Rheumatoid Arthritis

Rheumatoid arthritis is a long-lasting autoimmune disease that mainly affects the joints. With current treatments, many people with rheumatoid arthritis can lead active, productive lives.

Overview

Rheumatoid arthritis is a chronic autoimmune disease. In rheumatoid arthritis, the immune system, which normally protects the body from infection, attacks its own tissues instead. This causes pain, swelling, stiffness, and loss of function in the joints.

Rheumatoid arthritis most often affects the joints in the wrists, hands, and feet. It frequently occurs in a symmetrical pattern, meaning if one hand is affected, the other hand is often affected too.

Rheumatoid arthritis can also cause problems outside the joints, including in the heart, lungs, blood, nerves, eyes, and skin. Current treatments help many people with rheumatoid arthritis lead productive lives.

Signs and Symptoms

Rheumatoid arthritis can have differing effects in different people. Common symptoms include:

  • Joint pain at rest and when moving, along with tenderness, swelling, and warmth
  • Joint stiffness that lasts longer than 30 minutes, especially after waking up or resting for a long time
  • Joint swelling that may make daily tasks harder — such as making a fist, combing hair, buttoning clothes, or bending the knees
  • Fatigue, or feeling unusually tired or having low energy
  • Occasional low-grade fever
  • Loss of appetite

At times, symptoms can suddenly get worse. This is called a "flare." Flares can be triggered by  stress, cigarette smoke, viral infections, too much activity, or suddenly stopping medicines. Sometimes a flare happens for no clear reason.

Rheumatoid arthritis often starts with mild symptoms, affecting only a few joints. Without treatment, or if treatments are not working, rheumatoid arthritis can worsen and spread to more joints. This can lead to greater damage and disability.

Rheumatoid arthritis can also affect other parts of the body beyond the joints, including:

  • Rheumatoid nodules, which are firm lumps just below the skin, typically on the hands and elbows.
  • Anemia due to low red blood cell counts
  • Neck pain
  • Dry eyes and mouth
  • Inflammation of the blood vessels, lung tissue, airways, the lining of the lungs, or the sac around the heart
  • Lung disease, marked by scarring and inflammation of the lungs, which can be severe in some people with rheumatoid arthritis
  • Osteoporosis, especially in people who take corticosteroids: Osteoporosis is a bone disease that causes bones to weaken and break easily.

Causes and Risk Factors

Researchers do not know exactly what causes the immune system to attack the body’s own joints and tissues. Studies show that a combination of factors may lead to rheumatoid arthritis. Possible causes include:

  • Genes: Certain genes that affect how the immune system works may lead to rheumatoid arthritis. But genes alone don’t determine who gets rheumatoid arthritis – many people with these genes never develop the disease.
  • Environment: Factors such as cigarette smoke, inhalants, bacteria, viruses, gum disease, and lung disease may trigger rheumatoid arthritis in people who already have with certain genes.
  • Sex hormones: Researchers think sex hormones may also play a role, especially alongside genetic and environmental factors. Some women find their symptoms improve during pregnancy and worsen afterward.
  • Gut bacteria: An imbalance of bacteria in the body, particularly an expansion of a gut bacteria called Prevotella copri, may be associated with new-onset rheumatoid arthritis. Bacteria in the mouth may also contribute to this autoimmune process.

Risk Factors

You are more likely to develop rheumatoid arthritis if you have certain risk factors:

  • Older age: The risk of rheumatoid arthritis increases with age, although it can happen at any age. Children and younger teenagers may instead be diagnosed with juvenile idiopathic arthritis, a condition related to rheumatoid arthritis.
  • Female sex: Rheumatoid arthritis is more common in women than in men. About two to three times as many women as men have the disease.
  • Family history and genetics: If a family member has rheumatoid arthritis, you may be more likely to develop it. Several genetic factors slightly increase the risk.
  • Smoking: People who smoke over a long period of time have an increased risk of developing rheumatoid arthritis. For people who continue to smoke, the disease may be more severe.
  • Obesity: Having obesity may increase the risk of rheumatoid arthritis and may limit how much the disease can be improved.
  • Gum disease (periodontitis): Gum disease may increase the risk of developing rheumatoid arthritis.
  • Lung diseases: Diseases of the lungs and airways increase the risk of developing rheumatoid arthritis.

Diagnosis

Diagnosing rheumatoid arthritis can be difficult, especially in the early stages. The disease develops slowly over time.

There is no single test for rheumatoid arthritis. Doctors use several tools to diagnose rheumatoid arthritis and rule out other conditions.

