Rheumatoid Arthritis Symptoms, Causes, & Treatment

What is Rheumatoid Arthritis?

Arthritis is a general term that refers to joint pain or joint disease. There are over a hundred types of arthritic disorders, and rheumatoid arthritis (RA) is one of them.

RA is an inflammatory disease that affects the joints. In RA, all body joints can be affected, but at first the disease more commonly affects the hands, wrists, elbows, feet, ankles, knees or shoulders.

Joints are often affected bilaterally (e.g., both knees or both wrists) and several joints can be affected at the same time. Over the long term, chronic inflammation can destroy or deform the joints. This damage is permanent.

Although less common than osteoarthritis, rheumatoid arthritis is one of the most common forms of arthritis. It is estimated that 1 out of 100 Canadian adults has the disease. 

What Causes Rheumatoid Arthritis?

RA is an autoimmune disease, which means that the immune system erroneously identifies certain body cells (the lining of the joints, called synovium) as foreign invaders. This results in the release of chemical mediators that attack those cells, leading to inflammation and pain.

If left untreated, rheumatoid arthritis can eventually attack other organs, such as the lungs and heart.

The precise cause of rheumatoid arthritis is not yet fully understood. Current research suggests that certain genes may be activated by external factors, such as a viral infection, stress, smoking or environmental factors. Individuals with a parent affected by RA are at an elevated risk of developing the disease. New research suggests that an imbalance in the gut microbiota may contribute to the onset of rheumatoid arthritis.

Who can get Rheumatoid Arthritis?

Epidemiological data indicates a gender disparity, with two to three times as many women as men affected with RA.

The disease most often appears between the ages of 30 and 60 but can affect people of all ages. It’s called young-onset RA (YORA) when the first symptoms appear before the age of 40 and later-onset RA (LORA) when symptoms develop after the age of 60.

Rheumatoid Arthritis Symptoms

The symptoms and progression of rheumatoid arthritis vary greatly from person to person. People generally get pain and stiffness in the affected joint, which can also swell. The stiffness often lasts for at least an hour upon waking, and symptoms are worst after a period of rest. Conversely, symptoms decrease in intensity during movement.

Symptoms are felt not just at the affected site, as people with rheumatoid arthritis often experience generalized fatigue that can be debilitating for some people. They can also have a fever or experience loss of appetite.

About 20% of people with RA develop rheumatoid nodules. These are firm, usually painless lumps under the skin in joints that are exposed to trauma, most commonly the fingers and elbows. Smokers and people with severe RA are more likely to develop such nodules, which can also be associated with methotrexate therapy.

How is Rheumatoid Arthritis Diagnosed?

A rheumatologist (a doctor who specializes in diseases of the joints) is often the one who confirms a diagnosis and establishes treatment.

The diagnosis is based on a complete physical exam and health questionnaire, blood tests to look for RA markers and (or) imaging tests.

How is Rheumatoid Arthritis Treated?

Although rheumatoid arthritis can't be cured, treatment can relieve pain, reduce inflammation, improve joint mobility and stop the disease from progressing. The goal is to achieve remission, or a period between two flares when you can function as normally as possible and feel almost no symptoms.

It’s important to start treatment as soon as possible after diagnosis to prevent the disease from causing irreversible damage.

Lifestyle

A healthy lifestyle is an essential part of treatment.

• Achieve or maintain a healthy weight.
• Get regular physical activity to strengthen the muscles around the weakened joint and help control pain. While convincing yourself to get moving when you're in pain may be hard, the benefits will no doubt motivate you to continue. Avoid overtaxing your joints. Seek the help of a professional (occupational therapist, physical therapist, or kinesiologist) to design an activity program that is appropriate for your abilities.
• Eat a healthy and balanced diet to give your body the nutrients it needs to function. In combination with physical activity, a healthy diet will help you achieve and maintain a healthy weight.

Heat and cold therapies

Applying hot or cold therapy to your painful joint can help decrease pain, swelling and stiffness. Heat is an effective method for reducing morning stiffness and can be applied on a regular basis. This may include taking a warm bath or shower in the morning or using a heating pad.

Cold compresses can be used to alleviate acute pain and inflammation, for example during flare-ups or after a strenuous day. To avoid chilblains or burns, it is essential to never put a cold or hot compress directly on the skin.

Medication

To achieve remission as quickly as possible, a drug regimen that combines several medications is usually started as soon as RA is diagnosed.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce joint pain and inflammation. These medications are usually taken as needed because they don't prevent disease progression. 

Corticosteroids (also known as cortisone) may be prescribed to reduce inflammation at the beginning of treatment as you wait for other drugs to take effect. They can be injected directly into the joint or taken orally. They are also used whenever RA flares up. These drugs are typically used for a short period because of their potential long-term side effects.

To slow the progression of the disease, special medications called disease-modifying antirheumatic drugs (DMARDs) are used to prevent the immune system from attacking the joints. When taken early on, DMARDs can control rheumatoid arthritis before damage occurs. They can also relieve the inflammation and pain caused by RA. Combinations of drugs may be needed to control the disease. It may take several weeks to several months from the start of treatment for the medication to take full effect.

RA treatment usually requires close monitoring. Some of the drugs used to treat RA may reduce the production of white blood cells or platelets, while others can affect liver or kidney function. You must follow all of your doctor’s and pharmacist’s recommendations, go to your medical appointments, and get the tests they recommend.

Biologics are another drug class that is used to treat RA. These injectable drugs modify the biological reactions responsible for inflammation and therefore help reduce the damage caused by prolonged inflammation. Given their high cost, these drugs are typically prescribed when standard treatments have been unsuccessful in controlling the disease. Close monitoring is also essential due to the potential for serious side effects.

It is important to understand that even if your disease is under control, you must keep taking your medications as prescribed, to prevent flares and disease progression. RA cannot be cured. Never stop taking your medication without talking to your pharmacist or doctor first.

Surgery

If the disease is debilitating or if joints have become very deformed, surgery may be an option. However, this is a last resort.

What about “miracle” cures?

Many companies advertise "miracle" cures, such as wristbands, diets, or natural health products that they claim can relieve or cure the pain of joint disease. Their claims are rarely backed by strong evidence. The best way to control rheumatoid arthritis is with medication and a healthy lifestyle.

Heard about a new all-natural treatment on social media? Seek the professional advice of your pharmacist. They can tell you if it is backed by science and worth trying, or if it is just a fad to avoid.

Your Pharmacist Can Help You Manage your Rheumatoid Arthritis!

Make the most of the expertise of your pharmacist and other members of your healthcare team. They will make sure your treatment is effective and well tolerated. They can also help you adapt to your condition and achieve your goals so that you can maintain your quality of life and your independence. Don’t hesitate to also get support from your family and friends or other people who suffer from arthritis.