Rheumatoid arthritis (RA) is a chronic and systemic autoimmune condition that causes painful joint inflammation. The swelling occurs when the body’s immune system mistakenly targets the synovium, a flexible connective tissue that lines articulated joints, such as the wrists and knees. For unknown reasons, the immune system perceives healthy synovial cells as harmful invaders—much like viruses and bacteria—and releases inflammatory chemicals to attack and destroy them. In addition to eroding the synovium and damaging joints throughout the body, the resulting inflammation can potentially affect other areas of the body such as the lungs, heart, blood vessels, eyes, salivary glands, and bone marrow.

RA is one of more than 100 different types of arthritis. The most common is osteoarthritis, which results from mechanical wear and tear on the joints and is often associated with age-related degeneration. Although RA and osteoarthritis share some characteristics, such as joint pain and swelling, the conditions are treated differently. Therefore, the key to effective treatment is an early and accurate diagnosis.

What Does Rheumatoid Arthritis Feel Like?

Common symptoms of RA include:

• Persistent pain, tenderness, warmth, and swelling in more than one joint
• Pain and stiffness in the same joints on both sides of the body
• Joint stiffness that worsens with rest and inactivity
• Overwhelming fatigue and weakness
• Nonspecific flu-like symptoms, such as general malaise and low-grade fever
• Loss of appetite
• Anemia

Early-stage rheumatoid arthritis tends to affect small joints on both sides of the body, such as those that attach the fingers to the hands and the toes to the feet. As the inflammation progresses, the symptoms may begin to affect larger joints in the wrists, elbows, shoulders, ankles, knees, and hips.

Rheumatoid arthritis symptoms can vary widely in severity. Even if the symptoms are mild, however, it is important to seek medical attention. RA is progressive and advances rapidly at onset, and the resulting joint damage usually occurs within the first two years after a diagnosis. Therefore, there is a distinct “window of opportunity” for treatment.

What Can Trigger Rheumatoid Arthritis?

RA symptoms often come and go. There are two main types of flare-ups:

• Predictable – The symptoms temporarily worsen in response to a known trigger, such as stress, overexertion, insufficient rest, or infection. With time and self-care measures, such as rest and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), the symptoms usually improve or resolve.
• Unpredictable – The symptoms develop for unknown reasons and may progressively worsen.

At What Age Does Rheumatoid Arthritis Start?

While RA can occur at any age, it frequently develops between ages 30 and 60. It is interesting to note that women are almost three times more likely to develop Rheumatoid Arthritis than men.

How Is Rheumatoid Arthritis Diagnosed?

If RA is suspected, the diagnostic process typically begins with a medical history review and physical examination. Although symmetrical joint swelling is a hallmark sign of rheumatoid arthritis, the symmetry may not be apparent in the early stages of the disease when only a few joints are affected. The joints will be evaluated for swelling, warmth, and redness.  By gently touching the swollen joints, the physician may be able to distinguish the “spongy” inflammation that is characteristic of RA from the bony enlargement that is characteristic of osteoarthritis.

Next, the physician may order blood work to look for inflammation markers and measure the levels of certain antibodies in the blood, such as:

• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP)
• Rheumatoid factor (Rf)
• Anti-cyclic citrullinated peptide (CCP)

To check for joint damage caused by rheumatoid arthritis, the physician may also order imaging tests, such as X-rays, ultrasound scans, and magnetic resonance imaging (MRI) scans. The resulting images may reveal bone erosion, which is characteristic of RA, or a loss of cartilage and an asymmetrical narrowing of the joint space, which are characteristic of osteoarthritis. Notably, it is possible to have both conditions at the same time.

Because joint pain and inflammation can have many causes, rheumatoid arthritis can be challenging to identify. Before making a definitive diagnosis, the physician may monitor the symptoms for a few months.

Is Rheumatoid Arthritis Genetic?

Many autoimmune conditions have a genetic (inherited) basis. Studies show that, as compared to the general population, first-degree relatives of people who have RA tend to have a slightly higher risk of developing the condition themselves.

With that said, the role of genetics in the development of rheumatoid arthritis is not yet well understood, and further research is needed to determine why the condition develops in some people but not others. Scientists believe that RA is more likely to result from a combination of genetic factors and environmental factors, such as smoking, than from genetic factors alone.

How Is Rheumatoid Arthritis Treated?

Currently, there is no known cure for RA. The goal of treatment is to manage the symptoms and slow the progression of the joint damage. The cornerstone of rheumatoid arthritis treatment is disease-modifying antirheumatic drugs (DMARDs), which can help preserve the joints by blocking inflammation. Other options include:

• Physical therapy
• Assistive devices for hands and legs
• Prescription-strength NSAIDs
• Corticosteroids
• Surgery to repair a severely damaged joint

Talk With an Expert

If you have chronic joint pain or other symptoms of rheumatoid arthritis, you can talk with a specialist in the Department of Rheumatology at Florida Medical Clinic. We see patients at our offices in Land O’ Lakes, Tampa, and Zephyrhills. We understand how rheumatic diseases can affect your daily life, and we’re here to help ease your symptoms and provide relief so you can get back to doing the things you love. To request an appointment with our Rheumatology team, call us at (813) 782-1234

About Christina Arnold, PA-C

Christina Arnold, PA-C earned a Master of Health Science in the Physician Assistant Program from Lock Haven University in Lock Haven, PA. She is board certified by the National Commission on Certification of Physician Assistants and her special interests include rheumatoid arthritis and scleroderma.  When not caring for her patients, Christina enjoys being outdoors, gardening, trips to the beach and watching sports.