Young lady with wrist pain due to rheumatoid arthritis

Rheumatoid Arthritis 101: Symptoms, Causes, Stages, Diagnosis & Treatment

Learn all you need to know about rheumatoid arthritis, including its symptoms, causes, stages, diagnosis, and the treatment options available.

by Lorraine Bunag, R.N.

What is Rheumatoid Arthritis?

When we hear the word arthritis, many of us immediately associate it with achy joints. But, did you know that there are over 100 kinds of arthritis? The most common type is osteoarthritis (OA), which often happens due to wear-and-tear, followed by rheumatoid arthritis (RA). Other forms of arthritis include gout and psoriatic arthritis. 

Rheumatoid arthritis is both an autoimmune and inflammatory disease. The autoimmune part indicates that a person who experiences RA has a somewhat “faulty” immune system, wherein the immune cells mistakenly attack healthy joints. These attacks usually happen in many joints at the same time and cause inflammation or swelling, leading to joint stiffness and pain.

While rheumatoid arthritis most commonly affects the joints in our knees, hands and wrists, it can affect any joint in the body. It’s also worth mentioning that RA can also affect the other organs, including the eyes, lungs, and heart.

Osteoarthritis vs Rheumatoid Arthritis

Osteoarthritis or rheumatoid arthritis are the two most common forms of arthritis and share many of the same symptoms. However, there are key differences between the two. Osteoarthritis occurs due to the wear-and-tear of the cartilage surrounding the joints. Unlike RA, it is not an autoimmune disease and usually starts in just one joint rather than affecting multiple bones at once.

Rheumatoid Arthritis Symptoms

The signs and symptoms of rheumatoid arthritis vary from person to person; but generally, joint-related symptoms include:

  • Pains, aches, and stiffness in more than one joint at a time
  • Swelling and tenderness in more than one joint
  • Symmetrical symptoms, which mean you will most likely observe symptoms on both sides (both hands, both knees, etc.)
  • Fever
  •  Weakness or fatigue
  •  Weight loss

Additionally, when it comes to RA symptoms, it’s useful to remember the following:

Disease Progression Typically Varies

Rheumatoid arthritis usually progresses gradually or slowly. At first, you will feel aches and pains in the little joints, particularly the joints that connect their fingers and hands, or toes and feet. As the disease progresses, you may notice that the pain and stiffness has spread to your bigger joints, specifically your ankles, knees, elbows, wrists, and shoulders. In some cases, people may also experience RA rapidly.

There Could Be Flares and Remissions

People with rheumatoid arthritis usually have alternate periods of flares and remissions. Flares occur when the signs and symptoms get worse; remission happens when the symptoms fade or disappear.

You May Experience Non-joint Symptoms

According to reports, approximately 40% of people who have RA also develop non-joint symptoms that affect different organs. Examples of these non-joint symptoms include:

  • Rheumatoid nodules or growths commonly found in the exterior surfaces of elbows and arms.
  • Cardiopulmonary conditions such as pleurisy, wherein the layers covering the lungs become inflamed.
  • Atherosclerosis where the arteries get thicker due to plaque or cholesterol buildup. According to reports, atherosclerosis is the leading cause of death in people with RA.
  • Eye conditions like dry eyes and keratoconjunctivitis, a type of inflammation occurring in the conjunctiva, the surface covering the eyeball.

Rheumatoid Arthritis Causes

As of now, the exact cause of RA is yet to be determined. But, what’s clear to scientists is that rheumatoid arthritis happens because the person’s immune system attacks the body’s healthy cells.

Research shows that the target of the attacks is the synovium or the connective tissues covering the joints. An attack will trigger inflammation, which eventually thickens the synovium. Over time, the thickened synovium will cause damage to the cartilage within the joint. This becomes a concern since the cartilage serves as the bone’s “shock-absorber.” Now, the damage to the cartilage will spread to the tendons and ligaments holding the joints together, and then to the bone itself. In the long run, and especially without appropriate management, bone misalignment and deformities may set in.

But, what sets these immune attacks in motion is still unclear. Experts say that it could be one or a combination of the following risk factors.

Rheumatoid Arthritis Risk Factors

Age

According to the Center for Disease Control (CDC), RA can happen anytime, but the risk increases with age. In most cases, the symptoms manifest when the person is in their sixties.

Gender

RA is more common in women than in men.

