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Autoimmune diseases occur when the immune system mistakenly attacks healthy cells in your body. Rheumatoid arthritis, one type of autoimmune disease, affects joints, leading to pain, inflammation, and swelling. Rheumatoid arthritis can affect your quality of life and ability to participate in everyday activities, but relief from symptoms — and even remission — may even be possible with the right action plan. Knowing your risk of the autoimmune disease rheumatoid arthritis, when to seek care, and treatment options can help you take control of this chronic disease.
Rheumatoid arthritis (RA) is the most common autoimmune arthritis, affecting more than 1.3 million Americans, most of whom are women. Globally, RA affects .46% of the population. The onset of RA can occur at any age, but it usually appears between ages 30 and 50. (Source, Source)
As an autoimmune and inflammatory disease, RA affects the joints in your body. In RA, the lining of the joints becomes inflamed, damaging the joint tissue and causing chronic pain. Rheumatoid arthritis most commonly affects the joints in your hands, wrists, and knees, but other tissues may also be impacted. The disease typically attacks multiple joints simultaneously. (Source)
What Causes Rheumatoid Arthritis?
The exact cause of rheumatoid arthritis is unclear. Yet, scientists believe that a combination of genes and exposure to environmental factors initiates the onset of RA. Certain genes affect your chance of developing RA. Moreover, you are more likely to have RA if you have a family history of this disease. However, just because you have the genes associated with RA does not mean you will develop RA. (Source, Source)
Non-modifiable environmental factors — such as age and sex — influence your risk of rheumatoid arthritis. If you are genetically predisposed, your chance of developing RA increases as you age. Sex also affects your likelihood of RA — women are 2 to 3 times more likely to develop RA than men. Changes in sex hormones that occur with pregnancy can impact your RA; RA may improve during pregnancy only to flare afterward. (Source)
Modifiable environmental factors — such as smoking and diet — can trigger the onset of RA in genetically susceptible people. Cigarette smoking is the strongest environmental risk factor associated with RA. Obesity and a Western diet high in calories and low in fiber also increase risk. Quitting smoking and making healthy dietary changes may help prevent the onset of RA. (Source)
What Is the Difference Between Rheumatoid Arthritis and Osteoarthritis?
Osteoarthritis is the most common form of arthritis. It results from cartilage breakdown due to normal wear and tear on your body. The chance of developing osteoarthritis increases as you age, usually presenting after the age of 45. Symptoms include stiffness, swelling, tenderness, and joint pain that fluctuates in severity. You may also feel a crunching sensation or hear the sound of bone rubbing on bone due to the lack of cartilage. (Source, Source)
Although both involve inflammation and swelling of the joints, symptoms vary between RA and osteoarthritis. Rheumatoid arthritis causes more prolonged joint stiffness in the mornings and tends to affect joints on both sides of the body. While the effects of osteoarthritis are limited to joints, complications from RA can include damage to organs including the heart, kidneys, and skin. During RA flares you may experience flu-like symptoms such as fever, fatigue, and loss of appetite. (Source)
You may be unable to recognize the slight differences in symptoms between forms of arthritis. But your medical provider can diagnose your specific type of arthritis.
How Is Rheumatoid Arthritis Diagnosed?
To diagnose rheumatoid arthritis, your health care provider will review your medical history and conduct a thorough physical examination that may include X-rays, ultrasounds, and laboratory tests. Blood tests look for autoantibodies (antibodies that target your body’s own tissues) or markers of inflammation. You may be referred to a rheumatologist (a medical provider specializing in autoimmune disorders) to guide you through the diagnosis process.
Obtaining an autoimmune disease diagnosis can be difficult and may take time. You can prepare for your medical appointment by keeping a detailed record of symptoms to share with your provider. Treatment following an early diagnosis — within 6 months of the onset of symptoms — may effectively slow or stop disease progression, particularly in managing inflammation. (Source)
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What Are the Stages of Rheumatoid Arthritis?
There are 4 stages of rheumatoid arthritis. Progressively worsening symptoms and mobility characterize each stage.
Stage 1: Early Stage RA
Early stage rheumatoid arthritis is the initial inflammation of the joint and the synovium (the connective tissue that lines the joint capsule). Early stage is considered the first 6 months of symptoms. During this stage, swelling of the joint and synovium causes pain and stiffness.
