Rheumatoid Arthritis (RA): Symptoms, Causes & Treatment

Marcelle Pinheiro
About the author: Marcelle Pinheiro
Physiotherapist
November 2021

Rheumatoid arthritis (RA) is a chronic inflammatory auto-immune disease in which the immune system produces antibodies that attack healthy body cells, causing inflammation in the joints, especially of the hands, feet, wrists and knees. In some cases, rheumatoid arthritis can also affect the skin, eyes, lungs, heart and blood vessels.

Any joint affected by rheumatoid arthritis gets it's lining inflamed, causing symptoms such as chronic pain, swelling, difficulty holding objects or walking, and even deformity of the joint. Since this type of symptoms can greatly impact daily life, it's important that any suspicion of rheumatoid arthritis is checked by a rheumatologist who will run some tests to confirm the diagnosis.

Treatment for rheumatoid arthritis should always be oriented by a rheumatologist and it normally includes the use of medication, the adoption of an anti-inflammatory diet and physiotherapy sessions, which help relieve pain and swelling in the joints, improving life quality.  

Main symptoms

In it's initial stage, rheumatoid arthritis produces some mild symptoms such as light pain or discomfort in the joints, which can start suddenly and worsen with time. 

Typical symptoms of RA usually happen in the more advanced stages of the disease, and include: 

  • Intense pain and swelling of the joint;
  • Pain in more than one joint;
  • Burning sensation;
  • Redness of the joint;
  • Difficulty moving the affected joint, especially after waking up;
  • Lumps in the joint;
  • Weight loss;
  • Fever;
  • General weakness or fatigue.

Pain and swelling is frequently identified on the joints of both sides of the body, such as the two hands or the two feet.

In addition, rheumatoid arthritis can also affect other parts of the body such as the eyes, heart, lungs, causing very specific symptoms for each location, such as dry eyes, difficulty breathing or chest pain.  

How to confirm the diagnosis

RA diagnosis usually starts with an medical examination, in which the rheumatologist analyzes the swelling, redness and heat symptoms in the joints, and carries out some exams that test the reflexes and muscle strength.   

Rheumatoid arthritis can be hard to diagnose, especially in a initial stage when symptoms aren't clear. It can also be confused with other diseases such as osteoarthritis or lupus. So, to confirm the diagnosis, the rheumatologist will also request blood tests, such as:

  • Erythrocyte sedimentation rate (ESR): when it is high it indicates inflammation in the body;  
  • C-reactive protein (CRP) test: helps to check the severity of the inflammation ;  
  • Antinuclear antibody (ANA) test: checks the production of antibodies by the immune system;  
  • Rheumatoid factor (RF): identifies the presence of a protein that the immune system produces when it attacks the body's own tissues;  
  • Anti-cyclic citrullinated peptides (anti-CCP): helps to differentiate between rheumatoid arthritis and other types of arthritis. 

In addition, the doctor may also request an X-ray so he can check the evolution of the condition, as well as an MRI scan and an ultrasound to assess the severity of rheumatoid arthritis. 

Ideally, the diagnosis of rheumatoid arthritis is done within six months after first symptoms appeared, in order to start treatment as soon as possible and avoid or stop disease progression.

Possible causes

Rheumatoid arthritis is an auto-immune disease, which means that the immune system it reacts against the body's own cells, in this case the joints.

The reason this happens is still unknown, but some factors have been linked to the development of this condition, such as age and gender. It is more common in women over 40, it happens more frequently when there are viral or bacterial infections, when there is a history of rheumatoid arthritis in the family, or when the person is obese or smokes. 

Treatment options

Treatment for RA should be supervised by a rheumatologist and normally includes the use of medication, specially during moments of crisis. This medications can include:

  • Anti-inflammatory remedies such as ibuprofen or naproxen 
  • Corticosteroids such as prednisone or prednisolone;
  • Immunosuppressants such as methotrexate and sulfasalazine.
  • Biological agents such as abatacept, adalimumab or infliximab.

In addition, physiotherapy is very important in the treatment of rheumatoid arthritis and includes the use of devices, hot water bottles, exercises, and techniques to mobilize joints and strengthen the muscles. These help prevent deformities and improve movement in the day-to-day life.  

Another important recommendation is to do an anti-inflammatory diet that includes foods, such as tuna, salmon, garlic, berries, citrus fruits, dark green vegetables and turmeric. this type of diet not only decreases inflammation, but it also helps to regulate the immune system. 

Possible complications

The main complications related to rheumatoid arthritis are:

  • Osteoporosis;
  • Deformity of the joints;
  • Progressive loss of joint function;
  • Ruptured tendons or ligaments;
  • Carpel tunnel syndrome, if arthritis is in the wrist;
  • Instability of the spine, when the spine, hips, knees or ankle joints are affected;
  • Frequent infections;
  • Heart problems, such as pericarditis;
  • Lung problems such as pleurisy or lung fibrosis;
  • Blood vessel inflammation;
  • Lymphoma. 

These complications can arise mainly when rheumatoid arthritis is not treated properly, and so, whenever a problem in the joint is suspected it's very important to seek medical help.

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References

  • KAVUNCU, Vural; EVCIK, Deniz. Physiotherapy in Rheumatoid Arthritis. MedGenMed. 6. 2; 3, 2004
  • HERNÁNDEZ-HERNÁNDEZ, María Vanesa; DÍAZ-GONZÁLEZ, Federico. Role of physical activity in the management and assessment of rheumatoid arthritis patients. Reumatol Clin. 13. 4; 214-220, 2017
Show more references
  • LIN, Yen-Ju; ANZAGHE, Martina; SCHULKE, Stefan. Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis. Cells. 9. 4; 880, 2020
  • LIAO, Katherine P. Cardiovascular disease in patients with rheumatoid arthritis. Trends Cardiovasc Med. 27. 2; 136-140, 2017
About the author:
Marcelle Pinheiro
Physiotherapist
Physiotherapist degree provided by the University of Estácio de Sá (Brazil). Licensed to practice under CREFITO #170751.