Genetics & Heredity

The likelihood of developing rheumatoid arthritis increases in people born with a particular gene called HLA (human leukocytes antigen) class II genotypes. Furthermore, this gene seems to worsen the symptoms. Those who have this gene and other risk factors such as obesity and smoking have the highest risk of RA.

Smoking

Reports say that smoking not only heightens your risk but also increases the severity of your symptoms.

Obesity

Studies show that people who are overweight or obese, especially those aged 55 or younger, are at a higher risk of experiencing RA. The trend is that the higher your weight is, the more at risk you become.

Live Births

Women who have not given birth are more at risk than women who already got pregnant and gave birth.

Environmental Factors

And finally, some factors in the environment also heightens the risk of developing rheumatoid arthritis later in life. For instance, children whose mothers smoke cigarettes are twice as likely to develop RA than children with non-smoking mothers. Exposure to chemicals like silica and asbestos also appear to increase a person’s risk.

Types of Rheumatoid Arthritis

There are two types of rheumatoid arthritis.

Seropositive RA

Seropositive rheumatoid arthritis means that the person was found to have the rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCPs), which is a type of antibody. This means that if you have seropositive RA, your body is continuously attacking healthy cells. According to experts, around 60 to 80% of people with RA are RF-positive, making it the more common RA type.

Seronegative RA

Seronegative rheumatoid arthritis happens when the doctor doesn’t see the RF and anti-CCPs. If this is the case, the person will most likely need to undergo other laboratory tests to verify the diagnosis. Seronegative RA tends to be less severe than seropositive RA.

Rheumatoid Arthritis Complications

We’ve briefly touched some of the RA complications when we discussed the non-joint symptoms. In this section, we’ll describe the complications in detail.

  • Sjögren’s syndrome – This refers to the RA-related inflammation in the glands of the mouth and eyes that cause dryness.
  • Scleritis – The inflammation of the sclera (white of the eye). This can be dangerous for the eyes, hence prompt treatment is necessary.
  • Lung issues – Due to rheumatoid arthritis, nodules can develop within the lungs. Furthermore, respiratory symptoms such as coughing, shortness of breath, and chest pain can occur due to pleurisy.
  • Pericarditis – RA can also trigger inflammation in the pericardium or the tissues covering the heart. Pericarditis often causes chest pain which changes in intensity depending on the person’s position.
  • Anemia – Reports say that rheumatoid arthritis can reduce the person’s red blood cells, resulting in anemia.
  • Felty’s syndrome – It happens when the person with RA experiences enlarged spleen and reduced white blood cells. This may make them vulnerable to infections.
  • Osteoporosis – According to experts, RA itself, along with some medications used in treating RA, can weaken the bones and trigger osteoporosis.

Rheumatoid Arthritis Diagnosis

To diagnose rheumatoid arthritis, the doctor will have to conduct a health interview along with physical examination. Afterwards, he or she will order an x-ray and some laboratory tests.

Health Interview and Physical Assessment

During the interview assessment, the physician will ask the following questions:

  • Have you experienced joint stiffness in the morning that lasts for more than one hour?
  • Do you have swelling in three or more joints?
  • Do you have swelling in your wrists, hands, or finger joints?
  • Are your symptoms symmetrical, which means you experience them on both sides of your body?
  • How long have you been experiencing your symptoms?

In most cases, the person must be experiencing symptoms for at least 6 weeks for a doctor to give an RA diagnosis.

While conducting the interview, the doctor will also check your joints for visible tenderness, stiffness, and swelling. He or she will also look for other non-joint symptoms such as rheumatoid nodules.

Blood Tests

To diagnose RA, the doctor will also take a sample of your blood to check for the presence of the RF and anti-CCP antibodies to determine the type of RA, if any.

Furthermore, people with rheumatoid arthritis often have elevated erythrocyte sedimentation rate and C-reactive proteins.

Imaging Tests

Finally, the doctor may order an x-ray to look for swelling and its severity. Other imaging tests such as MRI and ultrasound scans will also help in determining the disease and its progression. 

Stages of Rheumatoid Arthritis

Based on your health interview, physical assessment, and laboratory and imaging test results, the doctor will be able to identify the stage of your RA. Generally, there are two ways to classify RA stages: one is based on the severity of the condition, and the other depends on how the condition is affecting your life.

Stage 1 RA or Early RA means there are no signs of bone damage, but there can be bone thinning. When a person reaches Stage 5 or Terminal Progression, it means that the bone has sustained significant damage and other concerns such as muscle atrophy, bone deformity, and soft tissue abnormalities may already be present.

