatoid. These include:
- Antinuclear antibody assay.
- Bone density test, to check for (osteoporosis).
- Complete blood count.
- Eye exam.
- magnetic resonance imaging (MRI), ultrasound, or X-rays. such as
- Joint fluid analysis.
- Kidney function tests.
- Liver and
muscle enzyme tests.
- Tissue type
destruction and disability over time, regular checkups are important to see if treatment is working or
needs to be adjusted.
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 usually continues throughout
your life, but it will vary depending on:
- The stage (active or in
remission) and severity of your
- Your treatment history.
- The benefits and risks
of treatment options.
- Your preferences for treatment options, such
as cost, side effects, and daily schedules.
The goal of treatment is to help you maintain your
lifestyle, reduce joint pain, slow joint damage, and prevent disability.
Making a plan
rheumatoid 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.
Treatment with medicines
Early and ongoing treatment of
RA with medicines called disease-modifying antirheumatic
drugs (DMARDs) can slow or sometimes prevent joint
destruction. Other medicines may be combined with DMARDs to relieve symptoms. These medicines include:
- Medicines that reduce swelling, including ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn).
- Medicines that relieve pain, such as acetaminophen, codeine, and hydrocodone.
- Corticosteroids for early treatment, to control flare-ups, or to help manage the disease.
Be safe with medicines. Read and follow all instructions on the label.
For more information, see Medications.
rheumatoid usually continues throughout your
life. Your doctor will want to closely monitor your condition. A
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:
- The amount of joint pain.
- How long
morning stiffness lasts.
- The number of actively inflamed
- How well you are functioning.
- Results of lab tests.
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 jointsâ€”especially the
knees, or feetâ€”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 and lifestyle changes
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.
Living With Rheumatoid Arthritis
rheumatoid 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
Rest when you're tired
The disease itself causes
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.
- With severe symptoms, you may need long periods
of rest. You might need to rest a joint by lying down for 15 minutes several
times a day to relax. Try to find a balance between daily
activities that you must do or want to do and the amount of rest you need to do those activities.
- Plan your day carefully, including
rest periods. Pace your activities so that you don't get
Protect your joints
You may need to change the way you do certain activities so that you are not
overusing your . Try to find different ways to relieve your joint
- Joint pain and stiffness may improve with heat
therapy, such as:
- Taking warm showers or baths after long
periods of sitting or sleeping.
- Soaking hand joints in warm wax
- Sleeping under a warm electric blanket.
- Taking warm showers or baths after long
assistive devices to reduce on your ,
such as special kitchen tools or doorknobs.
- Choose the right shoes that fit well and will not cause joint problems.
- Use splints, canes, or
walkers to reduce pain and improve function.
Keep moving to
keep your muscle strength, flexibility, and overall health.
your doctor. may be recommended by
- Exercise for arthritis takes three formsâ€”stretching,
strengthening, and conditioning. Exercise can improve or maintain quality of life for people who have rheumatoid . Your specific joint problem may
guide the type of activity that will help the most. For example:
- Swimming is a good activity if
you have joint problems in your knees, ankles, or
- Bicycling and walking are good activities if your
joint problems are not in your legs or feet.
- Swimming is a good activity if
Eat healthy foods
Try to eat a variety of healthy foods. Dietary needs are not the same for all people who have rheumatoid. To be sure you get the you need, you can ask a registered dietitian to help you make a plan.
- Be sure to get enough
to protect your against .
For more information, see the topic
- Lose weight, if you are
overweight. For more information, see the topic
- People who have rheumatoid
risk of heart disease. But healthy lifestyle changes, such as exercise and a
healthy diet, may reduce your risk. also have an increased
Take care of your teeth and gums
People who have rheumatoidtend to get . Some experts think that infection that enters the body through the mouth may make rheumatoid worse, although this has not been proved. You can help prevent through good .
Medicines are the main treatment for
rheumatoid . 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:
- Relieve or reduce pain.
- Reduce joint
include swelling, tenderness, and limited . . Signs of joint
- Prevent or delay significant
joint damage and deformity.
- Improve quality of life.
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. 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. 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
are pregnant or are trying to become pregnant, talk with your doctor about your medicines.
Medicines to slow the disease
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
Commonly used nonbiologic DMARDs
- Antimalarials such as
hydroxychloroquine or chloroquine
Less commonly used nonbiologic DMARDs
- Gold salts
Biologic DMARDs (biologics)
Medicines to relieve symptoms
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as , ibuprofen, and naproxen. NSAIDs are used to
control pain and may help reduce . They don't control the disease
or stop it from getting worse. NSAIDs may be combined with DMARDs.
such as prednisone. These medicines are used to reduce disease
activity and joint . But using only corticosteroids for an extended time is not considered the best treatment. Corticosteroids are
often used to control symptoms and flares of joint until DMARDs
reach their full effectiveness.
- Analgesics (pain relievers). These don't reduce
but may help with pain control. They include:
with codeine). with codeine (such as
). with hydrocodone (such as
What to think about
- Some DMARDs can take up to 6
months to work.
- In some people, a certain DMARD may not work at all. So a
different DMARD will be used.