Stage 2: Moderate Stage RA
Moderate stage rheumatoid arthritis is characterized by the spread of inflammation throughout the joint cavity and into the cartilage. As a result, the joint gradually becomes damaged, as inflammation narrows the joint cavity and cartilage deteriorates. This joint and cartilage deterioration leads to decreased mobility and range of motion.
Stage 3: Severe Stage RA
With severe stage RA, inflammation now destroys the cartilage and the bone. Imaging during this period will show extensive cartilage loss and deterioration around the joint. In addition, deformities may be present at this stage. Symptoms of severe stage RA include increased pain and swelling and further reductions in mobility.
Stage 4: End Stage RA
In end stage RA, the inflammatory process subsides, and joints stop functioning. Rheumatoid nodules may appear, representing the aggressiveness of the disease and signifying a poor prognosis. Symptoms of pain, swelling, stiffness, and loss of mobility are common in stage 4 RA. (Source, Source)
Know that medical treatment and holistic approaches can slow the disease’s progression and help manage symptoms so you can continue living your life.
What Are the Signs and Symptoms of Rheumatoid Arthritis?
Symptoms of RA can ebb and flow, resulting in periods of remission and flares. Signs and symptoms of RA include:
pain, aching, stiffness, tenderness, or swelling in the joints
fatigue or tiredness
loss of appetite
firm lumps (known as rheumatoid nodules) underneath the skin in areas such as the elbow and hands
Early treatment of RA is beneficial for slowing the progress of the disease and reducing the chance of complications. Over time, RA may progress to the point where joints become deformed and you have trouble maintaining your balance, putting you at increased risk of falls. Complications of RA may cause problems in other organs in the body, such as the heart, lungs, and eyes. (Source, Source)
How Serious Is Rheumatoid Arthritis?
If left untreated, RA can cause joint deformity and significantly affect your ability to participate in activities of daily living. Rheumatoid arthritis is a progressive disease that currently has no cure. People with RA are likely to experience multiple flare-ups and increasing disability. However, treatment can significantly help improve functional capacity and decrease disease activity (inflammation).
Serious complications of RA can occur, affecting multiple organ systems and worsening clinical outcomes. There is an increased risk of fracture due to complications such as osteopenia (low bone density) and osteoporosis (bone loss or weakening) that result from not only RA itself but also certain drugs used to treat this chronic disease. Rheumatoid arthritis can contribute to the risk of developing coronary artery disease. Due to the chronic inflammation accompanying the disease, RA is also associated with increased insulin resistance and diabetes. (Source)
There is hope — you may be able to lower your risk of developing complications of RA with early treatment and symptom management using medications and alternative approaches.
How Do You Manage Rheumatoid Arthritis?
While there is no cure for RA, disease management goals are to relieve pain, reduce inflammation, slow or stop joint damage, prevent disability, and maintain or improve your sense of wellbeing and ability to function. Rheumatoid arthritis management options will depend on the severity of inflammation and symptoms, disease progression, predicted course of the disease, and success (or lack thereof) of previous therapies. The most effective care plan for RA will include medication and alternative approaches, such as lifestyle modifications to sleep, physical activity, and dietary changes. (Source)
Medications Reduce Symptoms and Slow Disease Progression
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and corticosteroids such as prednisone can offer temporary relief from RA pain and inflammation. Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate not only alleviate symptoms in the short term, but actually slow disease progression and may even lead to remission. (Source, Source)
Sleep Helps Manage Symptoms
People with RA tend to have lower sleep quality or suffer from sleep disorders. Research has shown that poor sleep is correlated with a low quality of life in people with RA, and sleep disturbances may contribute to higher levels of inflammation. Getting adequate sleep is an integral part of managing symptoms of rheumatoid arthritis and promoting wellbeing. (Source)
Physical Activity Reduces Pain and Helps With Overall Health
Exercise is generally considered safe for people with RA and confers many health benefits. Engaging in physical activity is associated with reduced pain and disability and may improve sleep quality and reduce fatigue. Resistance training may improve mobility. Aerobic exercise helps maintain your ability to do activities of daily living, lessens pain, and over time contributes to lower levels of inflammation. (Source, Source, Source)
Regular physical activity can help with overall health and lower pressure on your joints. The Centers for Disease Control and Prevention (CDC) recommends following the Physical Activity Guidelines for Americans, which call for 150 minutes of moderate intensity exercise and 2 strength sessions per week. Despite a RA diagnosis, you can aim for these recommendations. (Source, Source)
