Rheumatoid arthritis (RA) is an autoimmune disease that can affect joints, the heart, the skin, and other body organs. Autoimmune diseases such as RA and systemic lupus erythematosus are caused by factors that prompt the body to attack itself. These factors, which normally help fight off infection, target the synovial membrane (joint lining) in RA. These linings are elastic and help the joint maintain its shape; damage to the linings allows the bones to change their position, leading the joint to become deformed. Inflammation can also affect other body parts. In some persons with RA, the autoimmune process affects the heart and its lining (the pericardium) or the lining of the lungs (the pleura). If fluid builds up within the pericardium or pleura, this can be life-threatening and require emergency drainage. Women are more likely to have RA than men. About 1% of the world's population may have RA. The cause of RA is unclear, but it probably has a genetic (inherited) influence in addition to outside (environmental) factors.
Joint pain, swelling, and deformity
Joint stiffness and difficulty moving
Fatigue
Lumps (nodules) under the skin
Anemia (low blood count)
Low-grade fever
Poor appetite
Your doctor will take a medical history and ask questions about your pain and your mobility. A physical examination, laboratory tests, and x-rays are usually done to evaluate a person for RA. Samples of joint fluid may be taken to help confirm the diagnosis. Blood tests may include a blood count (looking for anemia or signs of infection) and other tests for markers of inflammation. Osteoarthritis, damage to cartilage in the joints, is a different disease process. Osteoarthritis is not an autoimmune disease but is related to wear and tear on cartilage, which causes joint pain. Osteoarthritis does not have effects on the heart, lungs, or the body's immune system.
Anti-inflammatory medications ease pain and reduce inflammation within joints.
Steroids are often used in RA treatment. Because of adverse (side) effects of steroids, it is important to find the smallest effective dose for each individual.
Early treatment with disease-modifying antirheumatic drugs (DMARDs) can help to limit the progression of RA and severe joint damage. DMARDs are medications that act on the body's immune response.
Biologic products, such as monoclonal antibody medications, may be used as part of treatment for RA.
Lifestyle changes, such as gentle daily exercise and eating a healthy diet, can improve overall well-being, maintain muscle strength and joint motion, and help with mood. Quitting smoking may improve symptoms.
Joint replacement may be offered to persons with RA when joint pain, stiffness, and deformity become limiting factors in an individual's life. Consultation with an orthopedic surgeon may be recommended when joint damage is present.
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on knee replacement was published in the February 23, 2011, issue; one on knee pain was published in the April 18, 2007, issue; one on osteoarthritis of the knee was published in the February 26, 2003, issue; one on juvenile idiopathic arthritis was published in the April 7, 2010, issue; and one on systemic lupus erythematosus was published in the June 22/29, 2005, issue.
Sources: Arthritis Foundation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, World Health Organization
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
TOPIC: MUSCULOSKELETAL HEALTH