Penn Rheumatology

Rheumatoid Arthritis Treatment

Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissue. It can also affect other organs.

The cause of rheumatoid arthritis is unknown. It is considered an autoimmune disease. The body's immune system normally fights off foreign substances, like viruses. But in an autoimmune disease, the immune system confuses healthy tissue with foreign substances. As a result, the body attacks itself.

Rheumatoid arthritis can occur at any age. Women are affected more often than men. Rheumatoid arthritis usually affects joints on both sides of the body equally. Wrists, fingers (but not fingertips), knees, feet, and ankles are the most commonly affected joints. The course and the severity of the illness can vary considerably. Infection, genes, and hormones may contribute to the disease.

Symptoms

The disease often begins slowly, with symptoms that are seen in many other illnesses:

  • Fatigue
  • Loss of appetite
  • Low fever
  • Weight loss
  • Weakness

Eventually, joint pain appears. Morning stiffness, which often lasts more than an hour, is very common. Joints can become warm, tender, and stiff when not used. Joint pain is often felt on both sides of the body.

The joints are often swollen and feel warm and boggy (or spongy) to the touch. Over time, joints lose their range of motion and may become deformed.

Other symptoms that could be related to RA include:

  • Chest pain when taking a breath (pleurisy)
  • Eye burning, itching, and discharge
  • Nodules under the skin (usually a sign of more severe disease)
  • Numbness, tingling, or burning in the hands and feet

Joint destruction may occur within one to two years after the disease first appears.

Diagnosis

Specific blood tests are available for diagnosing rheumatoid arthritis and distinguishing it from other types of arthritis. These tests are called "rheumatoid factor" and "anti-CCP antibody." Rheumatoid factor is positive in approximately 75-80 percent of patients with RA. Other tests that may be done include:

  • Complete blood count
  • C-reactive protein
  • Erythrocyte sedimentation rate
  • Joint X-rays and sometimes joint ultrasound or MRI
  • Synovial fluid analysis

Regular blood or urine tests should be done to determine how well medications are working and whether drugs are causing any side effects.

Treatment

Rheumatoid arthritis usually requires lifelong treatment, including medications, physical therapy, exercise, education and possibly surgery. Early, aggressive treatment for rheumatoid arthritis can delay or prevent joint destruction. More information on the treatment of rheumatoid arthritis can be found on the American College of Rheumatology.