Rheumatoid arthritis (RA) is an autoimmune disease where the body's immune system mistakenly attacks the synovium, a thin membrane that lines the joints. It causes chronic inflammation that leads to pain, swelling, and stiffness. Over time, RA can damage bones and joints leading to disability.
RA usually affects joints on both sides of the body equally, meaning if a joint on one side is affected, the same joint on the opposite side is affected. Wrists, fingers, knees, feet, and ankles, and elbows are most often affected. RA can also affect other organs, and people who have RA are at higher risk for other diseases including heart disease, diabetes, and osteoporosis.
RA is a chronic disease, meaning it lasts a long time and can get worse. It is important that people with RA work closely with their doctor to find a treatment plan that lessens symptoms and joint damage.
There is no cure for RA. But taking medication and making lifestyle changes can help you manage the disease. Alternative and complementary therapies can also help relieve symptoms, but only conventional medications halt the progression of the disease and stop further joint damage. In some cases, medications can help put RA into remission and symptoms may go away completely.
Signs and Symptoms
Symptoms of RA include:
Researchers do not know what causes RA, although both genetics and environment probably play a part. Researchers believe that genetics make some people more likely to get RA. In those people, environmental factors, bacteria, and viruses may then trigger RA. Some evidence suggests that hormones may also play a role.
In RA, the body's immune system, which normally fights off foreign invaders, mistakenly attacks the lining of the joints (called the synovium). That causes inflammation, which makes the synovium thicker and eventually destroys the cartilage and bone in the joints.
RA can occur at any age. It usually occurs in people between 25 to 55 years of age. Women are affected more often than men.
RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, elbows, and ankles are the most often affected.
RA can be hard to diagnose because it looks like many other conditions, and symptoms often develop gradually. Even after RA has been diagnosed, it is important to see how the disease is progressing to treat it effectively.
Your doctor will take your medical history and do a physical exam. Blood tests, x-rays, and aspiration (the removal of fluid from the joint) may also be needed.
Your doctor may order several blood tests. One test checks for an elevated erythrocyte sedimentation rate (ESR, or sed rate), which is a sign of inflammation in the body. Other blood tests that may be done include checking for certain antibodies, including rheumatoid factor, antinuclear antibodies (ANA), and anticyclic citrullinated peptide (anti-CCP) antibodies. Most people with RA, but not all, have these antibodies.
If you have RA, it is important to get diagnosed and start treatment early. Studies show that early, aggressive treatment for RA can stop the destruction of joints. In addition to rest, regular exercise, and taking anti-inflammatory medications, your doctor will start you on disease-modifying antirheumatic drugs (DMARDs). These drugs do more than relieve symptoms, they halt the progression of the disease.
You can use complementary and alternative therapies along with conventional treatment to help relieve pain and stiffness. Studies show that certain dietary supplements, particularly omega-3 fatty acids, may help relieve pain and stiffness. Be sure to tell all your health care providers about any supplements, herbs, or other therapies you are using. Some herbs and supplements can interact with medications and should not be taken together.
RA usually requires lifelong treatment, including medications, physical therapy, education, and possibly surgery. Often, a combination of treatments can control the disease.
Regular exercise, consisting of aerobic exercise, strengthening exercises, and flexibility or range-of-motion exercises, can help to maintain joint motion and strength. Exercise also helps you relieve pain and maintain a proper weight, which takes pressure off your joints. A physical therapist can help create an exercise program for you.
Doctors often recommend walking, swimming, warm-water exercise, or biking for people with RA. If you are not used to exercising, start slow and work your way up, aiming for 30 minutes of aerobic exercise, 5 or more days a week.
Weight-bearing exercises, such as lifting weights, using a resistance band, or walking, are also recommended to keep bones strong. People with RA often take corticosteroids to reduce inflammation. Taking corticosteroids long term raises the risk of developing osteoporosis.
Joint protection techniques, such as heat and cold treatments and splints or orthotic (straightening) devices to support and align joints, may help as well.
The following drugs are used to treat RA:
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS are used to relieve joint pain and inflammation. They do not stop the progression of RA. Long term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. In April 2005, the U.S. Food and Drug Administration (FDA) asked drug manufacturers of NSAIDs to include a warning label on their products to alert users of an increased risk for heart problems and stomach bleeding. These drugs include ibuprofen (Motrin, Advil) and naproxen (Aleve), as well as prescription medications.
