10 Essential Facts About Rheumatoid Arthritis

Everydayhealth.com: By Stacey Colino

Rheumatoid arthritis (RA) is one of more than 100 rheumatic diseases that include gout, ankylosing

spondylitis, fibromyalgia, lupus, and others. While RA has some similarities to many of these conditions, it

also has unique features of its own.

Here are 10 essential facts about RA:

1. Rheumatoid arthritis is an autoimmune disease. In RA, your immune system, which normally defends the body

from foreign substances like bacteria and viruses, attacks your joints — making it an autoimmune disease. This

causes inflammation inside and around the joints, leading to pain, swelling, and stiffness and compromising the joints’

ability to move normally.

2. Approximately 1.5 million people in the United States have rheumatoid arthritis. Besides affecting a person’s

quality of life, rheumatoid arthritis can have lasting health consequences.

3. Approximately three times as many women have rheumatoid arthritis as men. The reason for this gender gap

isn’t known, but hormones may have something to do with it. RA can start at any age (even children can get it —

cases that are often referred to as juvenile RA or juvenile idiopathic arthritis), but the most common window is

between ages 20 and 60 for women. Men can get it, too, though often later in life.

4. Rheumatoid arthritis is different from osteoarthritis. Osteoarthritis is the most common form of arthritis, but it’s

a disease involving wear and tear on specific joints, while RA affects the entire body. Unlike osteoarthritis, which

usually affects weight-bearing joints such as the knees and hips, RA more typically affects the small joints in the

hands, wrists, and feet.

Another key difference: Rheumatoid arthritis usually occurs on both sides of the body, so if the joints in one hand are

red, hot, swollen, and painful, those in the other one are, too. Unlike people with osteoarthritis, those with RA may also

experience fatigue, occasional fevers, and loss of energy, according to the National Institute of Arthritis and

Musculoskeletal and Skin Diseases.

5. The cause of RA isn’t well understood. No one knows exactly why immune function goes haywire in people with

rheumatoid arthritis, but “it’s thought to be due to a combination of a genetic predisposition and a second hit, whether

it’s some environmental exposure or an infection,” explains Eric Ruderman, MD, professor of medicine-rheumatology

at Northwestern University's Feinberg School of Medicine in Chicago. Having a family history of an autoimmune

disease such as RA, lupus, or autoimmune thyroid disease increases the risk of getting RA. Other things that play a

role include hormones, obesity, exposure to cigarette smoke, and other environmental factors.

6. Diagnosing rheumatoid arthritis isn’t simple. There isn’t a specific laboratory or imaging test that diagnoses

rheumatoid arthritis. Instead, doctors look for certain signs and symptoms during a medical exam and take a thorough

medical history. These signs and symptoms include persistent joint pain, tenderness, swelling, or stiffness; morning

stiffness that lasts at least 30 minutes; and symmetrical symptoms (for example, both ankles or hands are affected).

Blood tests to detect the presence of rheumatoid factor (an antibody) and anti-CCP antibodies are often used to

confirm an RA diagnosis, notes Olivia Ghaw, MD, assistant professor of medicine in the division of rheumatology at

the Icahn School of Medicine at Mount Sinai in New York City. Sometimes, though, the blood test results are negative

but the signs and symptoms are positive, so a diagnosis of seronegative RA is made.

7. The earlier RA is diagnosed — and often the more aggressively it’s treated — the better the prognosis. The

sooner the disease is treated, the better the chances of stopping joint damage, says Stuart Kaplan, MD, chief of

rheumatology at South Nassau Communities Hospital in Oceanside, New York. “We want to stop rheumatoid arthritis

from eating away at the joints,” because once the damage is done, it can’t be reversed.

The primary goals of treatment are to stop the inflammation, slow the damage RA causes, and decrease the rate of

progression. Thanks to newer disease-modifying anti-rheumatic drugs (DMARDs) and biologic therapies, “we can

control the disease and achieve remission — the absence of signs — in about two-thirds of people with rheumatoid

arthritis,” says Dr. Ruderman. “Early and aggressive treatment changes outcomes for people. This is not a disease

where you can wait and see if it goes away.” (Besides altering the progression of RA, these treatments reduce the risk

of developing complications such as heart disease and lymphoma.)

In addition, many people with RA can take non-steroidal anti-inflammatory drugs or corticosteroids to ease pain and

stiffness, Ruderman says.

8. Having rheumatoid arthritis can increase your risk for developing osteoarthritis and osteoporosis, or brittle

bones. Even if your RA is under control, you can end up with secondary degenerative osteoarthritis in your weight-

bearing joints, such as the knees, hips, and ankles. “The RA-induced damage to that joint disrupts the integrity of that

joint, making it more vulnerable to wear and tear,” Ruderman explains.

In addition, having RA increases a woman’s risk of developing osteoporosis, a disease in which bones become brittle

and fragile from low bone mass and bone tissue loss. The reason: “Being in an inflammatory state accelerates bone

loss and bone turnover,” Dr. Ghaw explains.

9. RA can affect your health from head to toe. Unlike in osteoarthritis, the chronically elevated inflammation that

occurs with RA can cause problems that extend well beyond the affected joints, including to your eyes, mouth, skin,

lungs, and heart. “People with rheumatoid arthritis have a one-and-a-half to two times higher risk of cardiovascular

disease, which is comparable to the risk we see with type 2 diabetes,” Ruderman notes.

What’s more, because RA disrupts immune function, people with this form of arthritis have a higher risk of developing

infections such as pneumonia, urinary tract infections, and sinus infections, Ruderman says, as well as a higher risk

of getting lymphoma and other autoimmune diseases such as Sjögren’s syndrome. Other complications include carpal

tunnel syndrome and depression.

10. Staying active can help reduce your RA pain and protect joint health. Contrary to popular belief, exercise

does not make rheumatoid arthritis worse. In fact, research has found that regular physical activity — such as

walking, swimming, and cycling — helps preserve joint mobility and maintain muscle strength, Kaplan says, which

can in turn relieve pain, improve mood, and help you manage your weight. It’s important to “keep your weight under

control,” says Kaplan says, “because excess weight puts more stress on the joints in the lower extremities.”

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