What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is an autoimmune disease that is chronic (ongoing). It occurs in the joints on both sides of your body, which makes it different from other types of arthritis. You may have symptoms of pain and inflammation in your:
- Fingers.
- Hands.
- Wrists
- Knees
- Ankles.
- Feet.
- Toes.
Uncontrolled inflammation damages cartilage, which normally acts as a “shock absorber” in your joints. In time, this can deform your joints. Eventually, your bone itself erodes. This can lead to the fusion of your joint (an effort of your body to protect itself from constant irritation).
Specific cells in your immune system (your body’s infection-fighting system) aid this process. These substances are produced in your joints but also circulate and cause symptoms throughout your body. In addition to affecting your joints, rheumatoid arthritis sometimes affects other parts of your body, including your:
- Skin.
- Eyes.
- Mouth.
- Lungs.
- Heart.
What are the goals of treating rheumatoid arthritis?
The most important goal of treating rheumatoid arthritis is to reduce joint pain and swelling. Doing so should help maintain or improve joint function. The long-term goal of treatment is to slow or stop joint damage. Controlling joint inflammation reduces your pain and improves your quality of life.
How is rheumatoid arthritis treated?
Joint damage generally occurs within the first two years of diagnosis, so it’s important to see your provider if you notice symptoms. Treating rheumatoid arthritis in this “window of opportunity” can help prevent long-term consequences.
Treatments for rheumatoid arthritis include lifestyle changes, therapies, medicine and surgery. Your provider considers your age, health, medical history and how bad your symptoms are when deciding on a treatment.
What medications treat rheumatoid arthritis?
Early treatment with certain drugs can improve your long-term outcome. Combinations of drugs may be more effective than, and appear to be as safe as, single-drug therapy.
There are many medications to decrease joint pain, swelling and inflammation, and to prevent or slow down the disease. Medications that treat rheumatoid arthritis include:
Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs decrease pain and inflammation. They include products like:
- Ibuprofen (Advil®, Motrin®).
- Naproxen (Aleve®).
- Aspirin.
COX-2 inhibitors
COX-2 inhibitors are another kind of NSAID. They include products like celecoxib (Celebrex®). COX-2 inhibitors have fewer bleeding side effects on your stomach than typical NSAIDs.
Corticosteroids
Corticosteroids, also known as steroids, also can help with pain and inflammation. They include prednisone and cortisone.
Disease-modifying antirheumatic drugs (DMARDs)
Unlike other NSAIDs, DMARDs actually can slow the disease process by modifying your immune system. Your provider may prescribe DMARDs alone and in combination with steroids or other drugs. Common DMARDs include:
- Methotrexate (Trexall®).
- Hydroxychloroquine (Plaquenil®).
- Sulfasalazine (Azulfidine®).
- Leflunomide (Arava®).
Janus kinase (JAK) inhibitors
JAK inhibitors are another type of DMARD. Rheumatologists often prescribe JAK inhibitors for people who don’t improve taking methotrexate alone. These products include:
Biologics
If you don’t respond well to DMARDs, your provider may prescribe biologic response agents (biologics). Biologics target the molecules that cause inflammation in your joints. Providers think biologics are more effective because they attack the cells at a more specific level. These products include:
- Etanercept (Enbrel®).
- Infliximab (Remicade®).
- Adalimumab (Humira®).
- Anakinra (Kinaret®).
- Abatacept (Orencia®).
- Rituximab (Rituxan®).
- Certolizumab (Cimzia®).
- Golimumab (Simponi®).
- Tocilizumab (Actemra®).
Biologics tend to work rapidly — within two to six weeks. Your provider may prescribe them alone or in combination with a DMARD like methotrexate.
What is the safest drug for rheumatoid arthritis?
The safest drug for rheumatoid arthritis is one that gives you the most benefit with the least amount of negative side effects. This varies depending on your health history and the severity of your RA symptoms. Your healthcare provider will work with you to develop a treatment program. The drugs your healthcare provider prescribes will match the seriousness of your condition.
It’s important to meet with your healthcare provider regularly. They’ll watch for any side effects and change your treatment, if necessary. Your healthcare provider may order tests to determine how effective your treatment is and if you have any side effects.
Will changing my diet help my rheumatoid arthritis?
When combined with the treatments and medications your provider recommends, changes in diet may help reduce inflammation and other symptoms of RA. But it won’t cure you. You can talk with your doctor about adding good fats and minimizing bad fats, salt and processed carbohydrates. No herbal or nutritional supplements, like collagen, can cure rheumatoid arthritis. These dietary changes are safer and most successful when monitored by your rheumatologist.
But there are lifestyle changes you can make that may help relieve your symptoms. Your rheumatologist may recommend weight loss to reduce stress on inflamed joints.
People with rheumatoid arthritis also have a higher risk of coronary artery disease. High blood cholesterol (a risk factor for coronary artery disease) can respond to changes in diet. A nutritionist can recommend specific foods to eat or avoid to reach a desirable cholesterol level.
When is surgery used to treat rheumatoid arthritis?
Surgery may be an option to restore function to severely damaged joints. Your provider may also recommend surgery if your pain isn’t controlled with medication. Surgeries that treat RA include:
How is rheumatoid arthritis diagnosed?
Your healthcare provider may refer you to a physician who specializes in arthritis (rheumatologist). Rheumatologists diagnose people with rheumatoid arthritis based on a combination of several factors. They’ll do a physical exam and ask you about your medical history and symptoms. Your rheumatologist will order blood tests and imaging tests.
The blood tests look for inflammation and blood proteins (antibodies) that are signs of rheumatoid arthritis. These may include:
- Erythrocyte sedimentation rate (ESR) or “sed rate” confirms inflammation in your joints.
- C-reactive protein (CRP).
- About 80% of people with RA test positive for rheumatoid factor (RF).
- About 60% to 70% of people living with rheumatoid arthritis have antibodies to cyclic citrullinated peptides (CCP) (proteins).
Your rheumatologist may order imaging tests to look for signs that your joints are wearing away. Rheumatoid arthritis can cause the ends of the bones within your joints to wear down. The imaging tests may include:
In some cases, your provider may watch how you do over time before making a definitive diagnosis of rheumatoid arthritis.
What are the diagnostic criteria for rheumatoid arthritis?
Diagnostic criteria are a set of signs, symptoms and test results your provider looks for before telling you that you’ve got rheumatoid arthritis. They’re based on years of research and clinical practice. Some people with RA don’t have all the criteria. Generally, though, the diagnostic criteria for rheumatoid arthritis include:
- Inflammatory arthritis in two or more large joints (shoulders, elbows, hips, knees and ankles).
- Inflammatory arthritis in smaller joints.
- Positive biomarker tests like rheumatoid factor (RF) or CCP antibodies.
- Elevated levels of CRP or an elevated sed rate.
- Your symptoms have lasted more than six weeks.
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