Your immune system works hard to keep you disease-free. Sometimes, however, your defenses go awry, and your immune system attacks the healthy tissues in your body by mistake. Conditions like this are known as autoimmune diseases, and there are many types, affecting different areas of your body. Autoimmune arthritis affects your bones, joints, and sometimes, even your skin. The most common type of autoimmune arthritis is rheumatoid arthritis.
What Is Rheumatoid Arthritis?
When you have rheumatoid arthritis (RA), your immune system targets the lining of your joints, or the synovium, which can cause inflammation that slackens the ligaments that support your joints. When your joints no longer have stability, they are more easily damaged.
While rheumatoid arthritis can start at any age, it usually begins between the ages of 40 and 60 and affects over 1.3 million Americans — 75% are women. Without treatment, RA can increase your risk of heart attack or stroke and lead to irreversible joint damage. Fortunately, early treatment can reduce serious complications and joint damage, as well as help you effectively manage pain.
Stages and Types of Rheumatoid Arthritis
There are four stages of rheumatoid arthritis:
- Early-stage rheumatoid arthritis: The inflammation of the joint and synovial tissue begins, causing symptoms of pain, stiffness, and swelling.
- Moderate rheumatoid arthritis: The synovial tissue swelling begins to cause cartilage damage. New symptoms of reduced mobility and range of motion are evident.
- Severe rheumatoid arthritis: Bone and cartilage are being destroyed. Physical deformities and reduced muscle strength may occur.
- End-stage rheumatoid arthritis: The inflammation stops but the affected joints are so damaged by the formation of fibrous tissue and bone fusing that they no longer function. You will continue to experience symptoms that include stiffness, mobility loss, and pain.
Symptoms and Causes
The symptoms associated with rheumatoid arthritis are a result of your immune system’s misguided attack on your otherwise healthy tissues. Symptoms include the following:
- Joint pain, swelling, redness, and warmth
- Lasting joint stiffness that is worse after being inactive (such as in the mornings)
- Reduced range of motion
- Weight loss
- Joint deformity
- Symmetrical symptoms (both sides of the body are affected equally)
- More than one joint is affected
- Small joints (hands and feet) are affected first
Symptoms of more advanced RA include:
- Eye problems such as pain, redness, and light sensitivity
- Dry mouth
- Gum irritation
- Skin nodules
- Shortness of breath
- Nerve damage
Prevention and Risks
Some of the risk factors associated with rheumatoid arthritis are preventable, and others are beyond your control, but there are certain changes you can make to your lifestyle that can prevent certain risks.
Risk factors you can’t control include:
- Gender: Women are more susceptible than men.
- Age: RA is more common after age 40.
- Family history: Your risk increases if you have a family member with RA.
Some of the risk factors you can control include:
- Smoking: It increases both risk and severity of RA.
- Environmental toxins: Examples include asbestos and silica.
- Obesity: Being overweight increases your risk of developing RA.
Diagnosis and Tests
Some of the symptoms of rheumatoid arthritis, such as inflammation and pain, are also symptoms of other conditions, which can make early-stage RA difficult to diagnose. Your doctor will review your symptoms and assess you for characteristics of the condition, which include the following:
- Joint swelling
- Joint warmth
- Joint redness
- Altered reflexes
- Reduced muscle strength
While there is no single blood test to diagnose rheumatoid arthritis, your doctor can order tests to look for markers in your blood that indicate inflammation. Imaging tests such as ultrasounds, x-rays, and MRI can allow your doctor to see the progression of your condition.
Treatment, Procedures, and Medication
Your family doctor is the first person you should visit if you have concerns about symptoms or even questions about your family history. Your doctor may refer you to a rheumatologist who specializes in arthritis as well as other bone, muscle, and joint diseases. If you need therapy to maintain your flexibility or a surgeon to repair or replace a joint, your doctor can help you find the right professional to help manage your particular condition.
There is no cure for rheumatoid arthritis, but there are drugs that can help. Early treatment with medications can reduce the level of permanent joint damage. These medications include:
- DMARDs (disease-modifying antirheumatic drugs) slow down the disease progression.
