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Rheumatoid Arthritis (RA)

About Rheumatoid Arthritis (RA)

In this section, you or a loved one can find out more about medical treatments and practical information about rheumatoid arthritis (RA). Read on to find answers to some of your questions as well as links to other information. Being informed is an important first step toward becoming an active decision-maker in your care plan.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a long-term disease that causes inflammation of the membranes (synovium) that hold together and protect your joints. As RA develops, this inflammation causes swelling, pain and stiffness of the joints and eventually may damage the cartilage and bones of your joints. RA may also affect other body organs and tissues.

RA is one of the most common types of arthritis worldwide. As with many other types of arthritis, RA is chronic, which means once RA starts, it is likely to continue for the rest of your life. 

What Causes Rheumatoid Arthritis?

It is not known exactly what causes RA but it is thought to result from a combination of genetics and environment that tell your body's immune system  to attack your joints , almost as if they were a foreign bacteria or virus to be destroyed. It's more common in some families than others, in women than in men, and it begins most often between the ages of 35 and 55.

What Are the Effects of Rheumatoid Arthritis?

Joints that are inflamed due to RA may become red, swollen and painful, and feel hot or warm to the touch. The joints also get stiff, especially in the first few hours after waking up.

If left untreated, RA symptoms tend to be constant, though may get better or worse at times, and can appear differently in each person. People with RA may suffer from very painful episodes, called flares , followed by periods when symptoms are less.

Symptoms can vary: pain can be mild or extreme, periods of stiffness  can be short or very long, and the time between flares can range from weeks to years.

If RA inflammation is left untreated, it can eventually lead to permanent joint damage, abnormal appearance of joints and severe stiffness that make daily activities difficult. Fortunately, there are many ways to treat RA and prevent damage before it happens.

Which Body Parts Are Affected by Rheumatoid Arthritis?

RA tends to affect smaller joints first, like the U in your hands, wrists or feet. It's common for these joints to feel stiff in the morning, which can last for several hours.

One important sign that joint inflammation may be caused by RA is that the joints are affected in a symmetrical way, meaning the same joints on both sides of the body are affected (for example, both wrists and/or both thumbs).

Joints commonly affected by RA:

  • Knuckles
  • Wrists
  • Elbows
  • Shoulders
  • Feet (especially the "balls " of the feet)
  • Ankles
  • Knees
  • Hips

In some cases, RA may also affect the eyes, skin and linings around the heart and lungs.

Are There Other Symptoms of Rheumatoid Arthritis?

The inflammation from RA sometimes also causes more generalized symptoms in the body (not just joints) such as:

  • Feeling extremely tired
  • Feeling generally ill
  • Having a low fever
  • Losing your appetite
  • Losing weight without trying
Lifestyle Options

For most people, regardless of having rheumatoid arthritis (RA) or not, moderate low-impact exercise, healthy eating and good sleep habits are recommended. A healthy lifestyle can lead to enhanced quality of life for most people. Talk to your doctor before making any lifestyle changes.

Exercise doesn't make stiff and painful joints feel worse. In fact, a bit of moderate exercise may help to relieve joint symptoms. Physical activity strengthens muscles and tissues, which helps to support weakened or damaged joints.

Imagine the extra strain it would put on your joints to carry around a heavy backpack and suitcases all day long. Extra body weight can have the same damaging effect on your joints, especially the hips, knees, ankles and feet.

If you have rheumatoid arthritis (RA), maintaining a healthy weight is the main reason to watch what you eat. Losing just a few pounds can mean big stress relief on your hips, knees and other joints. Choose nutrient-packed foods for optimal health and energy.

Protect your joints from damage by making a few changes to daily activities:

  • Protect your knuckles: use gadgets to twist open lids, enlarge the grip on tools and kitchen utensils (or buy ones with easier grips), and push doors open using your body instead of just your fingers
  • Lift big pans and other heavy objects with two hands, with your palms facing upward, and carry them close to your body
  • Use a tool or gadget to pick up items from the ground, or a cane to decrease pressure on a knee or hip
  • Use a computer wisely: make sure your neck, wrists and lower back are in relaxed and neutral positions. Take a break and stand up every half hour or so
  • Balance periods of activity and rest: neither sitting nor standing all day is good for you
  • Pick a raised seat to decrease stress on hip and knee joints
One of the symptoms of rheumatoid arthritis (RA) is extreme tiredness. Dealing with pain can be exhausting. However, it's still important to keep up some level of activity and movement. Prevent strain by alternating between demanding activities and easier ones. The key is to rest and take breaks, and listen to what your body is telling you.
Stress can lead to an increase in blood pressure, interrupt sleep and worsen RA symptoms. The first step to handling stress is identifying stress triggers. The next step is developing relaxation and coping skills to improve your overall well-being and give you a greater sense of control over your RA.
Other Therapeutic Options

Complementary therapies are not part of conventional (Western) medicine. For some people with rheumatoid arthritis (RA), complementary therapies can sometimes help with pain relief. Ask your healthcare professional about different therapeutic options.