Celecoxib (Celebrex). Celebrex is a type of drug called a COX-2 inhibitor, which blocks an inflammation-promoting enzyme called COX-2. COX-2 inhibitors were developed to work as well as traditional NSAIDs but with fewer stomach problems. However, many reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Two drugs in this class were taken off the U.S. market following reports of heart attacks in people who took them. Celebrex is still available, but it is labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest time possible.
Corticosteroids. Also known as steroids, these medications are used to quickly bring down inflammation, often during a flare. Steroids have side effects including weight gain, nausea, and fluid retention. Long-term use raises the risk of osteoporosis and diabetes.
Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow progression of the disease and halt joint damage. Current recommendations are that everyone diagnosed with RA should start taking a DMARD, whether their symptoms are mild or severe. Side effects can include liver damage and being prone to infection. Methotrexate (Rheumatrex) is used most often for RA. Other DMARDs include:
Immune suppressants. These medicines suppress the immune system, which is overactive in people with RA. Side effects include being prone to infection. These drugs include:
Biologic agents. Biologics are newer drugs that target a specific part of the inflammation process and can slow or halt progression of joint damage. Etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia) block production of TNF-alpha, or tumor necrosis factor-alpha, a chemical produced by your body that is involved in inflammation. Anakinra (Kineret) stops a protein called interleukin-1 (IL-1). Abatacept (Orencia) stops the activation of T cells, a type of white blood cell, in the body. Rituximab (Rituxan) blocks B cells, another type of white blood cell involved in the immune system response.
Biologics are often used after other treatments have failed, and are often combined with a DMARD (usually methotrexate). DMARDs may increase the risk of harmful infections. Discuss the risks and benefits of these drugs with your doctor.
Surgery and Other Procedures
If a joint is severely affected, you may need surgery. The most successful surgeries are those on the knees and hips.
Sometimes people with RA need total joint replacement with an artificial joint. Surgeries may relieve pain, correct deformities, and modestly improve joint function. In some cases, total knee or hip replacement can restore mobility and improve quality of life.
Nutrition and Dietary Supplements
For anyone with a chronic illness, eating a healthy diet high in antioxidant-rich foods, fruits and vegetables, is essential. Eating a poor diet may increase inflammation in the body.
Also, people with RA are at higher risk of developing heart disease and diabetes. A healthy diet and regular exercise can lower that risk.
Although diet cannot cure RA, studies show that people with RA report less pain, stiffness, and fatigue when they switched from a typical Western diet to a Mediterranean diet that is high in fruits, vegetables, beans, nuts, seeds, fish, and olive oil, and low in red meat. Other studies link a vegan diet, with lots of uncooked berries, fruits, vegetables, nuts, roots, seeds, and sprouts with reduced RA symptoms. Vegan diets contain no animal products and get protein from vegetable sources.
Some people think food allergies play a part in the inflammation common in RA, and say their symptoms get worse after they eat certain foods. Although researchers are not sure if food allergies are to blame, you may want to try an elimination diet, which removes certain foods from your diet and then adds them back, one by one. You will need to keep track of your symptoms in a food diary. Usually it's best to try an elimination diet under the supervision of your doctor or a registered dietitian.
These general nutritional tips can help you eat a healthy diet:
Some supplements may help relieve pain and inflammation when you have RA, but none have been shown to stop joint damage. Supplements may also interact with some of the medications used to treat RA. Ask your doctor before taking any supplements.
These supplements may help relieve inflammation and pain:
You can use herbs in the form of dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.
Herbs may be a helpful addition to conventional treatment for RA, but you should never use them alone to treat RA. Herbs do not halt joint damage and progression of the disease, as some conventional medications can. Herbs can potentially interact with other medications and therapies. Speak to your doctor before adding herbal supplements to your regimen.
There is little scientific evidence supporting the use of acupuncture for RA, however, some people with RA say that acupuncture helps relieve pain and improves their quality of life. Acupuncturists treat people with RA based on an individualized assessment of the excesses and deficiencies of qi, or energy, located in various meridians. A qi deficiency is usually detected in the spleen and kidney meridians.