- NSAIDs (non-steroidal anti-inflammatory drugs) reduce pain and inflammation.
- Steroids slow down damage to joints in addition to reducing pain and inflammation.
- Biologic drugs, such as tofacitinib and etanercept, which reduce your immune system response so it won’t attack your joints as much.
Your doctor may also recommend physical therapy to help you maintain joint flexibility. In some cases, surgery is necessary to repair or replace damaged joints.
Healthy Lifestyle Tips
In addition to a treatment plan suggested by your doctor, you can manage your rheumatoid arthritis with certain lifestyle changes. Regular exercise not only increases your muscle strength, but it also fights fatigue and improves your overall health. Try low-impact, gentle activities such as walking and avoid aggravating painful joints.
Stress management techniques such as guided imagery and relaxation exercises can help reduce any discomfort you might experience. Studies have linked anxiety with an increase in RA symptoms, possibly due to changes in your nervous system that stress causes.
Some lifestyle changes that can help alleviate certain symptoms include the following:
- Quit smoking.
- Maintain a healthy weight.
- Get proper sleep.
- Schedule downtime.
- Maintain social connections.
“For older adults suffering from rheumatoid arthritis, who often also already have limited mobility due to age, managing the disease and maintaining an active lifestyle can be especially challenging,” said Kumar Dharmarajan, MD, a cardiologist, geriatrician, and the Chief Scientific Officer at Clover Health. Here are four tips Dr. Dharmarajan recommends to help manage RA:
- Use warmth to help loosen and lubricate stiff joints: “Whether it is a hot bath or shower, a heating pad, or a comfy sweater, keep your afflicted joints warm to reduce pain and maintain mobility,” said Dr. Dharmarajan “It can also be helpful to create a nighttime ‘warming’ routine. Many patients with RA have difficulty sleeping through the night due to discomfort, so ensuring your joints are warm before getting into bed, and while sleeping, can improve your rest.”
- Use a journal or smartphone to keep track of your symptoms: “In instances of increased pain, make sure to take note of the things you’ve eaten and your activity throughout the day, including your medication and sleep schedules,” said Dr. Dharmarajan. “This will help you recognize patterns and learn what things to avoid to help prevent RA flare-ups. You can also try an app for pain management and tracking, medication reminders, mood tracking, and more, such as RheumaHelper, and MyRA.”
- Find a support network — and don’t be afraid to ask for help:“Being diagnosed with RA can be confusing and scary,” said Dr. Dharmarajan. “Find someone you can confide in and trust to help you run errands, walk your dog, or drive you to appointments, especially at the beginning. One-third of those with chronic arthritis also suffer from depression, so it’s crucial to find the right resources for you. It may be helpful to also find support within the RA community, whether from advocacy organizations, blogs, or in-person support groups.”
- Upgrade your wardrobe: “For many with RA, once simple tasks like tying your shoes or buttoning up a shirt can be very painful,” said Dr. Dharmarajan. “Remove that barrier from your daily routine by creating an RA-friendly wardrobe. Consider replacing tennis shoes with slip-on shoes, and choosing pants and jackets with zippers instead of buttons to make your morning easier.”
Food and Nutrition
What you eat affects your health, and can, therefore, help reduce your rheumatoid arthritis symptoms. The following are foods that can reduce inflammation and ease RA symptoms:
- Coldwater fish such as herring, salmon, and tuna
- Fish oil supplement
- Whole grains
- Extra virgin olive oil
- Nuts such as almonds and pistachios
- Vitamin D-rich foods such as eggs
Other food can increase inflammation and make your symptoms worse. Menu items to avoid include:
- Grilled or fried meat
- Processed snack food
- Refined sugar
Rheumatoid arthritis is ongoing and debilitating and potentially disfiguring, but it can be managed and minimized with a proactive effort on your part. Keep track of any symptoms you may be experiencing, and never hesitate to visit your doctor for a check-up or even just to ask questions. You can impact the progress of your condition by taking action and seeking help.