Medical History

Your doctor will want to know:

  • Your symptoms, when they started, and how they have changed
  • Any limits on your daily activities, such as difficulty with work or household tasks
  • Your other medical problems
  • Whether any family members have similar symptoms or rheumatoid arthritis
  • What medicines you take

Physical Exam

A physical exam may include:

  • Examining your joints
  • Watching how you walk, bend, and carry out daily activities
  • Looking for a rash or nodules on your skin
  • Listening to your chest for signs of lung inflammation

Laboratory Tests

Common blood tests include:

  • Rheumatoid factor (RF) checks for an antibody that many people with rheumatoid arthritis have in their blood. Not everyone with rheumatoid arthritis tests positive. Some people may test positive without having rheumatoid arthritis.
  • Anti-cyclic citrullinated peptide antibody (anti-CCP) checks for antibodies that appear in many people with rheumatoid arthritis. This test can help diagnose rheumatoid arthritis early because anti-CCP can appear before symptoms develop.
  • Complete blood count measures different blood cell counts and can help diagnose anemia, which is common in rheumatoid arthritis.
  • Erythrocyte sedimentation rate (sed rate) measures inflammation in the body and monitors disease activity and response to treatment.
  • C-reactive protein is another test for inflammation that helps diagnose rheumatoid arthritis and monitor disease activity.
  • Other blood tests may check kidney function, liver function, thyroid function, and other markers to evaluate overall health and rule out other conditions.

It is important to know that some people have rheumatoid arthritis even with normal blood test results.

Imaging Tests

To check for joint damage, doctors may:

Treatment and Management

Rheumatoid arthritis may start causing joint damage during the first one to two years of the disease. Once joint damage occurs, it generally cannot be reversed, so early diagnosis and treatment are very important.

The overall goals of treatment are to:

  • Relieve pain
  • Reduce inflammation and swelling
  • Prevent, slow, or stop joint and organ damage
  • Improve your ability to take part in daily activities

Treatment of rheumatoid arthritis continues to improve, helping many people  find symptom relief and better quality of life. Doctors may use a combination of the following options:

  • Medicines
  • Physical therapy and occupational therapy
  • Surgery
  • Routine monitoring and ongoing care

Medicines

Most people with rheumatoid arthritis take medicines. Studies show that early treatment with combinations of medicines may be more effective than one medicine alone. Medicines may include:

  • Anti-inflammatory medicines to relieve pain and lower inflammation.
  • Corticosteroids to decrease inflammation, ease pain, and slow joint damage. Doctors prescribe the lowest dose possible because these are potent drugs with potential side effects.
  • Disease-modifying antirheumatic drugs (DMARDs) to help slow or change progression of the disease. 
    • Biologic response modifiers target specific immune messages to reduce or stop inflammation. These may be considered if the disease does not respond to initial therapies.
    • Janus kinase (JAK) inhibitors work inside cells to stop inflammation. These may also be considered if the disease does not respond to initial therapies.

Physical Therapy and Occupational Therapy

Physical therapy can help you regain and maintain overall strength and target specific joints. Occupational therapy can help you develop and maintain the skills needed for daily living and working. Assistive devices or braces may also help reduce pain and help you keep working.

Surgery

Your doctor may recommend surgery if you have permanent damage or pain that limits your daily activities. Types of surgery may include joint repairs and joint replacements. You and your doctor can discuss the options and decide what is right for you.

Routine Monitoring and Ongoing Care

Regular medical care is important so your doctor can:

  • Monitor how the disease is progressing.
  • Determine how well medicines are working.
  • Discuss any side effects from medicines.
  • Adjust your treatment as needed.

Monitoring may include regular doctor visits, blood and urine tests, and X-rays or other imaging tests. Many medicines used to treat rheumatoid arthritis may increase the risk of infection, so doctors may monitor for infections and recommend vaccines to lower that risk.

Living With Rheumatoid Arthritis

Research shows that people who take part in their own care report less pain, make fewer doctor visits, and enjoy a better quality of life.

Self-Care Strategies

You can take an active role in managing your rheumatoid arthritis by:

  • Learning about rheumatoid arthritis and its treatments
  • Using exercises and relaxation techniques to reduce pain and stay active
  • Communicating well with your healthcare team
  • Reaching out for support to help cope with the physical, emotional, and mental effects of rheumatoid arthritis

Rest and Exercise

Balance rest and exercise — more rest when rheumatoid arthritis is active, more exercise when it is not. Rest helps decrease active joint inflammation, pain, and fatigue. Short rest breaks are generally more helpful than long periods in bed.

Exercise helps maintain healthy and strong muscles. It also helps to preserve joint mobility and flexibility. Exercise can also improve sleep, reduce pain, support a positive attitude, and help maintain a healthy weight. Doctors may recommend low-impact exercises, such as water exercise programs. Talk to your healthcare providers before starting any exercise program.

Joint Care

Ways to protect your joints include:

  • Wearing a splint for a short time around a painful joint to reduce pain and swelling
  • Using self-help devices, such as items with a large grip, zipper pullers, or long-handled shoehorns
  • Using tools that help with daily activities, such as an adaptive toothbrush or silverware
  • Choosing activities that put less stress on your joints
  • Maintaining a healthy weight to lower stress on your joints

Monitoring Symptoms

Monitor your symptoms for any changes or new developments. Understanding how your symptoms change can help you and your doctor manage pain during a flare.

