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(RA; Arthritis, Rheumatoid)
Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints.
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RA is caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes include:
- Genes—People with rheumatoid arthritis may have a specific genetic defect that increases their risk for developing this condition.
- Defects in the immune system may cause the immune cells to fail to recognize the body’s own tissues.
- Infection with specific viruses or bacteria that kick off an abnormal immune response.
- Chemical or hormonal imbalances in the body.
RA is more common in women, and in people between the ages of 30 and 60. Other factors that may increase your chance of developing RA include:
- Family members with RA
- Excess weight or obesity
Heavy or long-term
RA causes many symptoms.
Joint symptoms include:
- Increased pain and stiffness in the morning and after inactivity
- Morning stiffness and pain that lasts more than 30 minutes
- Red, swollen, warm joints
- Deformed, misshapen joints
RA may also cause:
- Intense fatigue, decreased energy
- Muscle aches
- Decreased appetite
- Weight loss
- Fever and sweats
- Small lumps or nodules under the skin
Conditions associated with RA include:
- Sjogren's syndrome
—an inflammatory condition involving the tear and salivary glands
- Felty syndrome—three conditions marked by rheumatoid arthritis, enlarged spleen, and low levels of white blood cells
- Caplan syndrome—marked by rheumatoid arthritis and pneumoconiosis (lung disease in people exposed to coal mining dust or asbestos)
- Raynaud's disease and phenomenon
- Muscle inflammation
- Muscle weakness
- Kidney disease
The doctor will ask about your symptoms and medical history. A physical exam will be done. To be diagnosed with RA, you must have at least one swollen or tender joint or a history of a swollen joint. How many joints, and which joints are involved, will help aid your doctor in the diagnosis. The doctor will also rule out other conditions that may have similar symptoms.
Tests may include:
- Blood tests to determine if you have an autoimmune disease
Imaging tests, such as
, or an
There is no cure for RA. The goals of treatment are to:
- Relieve pain
- Reduce inflammation
- Slow down joint damage
- Improve functional ability
There are a variety of medications to treat the pain and inflammation of RA. In some cases, medications may be used in combination. These may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Cyclooxgenase-2 or COX-2 inhibitors
- Nonbiologic disease-modifying antirheumatic drugs (DMARDs)
- Biologic disease-modifying antirheumatic drugs
Medication may be taken by mouth, applied to the skin, or injected into the joint.
Rest and Exercise
Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility.
These steps may help relieve stiffness, weakness, and reduce inflammation:
- Maintain a balance between rest and exercise
- Attempt mild strength training
- Participate in aerobic exercise, such as, walking, swimming, or dancing
- Avoid heavy-impact exercise
- Control weight
- Participate in a physical therapy program
Splints applied to painful joints may reduce pain. Devices that help with daily activities can also reduce stress on joints. Devices include:
- Zipper extenders
- Long-handled shoehorns
- Specially designed kitchen tools
can ease the difficulties of living with a chronic, painful disease. Participating in an exercise program or joining a
are two strategies you can use to reduce stress.
Cognitive behavioral therapy
, a form of talk therapy, and
may also offer benefits in reducing your pain and improving your ability to cope with RA.
Joint replacement and tendon reconstruction help relieve severe joint damage.
There are no current guidelines to prevent RA.
American College of Rheumatology http://www.rheumatology.org
Arthritis Foundation http://www.arthritis.org
Canadian Orthopaedic Association http://www.coa-aco.org
Canadian Rheumatology Association http://rheum.ca
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http://www.arthritis.org/conditions-treatments/disease-center/rheumatoid-arthritis. Accessed August 21, 2013.
National Institute of Arthritis and Musculoskeletal and Skin Diseases
website. Available at:
http://www.niams.nih.gov/Health%5FInfo/Rheumatic%5FDisease/default.asp. Updated April 2009. Accessed August 21, 2013.
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Who gets RA? Arthritis Foundation website. Available at:
http://www.arthritistoday.org/about-arthritis/types-of-arthritis/rheumatoid-arthritis/who-gets-ra-and-why/who-gets-ra/how-do-you-get-ra.php. Accessed August 21, 2013.
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Arthritis Rheum. 2005;53:864-871.
Verstappen SM, Bijlsma JW, et al. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys.
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4/16/2009 DynaMed's Systematic Literature Surveillance
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1/4/2011 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Anis A, Zhang W, Emery P, et al. The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study.
1/4/2011 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Aletaha D, Neogi T, Silman AJ, Funovits J, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.
Ann Rheum Dis.
4/24/2014 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed April 24, 2014.