There are over 100 different types of arthritis, with the most common ones including rheumatoid arthritis (RA), juvenile idiopathic arthritis, osteoarthritis (OA), psoriatic arthritis (PsA), fibromyalgia, lupus, and gout. Arthritis and related diseases can cause chronic, debilitating, and life-changing pain.
More than one-third of adults who have arthritis report that it limits their leisure activities and work, and 25% of them say it causes severe pain. Forty-three percent report they have problems walking. Fortunately, early diagnosis can help delay RA severity, and there are plenty of treatment options available to help you manage the symptoms.
RA is estimated to affect approximately 0.5 to 1% of the U.S population and is twice as common in women than in men. A woman’s lifetime risk of developing RA is 3.6%, and it is 1.7% in men.
The prevalence of RA is much greater in some populations, such as in the Pima Native Americans, where rates are up to 10 times higher than those of most racial or ethnic groups.
What is RA?
RA is a disease that inflames the tissue of the joints, which is the lining of the joints called the synovium, of the body, causing chronic pain.
It is caused by a dysfunctional immune system attacking healthy cells on accident, resulting in painful swelling. Usually, RA affects hands, wrists, knees, and feet and can cause joint deformity. It can also involve organs of the body such as the liver, heart, lungs, and eyes.
Typical symptoms of RA include:
- Achiness and pain in at least one joint
- Enlarged, swollen and tender joints
- Stiff joints
- Both sides of the body are affected by the same symptoms, such as the hands and knees
- Decreased strength
- Easily exhausted
The four stages of arthritis
- Stage 1: You may not have many symptoms except some stiffness early in the day, usually in the smaller joints, like the hands and feet. The bones are not damaged yet. Symptoms can come and go, and perhaps only one joint is painful. At this stage, the body begins attacking its joint tissue as part of the autoimmune process of RA.
- Stage 2: The joints start to swell as the body begins making antibodies to reduce autoimmune joint pain. Inflammation damages the cartilage, the cushioning material that protects the end of your bones. You may have lost movement or range of motion, the ability to move an extremity as far as you used to.
- Stage 3: In the severe phase, symptoms become more visible as the joints become deformed and bent and the fingers and toes crooked. The end of the bones near the joint erodes, and the bones move around. Cartilage wears away. Nerve pain can result as misshapen joints can compress nerves.
- Stage 4: During the end of this phase, inflammation stops, but the damage continues. There is no joint remaining. The joint becomes fused and no longer works. Joint pain, swelling, and stiffness persist. The muscles may lose strength.
A rheumatologist is key to the diagnosis of RA. Early on, diagnosing RA may be difficult. Tests are not definitive; ultrasound and bloodwork may or may not show any inflammatory markers.
As RA progresses, joints will eventually swell up, and nodules or lumps can develop on the elbows. Blood work may or may not reveal antibodies like rheumatoid factor. The diagnosis may be confirmed with an x-ray. If not, a rheumatologist can do an ultrasound or an MRI.
RA eventually progresses to a severe level, and deformity and fusion become very visible. Treatment early on can prevent this from happening. Damage can be slowed or stopped.
Your joints will tell you when your RA is progressing. Pain and swelling get worse, typically longer in duration and more frequent. Symptoms like shortness of breath and painful eyes may be clues that RA is now affecting other body parts. Discuss this with your rheumatologist.
There are several management techniques to help treat RA. Treatment options include:
Medical management of RA
- Rest to help lower the chance of a flare-up, which may result in increased inflammation, pain, and fatigue.
- Hot compresses can be used to relax muscles, help lubricate joints and relieve joint and muscle stiffness, while cold compresses can reduce inflammation, swelling, and pain.
- Occupational and physical therapy can provide a safe range of motion and strengthen programs. They can teach you how to protect your joints and return to your activities of daily living.
- Drugs. Reducing pain may include the use of acetaminophen or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, and naproxen, to name a few.
- Corticosteroid joint injections may ease stiffness and pain, but relief may be temporary or long-lasting. Prednisone is a corticosteroid.
- Additional anti-rheumatic drugs that suppress an overactive immune system and may help preserve joint function include Humira, Orencia, Enbrel, Zeljanz, Rheumatrex (methotrexate), and many others.
- Antibiotics. Sometimes, large intravenous doses of antibiotics are required, as well as draining the joints of infected fluid.
Non-Medical management of RA
Cognitive-behavioral therapy (CBT) uses education and behavior modifications, along with relaxation techniques. CBT includes strategies to overcome stress and achieve relaxation, distraction techniques, imaging, problem-solving, and education in scheduling your routine.
Complementary therapies for RA
Currently, no complementary therapies have been approved by the FDA, so you need to discuss these with your rheumatologist. There is little to no evidence that they work. These include acupuncture, chiropractic, osteopathy, and massage.
- Educate yourself about your disease.
- Exercise and keep active.
- Use proper lifting and posture to protect your joints.
- Eat a healthy diet to strengthen muscles and bones. A Mediterranean diet is helpful. Olive oil can lower levels of the chemicals that cause inflammation.
- Lose weight if necessary to put less stress on your joints.
- Don’t put off treatment. The earlier you receive treatment, the less permanent joint pain, damage, and disability can occur.
- Consider supplements for arthritis. Some people find that dietary supplements complement their RA symptom management. Before incorporating supplements, it's advisable to consult with your healthcare provider.
- Arthritis Foundation. How Arthritis Hurts.
- England, B. R., & Mikuls, T. R. Epidemiology of, risk factors for, and possible causes of rheumatoid arthritis.
- WebMD. Can Food Ease RA Symptoms.