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Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs.

RA; Arthritis - rheumatoid

The cause of RA is unknown. It is considered an autoimmune disease. The body's immune system normally fights off foreign substances, like viruses. But in an autoimmune disease, the immune system confuses healthy tissue for foreign substances. As a result, the body attacks itself.

RA can occur at any age. Women are affected more often than men.

RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected. The course and the severity of the illness can vary considerably. Infection, genes, and hormones may contribute to the disease.

The disease usually begins gradually with:

• Fatigue
• Loss of appetite
• Morning stiffness (lasting more than 1 hour)
• Widespread muscle aches
• Weakness

Eventually, joint pain appears. When the joint is not used for a while, it can become warm, tender, and stiff. When the lining of the joint becomes inflamed, it gives off more fluid and the joint becomes swollen. Joint pain is often felt on both sides of the body, and may affect the fingers, wrists, elbows, shoulders, hips, knees, ankles, toes, and neck.

Additional symptoms include:

• Anemia due to failure of the bone marrow to produce enough new red blood cells
• Eye burning, itching, and discharge
• Hand and feet deformities
• Limited range of motion
• Low-grade fever
• Lung inflammation (pleurisy)
• Nodules under the skin (usually a sign of more severe disease)
• Numbness or tingling
• Paleness
• Skin redness or inflammation
• Swollen glands

Joint destruction may occur within 1-2 years after the appearance of the disease.

A specific blood test is available for diagnosing RA and distinguishing it from other types of arthritis. It is called the anti-CCP antibody test. Other tests that may be done include:

• Complete blood count
• C-reactive protein
• Erythrocyte sedimentation rate
• Joint ultrasound or MRI
• Joint x-rays
• Rheumatoid factor test (positive in about 75% of people with symptoms)
• Synovial fluid analysis

For additional information and resources, see arthritis support group.

Regular blood or urine tests should be done to determine how well medications are working and if drugs are causing any side effects.

RA differs from person to person. People with rheumatoid factor, the anti-CCP antibody, or subcutaneous nodules seem to have a more severe form of the disease. People who develop RA at younger ages also seem to get worse more quickly.

Many people with RA work full-time. However, after many years, about 10% of those with RA are severely disabled, and unable to do simple daily living tasks such as washing, dressing, and eating.

In the past, the average life expectancy for a patient with RA could be shortened by 3-7 years. Those with severe forms of RA would often die 10-15 years earlier than expected. However, as treatment for rheumatoid arthritis has improved, severe disability and life-threatening complications have decreased considerably and many people live relatively normal lives.

Rheumatoid arthritis is not solely a disease of joint destruction. It can involve almost all organs.

A life-threatening joint complication can occur when the cervical spine (neck bones) becomes unstable as a result of RA.

Rheumatoid vasculitis (inflammation of the blood vessels) is a serious, potentially life-threatening complication of RA. It can lead to skin ulcerations and infections, bleeding stomach ulcers, and nerve problems that cause pain, numbness, or tingling. Vasculitis may also affect the brain, nerves, and heart, which can cause stroke, heart attack, or heart failure.

RA may cause the the outer lining of the heart to swell (pericarditis) and cause heart complications. Inflammation of the heart muscle, called myocarditis, can also develop. Both of these conditions can lead to congestive heart failure.

The treatments for RA can also cause serious side effects. If you experience any side effects, immediately tell your health care provider.

Call your health care provider if you think you have symptoms of rheumatoid arthritis.

Rheumatoid arthritis has no known prevention. However, it is often possible to prevent further damage of the joints with proper early treatment.

Stop smoking. Research shows that the risk of developing RA is nearly double for current smokers compared with non-smokers.

Because RA may cause eye complications, patients should be have regular eye exams.

Harris ED Jr., Budd RC, Genovese MC, Firestein GS, Sargent JS, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005

Smolen JS, Aletaha D, Koeller M, Weisman MH, Emery P. New therapies for treatment of rheumatoid arthritis. Lancet. 2007;370(9602):1861-74.