Exercise safely with these tips. When becoming more physically active, start for shorter periods of time at a low intensity, and adjust your activity depending on symptoms. Scale back on physical activity during flare-ups. Consult your medical practitioner if you experience prolonged pain after exercising or notice large increases in swelling that do not improve with rest, medication, or hot or cold packs. (Source)
Dietary Modifications May Improve Symptoms
An anti-inflammatory diet is associated with improved disease activity in people with rheumatoid arthritis. Generally, an anti-inflammatory diet is rich in omega-3 fatty acids, antioxidants, vegetables, and fish. Specifically, fish, berries, and foods high in omega-3 fatty acids have been shown to improve symptoms of RA, whereas alcohol and soft drinks exacerbate symptoms. Research suggests following an anti-inflammatory diet can reduce pain and boost physical function in people living with RA. (Source, Source)
Some supplements, such as spices and fish oil, may help reduce symptoms of RA. Taken in high doses, certain spices — such as saffron, cinnamon, and ginger — may decrease joint inflammation. However, achieving such high doses of 1.5 grams to 2 grams per day can only be done via supplements. One systematic review found that marine oil supplements, rich in the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), reduced pain in people with RA. Be sure to consult with your medical practitioner before starting any supplement for RA. (Source, Source)
The autoimmune protocol (AIP) diet is similar to an anti-inflammatory diet but with a greater emphasis on organic foods full of fiber, antioxidants, and healthy fats. The diet is specifically intended to help manage autoimmune disorders, and may be effective at helping to reduce common symptoms of RA. The Nutritional Therapy Practitioners at WellTheory can work with you to implement the AIP and can help you determine whether supplements might help your RA symptoms.
How Do You Live With Rheumatoid Arthritis?
People with RA can have a successful and fulfilling life. Advancements in medications and holistic approaches can help keep symptoms at bay.
Attending Counseling Can Alleviate Feelings of Depression
Anxiety and depression are more common in people with RA than in the general population, but feelings of isolation or depression that may accompany a diagnosis often disappear as symptoms and energy improve. A systematic review of psychological interventions found that counseling, group therapy sessions, and behavior change interventions reduced symptoms of depression in people with RA. Moreover, these therapeutic strategies seem to help people to cope with RA. (Source)
Talk Therapy and Physical Activity Can Help With Fatigue
Chronic fatigue is one of the most significant symptoms of rheumatoid arthritis, affecting quality of life and activities of daily living. Fatigue due to RA is unpredictable in its duration, frequency, and intensity, and can feel overwhelming and endless. Fatigue impacts multiple systems, affecting physical activity engagement, cognitive function, personal emotions, and social interactions. (Source)
A systematic review found lower levels of fatigue in people who participated in psychosocial interventions or regularly engaged in physical activity. Adopting coping strategies — such as breaking down tasks over more extended periods, prioritizing activities based on how you feel, or devoting specific times to managing bad symptoms — can also help manage symptoms of fatigue associated with your RA. (Source, Source)
Above all, know that you are not alone — millions of others are affected by RA. Your medical provider and the Care Team at WellTheory are here to help you navigate this condition.
Sustained Remission Is Possible
Changes in the treatment approach to rheumatoid arthritis have made sustained remission possible. Early diagnosis and management of RA affect the likelihood of achieving and sustaining remission. Aggressive therapy with DMARDs, lifestyle modifications, and frequent follow-ups and support from a health care practitioner contribute to remission. Entering remission within 5 years of an RA diagnosis increases your chance of sustaining remission. The farther you are into remission, the more likely you will remain disease-free. However, remission is still possible even if the disease is more established.
With sustained remission, you can taper or even completely cease using medications (with guidance from your doctor), such as DMARDs — you may even return to a state of general health. Disease activity is suppressed in sustained remission and your immune system may fully regain immune tolerance, or the ability to tell foreign pathogens from your body’s own cells and tissues. (Source)
The Bottom Line on the Autoimmune Disease Rheumatoid Arthritis
Living with rheumatoid arthritis can be challenging, both physically and mentally. Advocating for yourself is important when managing this disease and its symptoms. In addition, you are in the driver’s seat regarding the support and care you need and deserve. Know that it is possible to lead a fulfilling life with rheumatoid arthritis — you may even be able to put your disease into remission.