Acupuncturists may use moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) to strengthen the entire energy system. Qualified acupuncturists may also provide lifestyle, dietary, and herbal advice to people with RA. Practitioners may apply local treatment to the painful areas and related sore points, either with a needle or moxibustion. You should not rely on acupuncture alone to treat RA, as it does not halt progression of the disease. It may help along with conventional medical therapy.
Regular exercise is important for people with RA. It boosts overall health, helps you maintain a proper weight (which takes pressure off joints), and helps prevent heart disease, diabetes, and osteoporosis. It also reduces pain and can boost your mood.
While you may choose to rest during an active flare, it's important to stay in good shape and maintain range of motion in your joints. Ask your doctor or physical therapist to design an exercise program for you. Many people with RA find that walking, swimming, or warm-water exercise are helpful.
Doctors used to advise people with RA to do only gentle exercises, fearing more joint damage. But recent research suggests that more intense exercise may produce greater muscle strength and overall functioning. To know how long or hard you should exercise, ask your doctor and pay attention to your bodies signals.
If you feel sharp pains while exercising, stop immediately.
Some soreness after exercising is normal. If aches and pains continue for more than 2 hours afterward, try a lighter exercise program for awhile.
Be sure to warm up and cool down.
Using large joints instead of small ones for ordinary tasks can help relieve pain. For example, use your hip to close doors or the palm of your hand to push buttons.
Balneotherapy (Hydrotherapy or spa therapy)
Balneotherapy is one of the oldest forms of therapy for pain relief for people with arthritis. The term "balneo" comes from the Latin word for bath (balneum), and refers to bathing in thermal or mineral waters. For example, sulfur-containing mud baths have been shown to relieve symptoms of arthritis. Sulfur-containing mud baths, for example, have been shown to relieve symptoms of arthritis. However, hydrotherapy, which can be done under the guidance of certain physical therapists, is sometimes referred to with the word balneotherapy. The goals of balneotherapy for RA include:
Exercising and swimming in a heated pool may also help.
Many devices, called orthoses, are available for people with RA to help support and protect joints. Made from lightweight metal leather, elastic, foam, and plastic, they allow the affected joint to move a little while not restricting nearby joints. For example, splints or braces help align joints and properly distribute weight.
Shock-absorbing soles in shoes can help in daily activities and during exercise. Physical therapists use these mechanical aids most frequently to treat hands, wrists, knees, ankles, and feet. Orthoses should be custom fit by a physical or occupational therapist.
Compression gloves may help some people. Two studies on the overnight use of compression gloves, close-fitting, nylon-spandex gloves, concluded that the gloves reduced pain and stiffness in people with RA in the fingers.
Other possibilities for symptom relief include:
Recent trials evaluating homeopathy to treat RA found that the remedies were no better than placebo in reducing symptoms. These studies contradict an older trial that showed positive effects with homeopathic treatment. Despite the lack of definitive evidence, professional homeopaths might recommend one of the following treatments for RA based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account an individual's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
Potential remedies include:
Chronic pain and disability can make daily life difficult, and stress can make an RA flare worse. Many people report that relaxation techniques, such as guided imagery and meditation, help improve quality of life and reduce pain and other symptoms of RA.
This ancient Indian practice is well known for its physical, psychological, emotional, and spiritual benefits. In the West, it is often recommended to relieve musculoskeletal symptoms and some studies have found it can help relieve RA pain.
Some yoga "asanas" (postures) strengthen the quadriceps and emphasize stretching, both of which help people with RA of the knee. People with arthritis should begin asanas slowly and they should be performed only after a warm up. Look for a reputable instructor who knows how to modify postures for people with RA.
People with RA should avoid "hot yoga."
This gentle exercise program practiced in China for centuries has been shown to produce a number of benefits, including the following:
Tai chi is generally safe for people with RA, and a review of scientific studies suggests it may help improve flexibility and range of motion, especially for people with RA in their ankles.
Prognosis and Complications
RA can have many complications, including:
RA is different for everyone. People with a certain antibody in the blood (anti-CCP) or nodules may be at risk for faster progression of the disease. People who develop RA at younger ages also tend to have faster disease progression.
Although complications may shorten the life expectancy of people with RA, treatment is constantly improving and newer medications offer better chances for remission.
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Review Date: 2/2/2016
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.
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