Frequently Asked Questions
WHAT IS RHEUMATOID ARTHRITIS?
Rheumatoid arthritis (RA) is an autoimmune, inflammatory disease that affects the joints. While its causes are still unclear, RA occurs when the body’s immune system malfunctions and attacks the healthy tissues of the synovium (lining of the joints) by mistake. RA triggers inflammation that quickly flares and causes severe pain and swelling in the joints. Joints can break down and become very difficult to bend or flex, making them unable to fulfill their intended function. RA also may affect other organs, such as the eyes, lungs, heart, or skin.
JUST WHY DOES RA HAPPEN?
The causes of RA are unclear at this time. Some people may develop RA due to having certain genes, such as HLA-DR4. However, carrying this gene or having a relative with RA does not mean that you will necessarily develop the disease. Some factors, such as having a bacterial or viral infection or smoking, may trigger active RA in someone with the genetic predisposition to develop it.
WHO IS MOST LIKELY TO GET RA?
About 1–2% of the U.S. population has RA. The disease affects women two to three times more often than men. Although RA usually affects people in their 30s, 40s, and 50s, with higher frequency in those over 50, it can also strike those who are younger or older. People with specific genetic mutations, those who have had certain bacterial or viral infections, or long-time smokers may be more likely to develop RA.
WHAT ARE THE MOST FREQUENT SYMPTOMS OF RA?
RA’s chief symptom is inflammation of the synovium (lining of the joints). In addition to severe pain, swelling, stiffness, or warmth around affected joints, the skin around these joints may look red or swollen. Joints may feel tender and painful to move. RA usually affects several joints—as many as five or more— especially in the hands, wrists, feet, shoulders, elbows, and ankles. There may be stiffness or pain in a joint after a long period of rest or inactivity. Other symptoms of an RA flare may include fatigue, malaise (a general sick feeling), and fever.
WHAT SHOULD I DO IF I BELIEVE I HAVE RA SYMPTOMS?
See a rheumatologist immediately if you notice pain, swelling, or stiffness in or difficulty moving one or more joints and these symptoms seem to come on suddenly and worsen over a few weeks. A rheumatologist is a physician with additional years of specialized training in treating RA and other rheumatic and musculoskeletal diseases. A rheumatologist can examine you and give you specific tests, such as blood tests or X-rays, to determine whether you have RA or there is another cause for your joint pain.
HOW DOES MY DOCTOR DIAGNOSE RA?
RA may affect each person differently, but there are some general common signs that your rheumatologist will look for to diagnose RA. Your rheumatologist will examine your joints and ask you to move them to test your range of motion. He or she may feel your joints to see if they are swollen and feel spongy. You will also be given blood tests to look for certain signs of inflammation, X-rays or other scans to look for signs of joint inflammation or damage, and other tests, such as urinalysis. Your rheumatologist will rule out any other causes of your joint pain or swelling. To have RA, you must have synovitis ( inflammation of the joint lining) in one or more joints that is not caused by some other disease. Your rheumatologist will also use a scoring method to see if you have at least six of the 10 other common signs of RA. These include symptoms affecting multiple joints; symptoms that last six weeks or longer; having a positive test for either one or both of rheumatoid factor or anti-citrullinated protein antibodies (ACPAs); and having abnormal levels of either one or both of C-reactive protein or erythrocyte sedimentation rate (ESR).
HOW IS RA TREATED?
There are many drugs available to treat RA inflammation and to help reduce symptoms that may be out of control. Disease-modifying antirheumatic drugs (DMARDs) are the first-line treatment for RA inflammation. These include methotrexate, the most common RA treatment, as well as leflunomide, azathioprine, hydroxychloroquine, and sulfasalazine, among others. Newer targeted drugs called biologics may be used if DMARDs do not adequately control your RA disease activity. These drugs include etanercept, adalimumab, infliximab, certolizumab pegol, anakinra, abatacept, golimumab, tocilizumab, sarilumab, rituximab, tofacitinib, and baricitinib. Other drugs that may be used to treat flares of RA pain or inflammation include nonsteroidal antiinflammatory drugs (NSAIDs), glucocorticoids, and analgesics, which only treat pain.
ARE DRUGS THE ONLY TREATMENT FOR RA?
Surgery may replace damaged joints that have become too stiff, misshapen, or painful to use. You can also do many things to help ease your RA symptoms or improve your joint range of motion. Regular joint-friendly exercises have been shown to help maintain flexibility and strengthen muscles to better support your joints. Maintaining a healthy weight, avoiding smoking, getting enough rest, and eating a healthy diet will help you feel better with RA. Physical therapy and occupational therapy may also help you deal with your RA symptoms and do daily tasks more effectively.
WHAT ARE MY TREATMENT GOALS?
Once your rheumatologist diagnoses your RA, you will work together to create a treatment plan with certain targets or goals for your treatment. The ideal target is remission (inactive disease). Your targets may include keeping your disease activity low, controlling your symptoms, and maintaining a good quality of life. You and your rheumatologist will work together to decide what type of drugs or other treatments you will take. Your rheumatologist can adjust your treatments, such as changing drugs or dosages, to help you achieve your targets and manage side effects or symptoms.
WILL HAVING RA AFFECT MY ABILITY TO HAVE A FAMILY?
RA should not affect a woman’s ability to get pregnant or have a healthy baby. Your rheumatologist will need to work with you to change your treatment plan if you want to conceive a baby since some DMARDs, including methotrexate, can cause severe birth defects. Both women and men with RA should use birth control to prevent pregnancy while taking methotrexate or other drugs that could cause birth defects. These drugs should also be avoided while a woman is pregnant or breastfeeding. Women who have RA often experience a reduction in their symptoms while they are pregnant.
WILL MY JOINTS BE DEFORMED IN THE LONG-TERM?
RA can have serious long-term effects if you do not seek a diagnosis early and start treatment to control your inflammation. In addition to becoming painful and stiff, joints can break down and become almost impossible to use. RA can also affect internal organs, causing inflammation of the eyes, heart, lungs, or skin. However, early diagnosis and treatment can help control your inflammation and minimize joint damage. Many people with RA today can avoid joint deformity or even the need to replace severely damaged joints. The best way to avoid joint damage and control your RA is to seek diagnosis and treatment with a rheumatologist as soon as possible. You can also stay fit by incorporating regular joint-friendly exercises, weight management, a healthy diet, and smoking avoidance in your life.
HOW DO I EXPLAIN MY RA TO OTHERS?
It is up to you to tell other people about your RA. You may wish to talk to your family first and let them know about your diagnosis. You may choose to tell them about the medicines you will be taking to control your disease and its symptoms. You may want to ease their concerns and let them know that you will be seeing your rheumatologist regularly to make sure your treatments are on track to achieve your target goals. You will need to decide how and when to tell your employers about your RA. However, you may wish to tell them about your diagnosis if you need to take time off from work for visits to your rheumatologist, physical therapist, occupational therapist, or infusion clinic. It is important to let them know that you are working with a rheumatologist to manage and treat your RA and that you need to stick to your treatment plan in order to feel better, prevent joint damage, control your disease activity, and continue to function well.