Alternative therapies are usually defined as therapies that replace conventional medical care. Some people with RA add alternative therapies (also known as natural relief therapies) to their medical treatment. Examples of alternative therapy include acupuncture, Swedish or classic massage therapy, vitamin, mineral or herbal supplementation and biofeedback (with or without hypnosis). Always discuss these treatment options with your physician first, and be sure to tell any alternative health specialist about your condition in order to avoid injury.

Heat or cold can help reduce rheumatoid arthritis (RA) pain. Below is a general guide as to when you should choose one over the other, and when it's best to avoid heat/cold.

  • Heat: Stiff joints can benefit from a bit of heat, especially first thing in the morning. Take a warm shower or hot bath, or apply warm compresses to help relax the muscles and relieve joint stiffness and pain. However, heat should never be applied directly to already warm or inflamed joints to avoid making symptoms worse.
  • Cold: Applying a cold compress (or a plastic bag of ice cubes wrapped in a towel) to hot and inflamed joints for about 15 minutes can help constrict blood flow and decrease pain and swelling. Cold can make a joint feel stiffer so be mindful of how long the cold compress is applied.
You and your doctor may consider surgery if medical therapies are not working well enough for you. The decision usually depends on the amount of pain and disability in the affected joint. Surgery can sometimes improve the appearance and function of deformed joints. Doctors may perform surgery to get a closer look at the damaged joint to better understand treatment options.
Medications

Medications for rheumatoid arthritis (RA) are divided into two general categories:

  • Those that relieve symptoms and inflammation.
  • Those that relieve symptoms and modify the progression of the disease.

Your doctor can explain the differences, benefits and side effects of each. You will likely try different therapies and combinations of therapies before finding the best option.

Please be sure to consult with your physician.

There are four types of medication used to treat rheumatoid arthritis (RA):

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of medications that can be used to treat the pain and inflammation of RA. NSAIDs do not control the disease; they only treat symptoms. Therefore, they can be taken daily or on an as-needed basis.

Your doctor may recommend taking an NSAID to reduce joint swelling and relieve pain, tenderness, and stiffness. You may start to experience benefits within a few weeks of starting NSAID treatment.

There are many NSAIDs available, including prescription and on-prescription types. All NSAIDs have an anti-inflammatory effect, but it is difficult to predict which one works best for each person, so you may have to try more than one type. 

The body naturally produces steroids like cortisone to regulate inflammation. Physicians use corticosteroids as fast-acting medications for particularly severe and painful symptoms of RA. Corticosteroids provide the same type of relief as NSAIDs, but are stronger, and are not meant for long-term use. Corticosteroids can have severe side effects, so they are usually taken for limited periods of time, or are used to provide relief while waiting for slower-acting medications to take effect.

Corticosteroids can be injected directly into a joint or taken orally. Some of the side effects of oral corticosteroids include facial rounding, fluid retention, fatty deposits in arms, legs or back, increased appetite, weight gain, difficulty sleeping, acne, hair growth, blurry vision, increased blood pressure, increased blood sugar levels, and mood swings. As the dosage of corticosteroids is decreased or stopped, these side effects disappear. 

Disease-modifying anti-rheumatic drugs (DMARDs) are prescription medications that relieve RA symptoms and limit joint damage. DMARDs do not reverse joint damage that has already happened; however, early treatment with DMARDs can prevent joint damage and can slow or even stop the progression of RA. When you take DMARDs, it can take time before there is a noticeable difference in pain and joint swelling. During this time, you might be prescribed an additional medication, like a steroid or NSAID, to help control symptoms.

DMARDs are meant for the long-term management of RA and may be taken for months or years in order to keep RA under control.

Common side effects of DMARDs include nausea, diarrhea, upset stomach, dizziness, sores in the mouth, fatigue, increased risk of infection and liver problems. Regular blood work is needed to monitor blood cell counts and liver function. Tell your doctor right away if you think you may have an infection.

Biologic response modifiers, or biologics for short, are medications specifically designed to target your body's immune system. Like DMARDs, biologics are used to slow the progression of rheumatoid arthritis (RA), help prevent damage to the joints and ease joint swelling, tenderness and pain.

Biologics can take some time to work. Some people notice the effects of biologics quickly (within a week), while it takes other people longer to feel the effects. Biologics are often combined with other medications, such as DMARDs, to treat RA. They are most often prescribed when other RA therapies aren't working.

Biologics are injected under the skin or into a vein, so a common side effect with biologics is mild skin reactions or discomfort at the injection site. Other potential side effects of biologics are nausea, abdominal pain, and headaches. Rarely, people who take biologics may develop serious infection, lupus-like reactions, nervous system diseases, and cancer. You should not take a biologic if you are pregnant or nursing, or have a history of multiple sclerosis or cancer. Tell your doctor if you have a history of tuberculosis, hepatitis B , or recurrent infections.

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