Rheumatoid arthritis: causes, symptoms, and treatment

Rheumatoid arthritis is a progressive inflammatory disease. Early symptoms include swollen, stiff joints on both sides of the body, which are especially noticeable first thing in the morning or after sitting for a while. 

Rheumatoid arthritis (RA) can be tricky to diagnose as a number of other health conditions––like lupus, psoriatic arthritis, and fibromyalgia––have similar symptoms. There is no cure for RA, but medication, physical therapy, and lifestyle changes can help alleviate symptoms and potentially slow or prevent disease progression.

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RA is a chronic autoimmune disease that affects your joints and can cause pain, swelling, and progression to loss of joint function, especially if left untreated. It’s considered a type of inflammatory arthritis. Unlike osteoarthritis, which is usually caused by everyday wear and tear, RA is a result of the immune system mistakenly attacking the body’s own joints. 

With RA, antibodies from the immune system (which normally protect the body and fight off invaders) cause joint damage by attacking cartilage, synovial fluid (fluid that keeps joints lubricated), and ligaments. The immune response RA triggers can move beyond joints, damaging other parts of the body like the skin, eyes, heart, blood vessels, and lungs. 

There are two main types of RA (Chauhan, 2021):

• Seropositive: This type refers to an RA diagnosis with positive blood tests for RF (rheumatoid factor) and/or ACPA (anti-citrullinated protein antibodies). These tests help show the levels of antibodies that may cause damage to healthy tissue in your body. One or both of the tests can be positive for a diagnosis of seropositive RA. Seropositive RA is more common than seronegative RA and tends to have more severe symptoms.

• Seronegative: This type of RA has negative blood tests for RF and ACPA, but has the same symptoms, physical exam findings, and imaging results seen in RA. It’s important to remember that seronegative RA is a diagnosis of exclusion. That means that there diseases that can mimic RA need to be ruled out by a healthcare professional before arriving at this diagnosis.

RA is a chronic disease with symptoms that can range from mild to severe. Some people can spend long periods of time in remission, while others experience regular flare-ups and disease progression. Signs and symptoms of RA include (Chauhan, 2021; Smolen, 2018):

• Painful joints and aching on both sides of the body

• Joint stiffness, especially in the morning

• Swelling or tenderness

• Loss of mobility and joint function

• Fatigue

• Low-grade fever

• Loss of appetite

• Weakness

Rheumatoid arthritis vs. osteoarthritis

Osteoarthritis (OA) is one of the most common types of arthritis. It usually develops in older adults, but can happen in younger people from joint overuse or after an injury. 

The biggest difference between OA and RA is that RA is triggered by the immune system while OA is a result of regular wear and tear on joints over time. OA and RA also tend to affect different joints. 

Furthermore, people with OA tend to feel better when they rest the affected joints and worse when they use them. On the other hand, people with RA tend to feel worse when they rest the affected joints (as seen in morning stiffness). Additional differences can be seen on X-rays.

It’s important to remember these diseases can look different in different people, and you should always speak with a healthcare professional to receive a diagnosis.

As we mentioned, RA is caused by the immune system attacking otherwise healthy tissues. While we know how RA happens, it’s not currently understood what triggers the immune system to attack its own joints. 

Risk factors that may increase your chances of developing RA include (Chauhan, 2021):

• Genetics: It’s suggested that genetics plays a role in RA. Researchers have found that certain genes (such as the HLA-DRB1 gene) increase the risk of RA. 

• Biological sex: Research shows that biological females are at higher risk for developing RA than males.

• Age: RA is more likely to occur in people over the age of 65.

• Cigarette smoking: Smoking cigarettes is strongly associated with an increased chance of developing RA.

• Obesity: Research suggests people with obesity (BMI of 30 or higher) may have an increased risk of RA

• Diet: Eating a high-calorie, low fiber diet appears to be a risk factor for RA.

RA can take time to diagnose because many other conditions have similar symptoms. There is no one test that can catch all RA diagnoses. Instead, RA is diagnosed by a combination of evaluating your symptoms, physical exam findings, and diagnostic testing. Your healthcare provider will also work to rule out other health conditions when appropriate. 

If your primary care provider suspects you have RA, they’ll likely refer you to a specialist called a rheumatologist. Rheumatologists specialize in diagnosing and treating rheumatic diseases, which are inflammatory conditions caused by autoimmune attacks. 

Here are some of the methods used to test for RA (Chauhan, 2021):

• Physical exam: A healthcare provider will perform a physical exam and assess affected joints for swelling, tenderness, range of motion, and strength. 

• Imaging: Imaging tests like MRIs, X-rays, CT scans, and ultrasounds can be used to examine the health of your bones, cartilage, and synovial fluid. 