- If you're taking DMARDs, it's a good idea to have a manage your care.
- Many DMARDs have serious side effects. You will need regular blood and
blood-producing cells ( ), the , and the . to check the drug's effects on
- If you have other conditions such as high or high , your doctor may recommend that you take medicine to control them.
Be safe with medicines. Read and follow all instructions on the label.
Surgical treatment for
rheumatoid is used to relieve severe pain
and improve function of severely deformed that don't respond to
medicine and physical therapy.
Total joint replacement
(arthroplasty) can be done for many different in the body. Its success
varies depending on which
Surgeries considered for people
who have severe include:
to replace part or all of a joint, such as the hip or knee.
which uses a small lighted instrument to remove debris or inflamed tissue from a joint.
- Carpal tunnel release, to relieve pressure on the in the wrist.
- Cervical spinal fusion, to treat severe and
- Finger and hand surgeries, to correct
joint problems in the hand.
- Foot surgery such as phalangeal head resection.
- Synovectomy, to
remove inflamed joint tissue.
What to think about
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 .
, particularly smaller , such as finger joints, which are needed
for many daily activities. Surgical treatment may not be an option for all of
the affected . usually affects multiple
- Joint surgery or replacement can relieve
disabling pain and restore enough motion to allow you to do your daily
activities. But it will seldom restore the joint to normal.
Before you decide to have surgery, consult with an
orthopedic surgeon who is experienced in joint surgery
for rheumatoid .
Other types of treatment that may
help you control some of the symptoms of
function. includes exercise, hot and cold therapy, and
massage. , to improve joint
movement in the while carrying out the activities of daily . . This helps you learn how to maintain
- Assistive devices such as household aids or mobility aids. For
more information and a catalog, contact the Arthritis Foundation at www.arthritis.org.
- Behavioral modification techniques to reduce pain and
stress. These include
biofeedback and relaxation therapy, such as
breathing exercises and
- Counseling. It can
help you cope with long-term pain and disability.
Complementary medicine therapies are
used by many people to relieve symptoms and
improve their quality of life, even though there isn't strong scientific evidence that they help. These therapies include:
- Acupuncture. This treatment is used to
relieve pain and treat certain health conditions. It is done by inserting very
thin needles into the skin at specific points on the body.
- Herbs and dietary supplements. If you decide to
use herbs or dietary supplements, be sure to tell your doctor.
- Herbs such as the oil of evening primrose, borage seed, or blackcurrant seed may help relieve symptoms and improve function without significant side effects.
- Essential fatty acids (such as fish oil) may provide some
relief of symptoms.footnote 4
- The dietary supplements
try to relieve joint pain. But there is not evidence that they are effective for rheumatoid . are sometimes used to
- Massage. It can help relieve and reduce
pain. But don't massage swollen or painful .
Find out about the safety of any complementary product or practice you want to try. Most mind and body practicesâ€”such as acupuncture and massageâ€”are safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.
Talk with your doctor about any complementary health practice that you would like to try or are already using. Your doctor can help you manage your health better if he or she knows about all of your health practices.
Other Places To Get Help
- O'Dell JR (2013). Treatment of rheumatoid . In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1137â€“1160. Philadelphia: Saunders.
- Fleischmann R, et al. (2012). Placebo-controlled trial of tofacitinib monotherapy in rheumatoid . New England Journal of Medicine, 367(6): 495â€“507.
- Von Vollenhoven RF, et al. (2012). Tofacitinib or adalimumab versus placebo in rheumatoid . New England Journal of Medicine, 367(6): 508â€“519.
- Gomez FE, Kaufer-Horwitz M (2012). Medical nutrition therapy for rheumatic disease. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 901â€“922. St Louis: Saunders.
Other Works Consulted
- Combe B, et al. (2016). 2016 update of the EULAR recommendations for the management of early. Annals of the Rheumatic Diseases, published online December 15, 2016. DOI: 10.1136/annrheumdis-2016-210602. Accessed January 13, 2017.
- O'Dell JR (2013). Treatment of rheumatoid. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1137â€“1160. Philadelphia: Saunders.
- Singh JA, et al. (2016). 2015 American College of Rheumatology guideline for the treatment of rheumatoid. Arthritis Care and Research, 68(1): 1â€“25. DOI: 10.1002/acr.22783. Accessed April 14, 2016.
- Steultjens EEMJ, et al. (2009).for rheumatoid . Cochrane Database of Systematic Reviews (1).
- Sweeney SE, et al. (2013). Clinical features of rheumatoid. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1109â€“1136. Philadelphia: Saunders.
- Yasuda GT, et al. (2013). Rheumatoid. In JE Pizzorno, MT Murray, eds., Textbook of Natural Medicine, 4th ed., pp. 1769â€“1784. St. Louis: Elsevier.
ByHealthwise StaffPrimary Medical Reviewer Anne C. Poinier, MD - Internal Medicine E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Martin J. Gabica, MD - Family Medicine Kathleen Romito, MD - Family Medicine Specialist Medical Reviewer Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
Current as ofOctober 10, 2017
Current as of:
October 10, 2017
Anne C. Poinier, MD - Internal Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology