Rheumatoid Arthritis: FAQ

Rheumatoid arthritis, also called RA, is an autoimmune, inflammatory disease that affects the joints. While its causes are still unclear, RA happens when the body’s immune system malfunctions and attacks the healthy tissues of the synovium, or lining of joints, by mistake. RA triggers inflammation that quickly flares and causes severe pain and swelling in your joints. Joints can break down and become very difficult to bend or use. RA may affect other organs, too, such as the eyes, lungs, heart or skin.

The causes of RA are unclear at this time. Some people may develop RA due to having certain genes, such as HLA-DR4. However, having this gene or having a relative with RA does not mean that you will necessarily develop the disease. Some factors may trigger active RA in someone with the genetic predisposition to develop it, such as having a bacterial or viral infection, or smoking.

About 1-2% of the Indian population has RA. The disease affects women two to three times more often than men. RA usually affects people in their 30s, 40s and 50s, with higher frequency over 50. But it can strike younger or older people as well. People with certain genetic mutations, those who have had certain bacterial or viral infections, or long-time smokers may be more likely to get RA.

RA’s chief symptom is inflammation of the synovium, or the lining of joints. You may feel severe pain, swelling, stiffness or warmth around your joints, and the skin around the affected joints may look red or swollen. Joints may feel tender and painful to move. Usually, RA affects many joints, as many as five or more, especially the hands, wrists, feet, shoulders, elbows and ankles. You may feel stiffness or pain in a joint after a long period of rest or inactivity. Other symptoms of an RA flare may include fatigue, malaise or a general sick feeling, and fevers.

If you notice pain, swelling, stiffness or difficulty moving one or more joints, and these symptoms seem to come on suddenly and worsen over a few weeks, you should see a rheumatologist immediately. A rheumatologist is a physician with years of additional, specialized training in treating RA and other rheumatic and musculoskeletal diseases. A rheumatologist can examine you and give you specific tests, such as blood tests or X-rays, to determine if you have RA, or if there is another cause for your joint pain.

RA may affect each person differently, but there are some general, common signs that your rheumatologist will look for to diagnose you with RA. Your rheumatologist will examine your joints, and ask you to move them to test your range of motion. He or she may feel your joints to see if they are swollen, and feel spongy. He or she will also give you blood tests to look for certain signs of inflammation, X-rays or other scans to look for signs of joint inflammation or damage, and other tests, such as urinalysis. Your rheumatologist will rule out any other causes of your joint pain or swelling. To have RA, you must have synovitis, or inflammation of the joint lining, in one or more joints that can’t be caused by some other disease. Your rheumatologist will also use a scoring method to see if you have at least six of the 10 other common signs of RA. These include: symptoms affecting multiple joints; symptoms that last six weeks or longer; having a positive test for either one or both of rheumatoid factor or anti-citrullinated protein antibodies (ACPAs); and having abnormal levels of either one or both of C-reactive protein or erythrocyte sedimentation rate (ESR).

There are many drugs available to treat RA inflammation and to help reduce symptoms that may be out of control. Disease-modifying antirheumatic drugs, or DMARDs, are the first-line treatment for RA inflammation. These include methotrexate, the most common RA treatment, as well as leflunomide, azathioprine, hydroxychloroquine and sulfasalazine, among others. Newer, targeted drugs called biologics may be used if DMARDs do not adequately control your RA disease activity. These include etanercept, adalimumab, infliximab, certolizumab pegol, anakinra, abatacept, golimumab, tocilizumab, rituximab and to facitinib. Other drugs may be used to treat flares of RA pain or inflammation, such as nonsteroidal antiinflammatory drugs (NSAIDs), glucocorticoids or analgesics, which only treat pain.

Surgery may replace damaged joints that have become too stiff, misshapen or painful to use. You can also do many things to help ease your RA symptoms or improve your joint range of motion. Regular, joint-friendly exercises have been shown to help maintain flexibility, and help strengthen muscles to better support your joints. You can maintain a healthy weight, avoid smoking, get enough rest and eat a healthy diet to feel better with RA. Physical therapy and occupational therapy may also help you deal with your RA symptoms and do daily tasks more effectively.

Once your rheumatologist diagnoses your RA, you will work together to create a treatment plan. This plan will have certain targets or goals for your treatment. The ideal target is remission, or inactive disease. Your targets may include keeping your disease activity low, controlling your symptoms, and maintaining a good quality of life. You and your rheumatologist will work together to create your treatment plan, including what type of drugs or other treatments you will take. Your rheumatologist can adjust your treatments, such as changing drugs or dosages, to help you achieve your targets and manage side effects or symptoms.

RA should not affect your ability to get pregnant or have a healthy baby. Your rheumatologist will work with you to change your treatment plan if you want to conceive a baby, as some DMARDs, including methotrexate, can cause severe birth defects. Both women and men with RA should use birth control to prevent pregnancy while taking methotrexate or other drugs that could cause birth defects. These drugs should also be avoided while a woman is pregnant or breastfeeding. Women who have RA often experience a reduction in their symptoms while they are pregnant.

RA can have serious long-term effects if you do not seek a diagnosis early and start treatment to control your inflammation. Joints can become painful and stiff, and they can break down and become almost impossible to use. RA can affect internal organs as well, causing inflammation of the eyes, heart, lungs or skin. However, early diagnosis and treatment can help control your inflammation and prevent joint damage. Many people with RA today can avoid joint deformity or even the need to replace severely damaged joints. The best way to avoid joint damage and control your RA is to seek diagnosis and treatment with a rheumatologist as soon as possible. You can also stay fit with regular, joint-friendly exercises, manage your weight, eat a healthy diet and avoid smoking.

It is up to you to tell other people about your RA. You may want to talk to your family first, and let them know about your diagnosis. You may want to tell them about the medicines you will be taking to control your disease and its symptoms. You may want to ease their concerns, and let them know that you will be seeing your rheumatologist regularly to make sure your treatments are on track to achieve your target goals. It is up to you how and when to tell your employer about your RA, but if you need to take time off for visits to your rheumatologist, physical therapist, occupational therapist, or infusion clinic, you may wish to tell them about your diagnosis. It’s important to let them know that you are working with a rheumatologist to manage and treat your RA, and that you need to stick to your treatment plan in order to feel better, prevent joint damage and control your disease activity.