What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the lining of your joints. Unlike “wear-and-tear” arthritis, RA occurs when your immune system mistakenly attacks healthy tissue, leading to inflammation, pain and, over time, joint damage. Although it most often targets small joints in the hands and feet, RA can involve multiple joints symmetrically (on both sides of the body) and may impact other organs, such as the lungs, heart and eyes.

How RA Develops
• Autoimmune trigger: Genetic factors and environmental exposures (like smoking or certain infections) can prompt your immune system to turn against your own joint tissues.
• Synovial inflammation: The synovium, a thin membrane that lines joints, becomes inflamed and thickened.
• Joint damage: Prolonged inflammation erodes cartilage and bone, leading to deformity, reduced mobility and chronic pain.
• Systemic effects: RA is a whole-body condition—persistent inflammation can raise your risk of cardiovascular disease and fatigue.

Key Symptoms
RA symptoms may come on gradually or appear suddenly. Common signs include:
• Joint pain and tenderness, especially in the wrists, knuckles and the base of the toes
• Morning stiffness lasting an hour or more
• Swelling, warmth and redness around joints
• Fatigue, low-grade fever and a general sense of unwellness
• Symmetrical joint involvement (both wrists or both knees, for example)

Because RA is variable, you might experience periods of increased symptoms (“flares”) alternating with periods of relief (“remission”).

Diagnosing Rheumatoid Arthritis
In 2010, the American College of Rheumatology and the European League Against Rheumatism defined classification criteria to help identify RA early:
• Joint involvement: Number and size of affected joints (small versus large)
• Serology: Presence of autoantibodies such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA)
• Acute-phase reactants: Elevated markers of inflammation in blood (C-reactive protein, erythrocyte sedimentation rate)
• Symptom duration: Symptoms lasting six weeks or longer

A formal diagnosis usually involves:

1. Medical history and physical exam
2. Blood tests for RF, ACPA and inflammation markers
3. Imaging (X-rays, ultrasound or MRI) to assess joint damage

If you’re worried about joint pain or stiffness, you might consider doing a free, online symptom check for rheumatoid arthritis to gather more information before talking with your healthcare provider.

Treatment Goals and Strategies
While there’s no cure for RA, early and aggressive treatment can:
• Prevent or slow joint damage
• Preserve joint function and quality of life
• Reduce pain and fatigue

Treatment plans are personalized but often include:
• Disease-Modifying Antirheumatic Drugs (DMARDs)
– Methotrexate is usually first-line
– Biologic DMARDs (e.g., TNF inhibitors) or targeted synthetic DMARDs (e.g., JAK inhibitors) for those who need additional control
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for short-term pain relief
• Corticosteroids (prednisone) to reduce acute inflammation
• Physical and occupational therapy to maintain mobility and joint protection
• Lifestyle modifications: balanced diet, regular low-impact exercise (swimming, cycling), stress management and smoking cessation

Your doctor will monitor disease activity through exams and lab tests, adjusting medications if you’re not reaching low-disease or remission targets.

Living with RA
Coping with a chronic condition involves more than medication. Consider these strategies:
• Joint safety: Use assistive devices (splints, jar openers) and adapt your environment (raised toilet seats, lever-style handles)
• Exercise: Strengthening muscles around joints helps stability and reduces pain. Aim for flexibility, endurance and strength training.
• Balanced diet: An anti-inflammatory diet rich in fruits, vegetables, whole grains, lean proteins and omega-3 fatty acids may ease symptoms.
• Stress reduction: Techniques like yoga, meditation or mindfulness can help manage pain and fatigue.
• Support networks: Connect with support groups—online or in your community—for shared experiences and practical tips.

Potential Complications
If RA is untreated or poorly controlled, you may face:
• Joint deformities and loss of function
• Osteoporosis (weakening of bones)
• Increased risk of heart attack and stroke
• Lung problems (interstitial lung disease)
• Eye inflammation (scleritis, uveitis)
• Carpal tunnel syndrome

Regular follow-up appointments and adherence to treatment are key to minimizing these risks.

Prognosis and Outlook
RA varies greatly among individuals. According to long-term studies, early diagnosis and appropriate use of DMARDs can induce remission or low-disease activity in many patients. Even if you’ve had RA for years, updated therapies offer new hope for controlling symptoms and preventing damage. Your outlook improves significantly when you:
• Detect symptoms early
• Start effective treatment swiftly
• Maintain open communication with your rheumatologist
• Adopt a healthy lifestyle

When to Seek Immediate Help
Although RA itself is seldom life-threatening, complications can be serious. Contact your doctor or seek emergency care if you experience:
• Chest pain or severe shortness of breath (possible heart or lung involvement)
• High fever, chills and worsening joint pain (infection risk, especially if you’re on immunosuppressive drugs)
• Sudden vision changes or eye pain (possible uveitis)
• Severe, unrelenting pain or signs of joint infection (redness, warmth, swelling with fever)

Speak to a doctor about any symptoms that could be life-threatening or indicate serious complications.

Key Takeaways
• Rheumatoid arthritis is an autoimmune disease causing joint inflammation and potential systemic effects.
• Early recognition and treatment with DMARDs can prevent joint damage and improve long-term outcomes.
• A combination of medication, exercise, diet and stress management helps control symptoms.
• Stay vigilant for complications and maintain regular check-ups with your healthcare team.
• For initial guidance, you can try a free, online symptom check for rheumatoid arthritis.
• Always consult your doctor about anything that could be serious or life-threatening.