As for the person’s functional status, Class 1 indicates that you can still perform your activities of daily living (ADLs) completely and independently. As the classes go up, the limitations in performing ADLs also mount up. Once a person is under Class 4, it indicates that he or she has limited capacity to perform self-care, work, and other activities.

The goal of treatment is to prevent disease progression, thereby reducing joint damage and symptoms, and maintaining the person’s quality of life. 

Rheumatoid Arthritis Treatment

At this point, you must be wondering: is there a cure for rheumatoid arthritis? The short answer is no; as of now, RA is not a curable disease. However, there are various ways to effectively manage the condition.

Mainly, rheumatoid arthritis treatment centres on 3 things, which are:

  • To prevent joint damage
  • To manage the signs and symptoms; and
  • To maintain your quality of life

Reports indicate that joint damage typically happens within 2 years of identifying RA. That’s why going to the doctor as soon as you experience any of the symptoms is crucial as it gives you enough time to prevent the damage.

Medications

One of the most common ways to manage arthritis is through drugs. After your doctor ascertains that you have rheumatoid arthritis, he or she might order one or a combination of the following medications:

  • NSAIDs – To help manage pain, the doctor may give you over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs are ibuprofen and naproxen.
  • Steroids – Sometimes, people with rheumatoid arthritis also need steroids, like prednisone. This medication not only reduces inflammation, but also slows down joint damage. It’s not advisable for a person to take steroids over the long term, that’s why when doctors order it, the usual goal is to manage acute symptoms and eventually lower the dose.
  • DMARDs – Disease-modifying anti-rheumatic drugs (DMARDs) work by slowing down the disease progression and preventing tissue and joint damage. Examples of these medications include methotrexate and hydroxychloroquine. There are also newer kinds of DMARDs known as biologic agents that manage RA by targeting the part of the immune system that triggers the attack on joints and tissues. Examples include infliximab and golimumab; these drugs are also known as anti-TNF drugs or Tumor Necrosis Factor (TNF) Blockers.

Do note that most DMARDs don’t work immediately. You may need to wait a couple of weeks or months for them to take effect. For instance, people who take methotrexate may need 4 to 6 weeks before they show signs of improvement; those who take hydroxychloroquine may need 2 to 3 months. Biologic agents tend to work faster; with some taking effect after just 2 weeks and others working within 4 to 6 weeks.

When it comes to medications, be sure to follow your doctor’s orders as most of these medications come with precautions. For one, DMARDs (including biologic agents) usually reduce the immune system’s capacity to fight infection. Hence, the physician may not order it for people with existing serious infections.

Surgery

In cases where medications are not able to control or prevent bone damage, the doctor may resort to surgery. If ever, you may be presented with the following options: 

  • Synovectomy, a procedure that removes the inflamed synovium (lining of the joints).
  • Joint fusion, which combines two joints for better alignment and pain relief.
  • Tendon repair, in cases where joint inflammation has already damaged the tendons.
  • Total joint replacement, wherein the doctor removes the damaged part of the joint and replaces it with prosthesis.

Living with Rheumatoid Arthritis

Besides medications and surgery, the doctor will definitely point out some important reminders when it comes to your lifestyle, diet, and possibly, even therapy.

Lifestyle Changes

Regular Exercise

If you have rheumatoid arthritis, don’t forgo physical activity in the fear that it will trigger pain. According to experts, staying physically active strengthens the muscles around your joints, which helps to prevent or reduce damage. Working out also releases endorphins, which are the body’s natural pain killers.

Furthermore, exercising maintains your quality of life by preventing a range of chronic diseases including obesity, cardiovascular conditions, and diabetes. The CDC recommends at least 30 minutes of moderate physical activity daily. If that seems daunting, one quick tip is to break up this 30 minutes into 3 periods of 10-minute workouts.

The most important thing here is to work closely with your doctor and find out what exercises are suitable for your condition.

Stop Smoking

If you’re currently smoking, it’s best to consider quitting the habit. Smoking not only worsens RA symptoms, but also triggers various health conditions that may make it hard for you to manage your condition.

Pain Reduction

When the symptoms of rheumatoid arthritis flare up, there are several remedies you can perform that do not necessarily involve medications.

One example is heat and cold application. Applying heat compress helps muscles relax and reduce tension; on the other hand, cold application helps to numb the pain and reduce swelling.