• Blood tests: Blood tests that look for antibodies and inflammatory markers can help with the diagnosis  

The inflammation and autoimmune effects of rheumatoid arthritis can cause damage to other areas of the body. It may also increase the risk for complications like (Kim, 2020; Smolen, 2018):

• Heart disease: People with RA are more likely to develop heart and vascular diseases.

• Carpal tunnel syndrome: RA causes inflammation and damage to the wrist joints, which puts pressure on nerves in the wrist and may lead to carpal tunnel syndrome.  

• Interstitial lung disease: The swelling and inflammation caused by RA can increase swelling and lead to scarring of lung tissue.

• Sjogren’s syndrome: This autoimmune condition can be a complication of RA and causes dry eyes and mouth. 

• Lymphoma: RA increases the risk of developing lymphoma, a type of blood cancer.

RA is a chronic condition that doesn’t have a cure. However, there are effective treatment plans available that can help improve your quality of life.

Some treatment options can slow or prevent the progression of the disease, so it’s important to start them early. Additionally, treatment can help some people to reach remission or have periods of time without symptoms. 

Treatment options for RA usually include a combination of medication, physical therapy, and in more severe cases, surgery. 

Medication

There are a number of medications for RA depending on the severity of symptoms and time since diagnosis. Common medications include (Aletaha, 2018; Bullock, 2019):

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter NSAIDs, like ibuprofen, can help reduce pain and inflammation. These medications may cause side effects like stomach irritation, kidney damage, and heart problems.

• Steroids: Corticosteroids (like prednisone) reduce inflammation, joint pain, and prevent damage. These drugs are effective at providing quick relief from symptoms. However, they usually aren’t recommended long-term. Side effects of corticosteroids include bone loss, weight gain, and high blood sugar.

• Conventional disease-modifying antirheumatic drugs (DMARDs): DMARDs are used to slow the progression of RA and prevent tissue damage. Examples of conventional DMARDs include methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine. Side effects from these drugs can include rash, nausea, vomiting, not having enough white blood cells in your blood (leukopenia), and liver damage.

• Biologic DMARDs: Biologic DMARDs are newer and made using biotechnology. They target specific molecules to reduce damage caused by autoimmune diseases. Examples of biologic DMARDs used to treat RA are rituximab, abatacept, anakinra, and certolizumab. Side effects include an increased risk for infection.  

Physical therapy

Your healthcare provider may refer you to a physical therapist who can teach you exercises that can increase strength and improve your range of motion. They may recommend assistive devices like splints or other equipment like jar openers to make daily tasks easier. 

Surgery

In more severe cases of RA, surgery may be recommended to replace or repair damaged tissues. 

Joint replacement surgery removes damaged parts of the joint to help you move more easily and restore range of motion. 

Lifestyle changes are things you can do at home to care for your body and try to manage RA symptoms. Here are some easy remedies to try at home:

• Apply a hot or cold compress: Heat may ease pain in sore muscles around the joints. Icing affected joints can help reduce inflammation, swelling, and pain. Sometimes alternating between hot and cold can have beneficial effects (Bullock, 2018).

• Rheumatoid arthritis diet: An anti-inflammatory diet may help reduce inflammation and lessen symptoms (Vadell, 2020). A diet like this is high in omega-3 fatty acids, antioxidants, vitamins, minerals, and fiber. 

• Exercise regularly: Low impact exercise, like walking or water aerobics, strengthens your muscles without putting too much stress on your joints. Research suggests exercise also bolsters overall health and could help prevent chronic diseases (Ruegsegger, 2018).

• Change positions regularly: Staying in one position, like sitting or standing for a long time, can make your joints sorer. If you work at a desk, try getting up every 15 minutes for a stretch or walk around the office.

• Maintain a healthy weight: If you’re overweight or live with obesity, losing weight may help lower rheumatoid arthritis disease activity. Losing weight may also reduce pressure on joints, which could help prevent further joint damage and lower the risk for other diseases (Kreps, 2018). 

If you’re experiencing joint pain or RA-like symptoms, it’s best to talk with a healthcare professional. Even though RA doesn’t have a cure, it’s important to get treatment to help prevent further tissue damage and make everyday life more comfortable. 

Early treatment helps maintain the health of joints and increases the rate of symptom-free periods (Monti, 2015). While RA is a lifelong condition, it’s still possible for you to manage your symptoms by getting connected with the right healthcare professionals.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

March 17, 2022

Written by

Ashley Braun, RD, MPH

Fact checked by

Raagini Yedidi, MD

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About the medical reviewer

Raagini Yedidi, MD

Raagini Yedidi, MD, is an internal medicine resident and medical reviewer for Ro.