Stress Management

Rheumatoid arthritis can increase stress levels through fear, anger, frustration, pain, and the unpredictable nature of flares. Ways to cope with stress include:

  • Regular rest periods
  • Relaxation techniques such as deep breathing, meditating, or listening to quiet music
  • Movement programs such as yoga and tai chi

Mental Health

Living with rheumatoid arthritis can be hard and isolating. If you feel alone, anxious, or depressed, talk to your doctor, an rheumatoid arthritis support social worker, or a mental health professional. Talk to family and friends about your diagnosis to help them understand the disease. You may also find it helpful to join an online or community support group.

Healthy Diet

A healthy diet that includes a balance of calories, protein, and calcium is important for overall health. Talk to your doctor about drinking alcohol, as it may interact with rheumatoid arthritis medicines. Before making any changes to your diet or activity level, talk to your doctor.

Find Clinical Trials

 Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on rheumatoid arthritis.

Find Treatment

Diagnosing and treating rheumatoid arthritis requires a team effort involving you and several types of healthcare professionals. These may include:

  • Rheumatologists, who specialize in autoimmune diseases, arthritis, and other diseases of the bones, joints, and muscles
  • Physician assistants, who help doctors diagnose, treat, and monitor diseases
  • Primary care providers, such as internists or nurse practitioners, who specialize in diagnosing and treating adults
  • Orthopedists, who specialize in the treatment of and surgery for bone and joint diseases or injuries
  • Other medical specialty doctors, such as pulmonologists or cardiologists, for people whose rheumatoid arthritis affects other organs such as the lungs or heart
  • Podiatrists, who specialize in the treatment of and surgery for problems in the feet
  • Physical therapists, who help improve joint function
  • Occupational therapists, who teach ways to protect joints, minimize pain, perform daily activities, and conserve energy
  • Pharmacists, who dispense medicines and help check dosing and potential interactions with other medicines
  • Dietitians, who teach ways to eat a healthy diet and maintain a healthy weight
  • Nurse educators, who help people understand their condition and set up treatment plans

  • Mental health professionals and social workers, who help people cope with difficulties at home and work that may result from their condition

     

  • Rheumatologists, who specialize in autoimmune diseases, arthritis, and other diseases of the bones, joints, and muscles
  • Primary care providers, such as internists or nurse practitioners, who specialize in diagnosing and treating adults
  • Orthopedists, who specialize in the treatment of and surgery for bone and joint diseases or injuries
  • Physical therapists, who help improve joint function
  • Occupational therapists, who teach ways to protect joints, minimize pain, perform daily activities, and conserve energy
  • Dietitians, who teach ways to eat a healthy diet and maintain a healthy weight
  • Mental health professionals and social workers, who help people cope with difficulties at home and work that may result from their condition
  • Other medical specialty doctors, such as pulmonologists or cardiologists (for people whose rheumatoid arthritis affects other organs such as the lungs or heart) and podiatrists (who specialize in the treatment of and surgery for problems in the feet)

Community Support

The following organizations offer information and support for people with rheumatoid arthritis:

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

Research has greatly increased our understanding of the immune system, genetics, and biology as they relate to rheumatoid arthritis.

Genetics

Scientists have learned that dozens of genes determine whether a person develops rheumatoid arthritis and how severe the disease will become. NIH-supported researchers have identified several of these genetic factors and are studying them to help find to new treatment approaches.

Gut Bacteria and Rheumatoid Arthritis

Researchers are investigating the connection between rheumatoid arthritis and the microbiome — the microorganisms that live in the human body. One study found that a specific type of gut bacteria was more common in people newly diagnosed with rheumatoid arthritis. Another study found that bacteria in the mouth may contribute to the disease process, suggesting that good dental hygiene is important.

Studies by NIH-supported researchers strongly suggest that the immune system’s response to a newly-discovered species of gut bacteria may trigger rheumatoid arthritis in some people, possibly because the bacteria and joint tissue share a similar structure that confuses the immune system

The Disease Process

NIH researchers are studying the natural history of rheumatoid arthritis in children and adults to understand how the disease progresses and affects symptoms and daily function.

NIH-funded researchers have found that joint inflammation can continue in rheumatoid arthritis even after clinical symptoms have eased. This finding may help doctors determine when a person is truly in remission and can safely stop treatment.

New Therapies

There is still no cure for rheumatoid arthritis. Researchers continue to look for genes and molecules that could become targets for new treatments. Several new medicines for rheumatoid arthritis have emerged over the past decades that substantially reduce symptoms and joint damage. However, over time, medicines may stop working for some people, creating a need for new advanced therapies.

The Accelerating Medicines Partnership

NIH's Accelerating Medicines Partnership® Autoimmune and Immune-Mediated Diseases (AMP® AIM) program is a public-private partnership. It aims to understand the cellular interactions and biological pathways that cause inflammation and disease in autoimmune conditions such as rheumatoid arthritis.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.