Relaxation techniques can also help to manage RA symptoms. Examples of relaxation techniques are deep breathing exercises and guided imagery, where you focus your imagination on peaceful or calming pictures.

Rheumatoid Arthritis Diet

One of the most important aspects of managing rheumatoid arthritis is through diet and nutritional therapy.

First, through diet (and exercise), you’ll be able to maintain a healthy weight. This is important seeing that excess weight can put pressure on your joints and worsen your RA symptoms. Secondly, choosing your food carefully based on their ability to prevent or promote RA activity can potentially ease rheumatoid arthritis symptoms.

A Healthy Diet for Rheumatoid Arthritis

People with RA are encouraged to have a balanced diet that maintains a healthy weight. This healthy diet generally means that you need to:

  • Eat a variety of food; don’t focus on just a few kinds of foods, even if they are healthy.
  • Exercise while you are consuming a balanced diet.
  •  Have plenty of grains, fruits, and vegetables.
  • Choose food that’s low in fat, cholesterol and saturated fats.
  • Consume sugar in moderation.
  • Consume alcohol in moderation.

Do take note that this general structure of a healthy and balanced diet may be suitable for most, but not all. The ideal diet for you may look slightly different depending on your individual health condition. The best course of action is to talk to your doctor about your unique nutritional needs.

Dietary Factors that Prevent RA Activity

According to a study, several factors can prevent rheumatoid arthritis activity. In other words, these factors can potentially reduce the symptoms of RA:

  • Healthy eating patterns, such as the one described above, or one ordered by your physician
  • Mushrooms
  • Citruses, like freshly squeezed orange juice
  • Dairy
  • Probiotic like Bacillus coagulans
  • Fish oil, alone or together with alpha-linoleic acid and vitamin D
  • Mediterranean diet
  • Low-sodium diet
  • Spices rich in polyphenols
  • Berries and spinach

Dietary Factors that Promote RA Activity

The same report also identified that the following dietary factors may trigger or worsen your RA symptoms:

  • Sugary foods and drinks rich in fructose; examples include sweetened sodas, fruit drinks, apple juice, and fructose corn syrup
  • Plant seeds containing lectins
  • High-fat diet
  • Obesity

Physical and Occupational Therapy

Not all people who have rheumatoid arthritis need physical or occupational therapy, but for some, it’s an essential part of the treatment plan. In the event that your doctor sends you to a physical or occupational therapist, please note that your sessions will focus on at least one of the following goals:

  • To devise a workout plan – The therapist will formulate an appropriate workout routine for you.
  • To teach you new ways of doing things – The occupational therapist will teach you news ways of doing things to prevent flares or at least reduce pain. For instance, during one of your sessions, the therapist might show you how to pick up objects using your forearms so that you don’t need to use your hands that much.
  • To give you suggestions on assistive devices – Finally, the therapist might give you suggestions about the use of assistive devices that’ll reduce your workload. Case in point, there are kitchen tools that have special grips to make it easier for people with RA to use them. Likewise, splinting the fingers may reduce the risk of developing deformities.

If you’re looking for an occupational therapist, you can consider Homage’s Occupational Therapy Service. Our occupational therapists are certified under the Ministry of Health’s Allied Health Professions Council (AHPC) and can give you a home visit. We also have certified physiotherapists who can attend to your arthritis problems at home.  

Worried About Rheumatoid Arthritis?

If you observe any of the signs and symptoms of RA, the best course of action is to consult a doctor in the nearest clinic or hospital. If it’s difficult for you to get to a clinic, you can readily consult one of our online doctors or house call doctors.

The bottom line is that you should avoid delaying your health. Remember that the sooner you get a diagnosis, the earlier you can start treatment strategies, which significantly improves long-term outcomes.


Need care support for rheumatoid arthritis? From meal preparation and simple exercises to therapy and pain management, our Care Pros at Homage can help. Reach out to our Care Advisors at 6100 0055 to learn more.

References
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  8. William C. Shiel Jr. (n.d.). Rheumatoid arthritis (RA) symptoms, treatment, diagnostic tests, diet, causes. MedicineNet. Retrieved January 2, 2021, from https://www.medicinenet.com/rheumatoid_arthritis/article.htm
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About the Writer
Lorraine Bunag, R.N.
Lorraine is a registered nurse who spends most of her time writing informative articles on health and wellness. At the end of the day, she relaxes by reading a book or watching documentaries about unsolved mysteries.
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