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.

Causes #

• The exact cause of rheumatoid arthritis is unknown.

• Researchers think it’s caused by a combination of genetics, hormones and environmental factors.

• Normally, your immune system protects your body from disease. With rheumatoid arthritis, something triggers your immune system to attack your joints.

• An infection, smoking or physical or emotional stress may be triggering.

Symptoms #

• Pain, swelling, stiffness and tenderness in more than one joint.

• Stiffness, especially in the morning or after sitting for long periods.

• Pain and stiffness in the same joints on both sides of your body.

• Fatigue (extreme tiredness).

• Weakness.

• Fever.

Diagnosis #

The blood tests look for inflammation and blood proteins (antibodies) that are signs of rheumatoid arthritis. These may include the following

• 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 the following

• X-rays.

• Ultrasounds.

• Magnetic resonance imaging (MRI) scans.

Treatment #

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 the following

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

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).