Overview and Frequently Asked Questions
Rheumatoid Arthritis is an autoimmune disease which causes pain, swelling and stiffness to the joints. It can occur at any age, although is seen more often in middle aged women. If not promptly treated, it can cause permanent damage to the bones surrounding the joints, which leads to pain, deformity, and loss of function. If left under-treated, it can also affect other organs. While we do not yet have a permanent cure, we are fortunate today to have many good options to treat rheumatoid arthritis.
Anti-inflammatories, or NSAIDS, act quickly to try to decrease pain and swelling, but they do not treat the underlying disease. Examples include aspirin, ibuprofen, naprosyn, and diclofenac.
Corticosteroids (cortisone), such as prednisone, are more powerful anti-inflammatories that are very effective, but can have severe side effects and their use should be limited in consultaton with your doctor. A cortisone joint injection is a safe alternative to pills.
Disease Modifying Anti-Rheumatic Agents, or DMARDS, act slowly but treat the underlying cause of rheumatoid arthritis and in time, improve pain, swelling, stiffness and function. Biologic DMARDs are a new class which target specific inflammatory proteins in the body.
Patients with rheumatoid arthritis often need a combination of different medications to treat their condition. Over time, many people with rheumatoid arthritis only know they have rheumatoid arthritis because of the medications they require. Unfortunately, the arthritis can return if the medications are stopped.
Exercise, a good diet, and education remain crucial elements in the treatment of rheumatoid arthritis. There is also evidence suggesting Omega-3 fatty acids, found in fish and supplements, may add to the management of RA patients in some cases.
What is Rheumatoid Arthritis?
Rheumatoid Arthritis, or RA, is an autoimmune disease where your immune system causes inflammation in your joints.
Why does RA happen?
No one really knows. There is as of yet an unidentified trigger which causes your immune system not to recognize the cells in your joint as belonging to you. Because of this, they attack these cells, causing the clinical symptoms.
Is there something I could have done to prevent RA?
Because we do not fully understand why RA happens, we do not know if anything could prevent it. We do know there is a genetic predisposition for some patients for RA, meaning it may be inherited. We also know smoking increases your risk of developing RA, particularly if you have the right genetic makeup. It’s never too late to stop smoking though; even quitting now may decrease the severity of RA and make it easier to treat effectively.
Who gets RA?
Anyone can get RA. On average, every 1 in 100 people have RA. It is not related to age, as patients from 6 months of age to over 80 years old can develop RA for the first time. The peak age to develop RA is in the fifth decade. More women than men develop RA.
What are the symptoms in RA?
RA starts slowly in most people, developing over weeks. However, it can develop suddenly too. Most people notice joints becoming increasingly stiff, worse in the morning and better with activity. There can also be joint pain, decreased range of motion in the joints, inability to do some activities (Eg turning door knobs, difficulty with keys, etc.), swelling around joints and fatigue.
Which joints are commonly involved?
While almost any joint can be affected by RA, the most common ones are the small joints in the hands and feet. Wrists, elbows, shoulders, neck, hips, knees and ankle can also all be involved. It is unusual however to have lower back involvement because of RA.
What is the difference between RA and osteoarthritis?
While RA is an autoimmune disease, osteoarthritis, or OA is often described as a disease of “wear and tear.” In other words, for most people with osteoarthritis, the cartilage in the joints can wear out because of mechanical damage from years of use. OA is very common; 10% of people will develop OA in their lifetime and that number increases with age. Common joints in OA are weight bearing joints and the spine.
How do you diagnose Rheumatoid Arthritis?
RA is a clinical diagnosis made by your rheumatologist based on your medical history and the findings on your physical examination.
Is there a blood test which can confirm the diagnosis?
There are a number of blood tests which can be and are performed by your rheumatologist to help make the diagnosis of RA. They may look for signs of inflammation, or antibodies which can be associated with RA. However, these tests do not diagnose RA. Many patients are diagnosed with RA with completely normal blood tests. RA is diagnosed based on your medical history and physical exam findings.
How about x-rays?
There are typical findings on x-rays in patients with rheumatoid arthritis. However, we hope never to see them! The goal of treatment is not only to prevent pain, stiffness, swelling and loss of function, but also to prevent bone changes. If RA is diagnosed early enough and treated properly, the chance of bone changes is reduced. Hopefully, your x-rays are still normal when diagnosed with RA.
Can RA affect more than just joints?
Unfortunately, RA is not always just limited to joints. Some patients can have involvement of other parts of the body, including skin, eyes, heart, lungs, nerves, blood and blood vessels. Often, these findings are in patients with more severe joint involvement, but it reinforces the need to treat RA.
Is there a cure for RA?
No, there is currently no cure for rheumatoid arthritis. However, there are a growing number of medications which have been shown to be very effective in treating RA, reducing patient symptoms and slowing bone changes. Click here for a general overview for RA treatment. Please see the medications page for more specific information on particular drugs.
DMARDs sound dangerous. What can happen if I don’t want to use them?
DMARDs, or Disease Modifying Anti-Rheumatic Drugs, are the class of choice to treat RA. While many of them do have the risk of side effects, which can particularly sound scary for patients who have never required medications before, their benefit outweighs the risk. Your rheumatologist has training and experience with these medications, and would only prescribe a DMARD if it was appropriate, if it was thought to be helpful in treatment, and that benefit outweighed any risk. Keep in mind, it is likely more dangerous to let RA continue without treatment.
Are there any natural treatments that have been proven to be helpful?
There are many different products patients use in the hope it would help treat their RA. Unfortunately, there has been little research in this area to recommend anything specific. However, if you do want to try a natural treatment, please be sure to discuss it with your rheumatologist to ensure its safety with your other medications.
Other suggestions include:
There is some evidence that Omega-3 supplementation may help reduce joint swelling, although not in place of other treatment.
Maintaining joint mobility and strength with regular exercise is not only safe, but encouraged and beneficial.
Smoking cessation may make it easier to treat RA and therefore lead to a quicker recovery, besides its other harmful effects.
RA Education is important. Please feel free to read more about RA at your leisure. If you have questions for your rheumatologist, remember to bring them with you to your next appointment. Some centres offer comprehensive educational programs.
What is the prognosis for rheumatoid arthritis?
Older data suggests patient with RA may die younger than those without RA as well as develop disabilities. However, with appropriate DMARD therapy and newer medications now available, the prognosis for RA is becoming brighter.