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Rheumatoid arthritis (RA) is an inflammatory chronic condition in which the body’s immune system attacks the joints, resulting in pain, swelling, and deformity. There is no cure for RA.
What is rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease in which the immune system mistakenly attacks the joints in the same way that the immune system normally would fight viruses or bacteria. In other words, the damage in RA is caused by the body’s immune system attacking the joints, most commonly those of the hands, feet, wrists, elbows, ankles, and knees. With RA, damage is typically symmetrical – when a joint is impacted, it tends to be on both sides of the body. For instance, both knees or both ankles are usually affected.
What causes rheumatoid arthritis?
The cause of RA is unknown, although it likely involves both hereditary and environmental factors. Environmental factors such as smoking and obesity increase the risk of developing RA. Read more about causes of RA.
The history of rheumatoid arthritis
People have had rheumatoid arthritis since the early days of recorded history. As early as 1,500 B.C.E., a disease similar to RA was described in the Ebers Papyrus, an ancient Egyptian scroll documenting knowledge of medical herbs. RA has been discovered in Egyptian mummies, discussed in Indian literature dating as far back as 300 B.C.E., and identified in the subjects of early paintings. The term rheumatismus, meaning “to suffer from a flux,” was mentioned by famed Greek physician Galen sometime in the second century of the common era. In the western world, bloodletting and leeches were popular treatments for RA. In the East, acupuncture was used. At least two ancient treatments – gold compounds and willow bark (which contains the active compound in Aspirin) – are effective and continue to be used today.
In 1819, English surgeon Sir Benjamin Collins Brodie described how RA affects the joints and tendons as well as the progressive nature of the disease. The term rheumatoid arthritis was first mentioned by Archibald Garrod in Treatise on Rheumatism and Rheumatoid Arthritis written in 1890.
Early in the 20th century, RA was believed to be caused by an infection. Gold compounds and sulfa drugs were the mainstays of treatment during this period. Acetylsalicylic acid was isolated from willow bark and marketed as Aspirin in the early 1900s, followed later in the century by other non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen. Disease-modifying treatments came into use in 1938, when sulfasalazine was formulated to treat RA. Methotrexate and corticosteroids became common treatments for RA in the 1980s. Other 20th century breakthroughs include research proving that RA is an autoimmune disease and the identification of a genetic component. Anti-tumor necrosis factor drugs (or anti-TNFs), also known as biologics, first became available in the 1990s, and new biologics continue to be created.
How common is rheumatoid arthritis?
In the U.S., roughly 1.5 million people are thought to have RA. Rheumatoid arthritis affects women about three times as often as men and typically develops between the ages of 30 to 60.
What are symptoms of rheumatoid arthritis?
Rheumatoid arthritis affects each person a little differently. Symptoms depend on the stage of the condition and can appear or disappear at any time. Symptoms generally focus on the joints and tend to occur symmetrically, on both sides of the body. Symptoms worsen during disease exacerbations (also called flares) and may subside during periods of remission.
The most common symptoms of RA include swollen, stiff, painful joints, joint damage, and limited mobility. Fatigue and inflammation in other parts of the body, especially the eyes, mouth, and lungs, are also typical in cases of RA. Many people with RA experience weight loss and depression, which is common in all chronic illnesses. Read more about rheumatoid arthritis symptoms.
Types of rheumatoid arthritis
As part of the evaluation for RA, a blood test may be taken that can determine whether you test positive for anti-cyclic citrullinated peptide (anti-CCP). Around 60 to 70 percent of people diagnosed with RA test positive for anti-CCP. Presence of anti-CCP leads to a classification of seropositive RA. A negative result leads to a diagnosis of seronegative RA, which is often a milder form of the disease. When children are diagnosed with RA, it is called juvenile RA or juvenile idiopathic arthritis. Juvenile RA may or may not disappear as the child grows up.
Read more about types of RA.
How is rheumatoid arthritis is treated?
Rheumatoid arthritis treatments are typically aimed at modulating the immune system to calm inflammation, reduce autoimmune attacks on the joints, and ease symptoms such as pain and swelling. Some RA treatments are taken orally, while others are administered by injection. Mild pain and swelling may be relieved with over-the-counter treatments such as Ibuprofen or Aspirin. There are many classes of disease-modifying treatments (DMTs) prescribed for RA that can effectively reduce disease activity and prevent damage. Surgery can be used to reconstruct joints and restore function when RA has caused severe damage. Some people with rheumatoid arthritis feel better when they change their diet or try complementary or alternative therapies such as acupuncture or acupressure. Read more about rheumatoid arthritis treatments.
What is the prognosis for rheumatoid arthritis?
There is no cure for RA. While symptoms may appear during disease flares and subside during remission periods, RA itself does not go away. However, there are effective treatments to manage many of the symptoms of rheumatoid arthritis and to help slow progression.
Rheumatoid arthritis itself is not considered a fatal disease. However, severe RA can cause respiratory or cardiovascular complications that raise the risk of death. People living with RA also have a higher risk for developing diabetes, which can lower life expectancy.
Triggers for rheumatoid arthritis flares
Rheumatoid arthritis symptoms can come and go with flares. Common triggers for flares include stress, overexertion, infection, and lack of sleep.
Rheumatoid arthritis diet
No single diet has been proven by clinical studies to improve symptoms in everyone with RA. However, eating a healthy diet can help people with RA achieve and maintain a healthy weight, lower the risk of heart disease, and fight inflammation. Read more about diet recommendations and other rheumatoid arthritis treatments.
What is the difference between rheumatoid arthritis and osteoarthritis?
Both osteoarthritis and RA are conditions that affect the joints. Unlike RA, osteoarthritis is not an inflammatory disease. Rather, it is caused by the breakdown of the cartilage with age or heavy usage. This breakdown exposes the bones of the joints and causes pain, stiffness, and a decrease in mobility. It is typically found in the hips, hands, knees, neck, and lower back. Read more about osteoarthritis and rheumatoid arthritis.
What does rheumatoid arthritis look like?
Rheumatoid arthritis can show up as swollen or disfigured joints, such as toes that curl up (clawed toes) or twist and overlap with one another, or fingers that twist and point outward.
Who treats rheumatoid arthritis?
Rheumatoid arthritis is commonly diagnosed and treated by a rheumatologist. RA can also be treated by an internal medicine specialist.