Patient education: Rheumatoid arthritis (The Basics)

What is rheumatoid arthritis? — Rheumatoid arthritis, or "RA," is a disease that causes pain, swelling, and stiffness in the joints.

RA is one of many different types of arthritis. Doctors do not know what causes it, but they know that it is an autoimmune disorder. "Autoimmune" means a person's infection-fighting system, called the immune system, "attacks" their body. In RA, the immune system attacks the joints. It can also attack other parts of the body, such as the heart, lungs, or eyes.

What are the symptoms of RA? — The main symptom is joint pain and swelling. Other types of arthritis can cause similar symptoms. But there are some things that are unique to RA. For example:

●People with RA have joint stiffness for the first few hours of the day. This usually gets better in the afternoon. Other types of arthritis tend to make people feel stiff all day. They can also make people stiffer toward the end of the day.

●RA usually starts by affecting the small joints in the fingers (picture 1), the balls of the feet, and the wrists. It usually affects both the left and the right side at the same time.

Some people with RA have other symptoms, too. These might include:

●Muscles that ache

●Feeling very tired

●Feeling depressed

●Losing weight without trying

These symptoms can also be caused by other conditions besides RA.

What happens as RA gets worse? — Pain and swelling usually start in the fingers and toes and can affect any of the joints. Sometimes, RA damages the joints forever. Rarely, it can also cause problems in other parts of the body. These include the heart, lungs, or eyes. Usually, these problems happen in people who have had RA for many years but were not getting treatment.

If your doctor or nurse says that you have RA, start treatment right away. Do not wait until your symptoms get worse. Getting treated early can help prevent a lot of damage to your body.

How is RA treated? — It is best to start treatment as soon as possible. You will probably need to see a doctor who specializes in RA, called a "rheumatologist."

There are lots of different medicines for RA. The right one for you depends on:

●How bad your symptoms are

●How many of your joints are affected

●How your disease has changed over time

●What side effects you get with the medicines you try

●What your X-rays look like

●The results of certain blood tests

The medicines to treat RA are called disease-modifying antirheumatic drugs, or "DMARDs." It can take several weeks of taking DMARDs before you feel better. Your doctor might give you other medicines to help in the meantime, such as:

●Nonsteroidal antiinflammatory drugs, or "NSAIDs"

●Steroids – These can be taken as a pill. If your pain is severe, your doctor might give it as an injection. This is sometimes called a "cortisone shot."

Most people do not need stronger pain medicines, called "opioids." Unlike the other medicines, opioids do not help with inflammation or joint damage.

People with RA might also work with other health professionals. These include:

●A physical therapist (exercise expert) – Movement can be painful with RA. A physical therapist can help you figure out which types of activity are best for you.

●An occupational therapist – They can help you figure out how to keep doing your normal everyday tasks. They can also make you a special splint if certain joints are very painful.

●A dietitian (food expert) – Losing weight helps some people with RA feel better. Carrying excess weight puts extra strain on your joints. If your doctor agrees, a dietician can help you make changes to your diet to help you lose weight.

Some people with RA do not feel as hungry as usual. If this happens, a dietician can help make sure that you get the nutrients you need.

●A cardiologist (heart doctor) – People with RA have a higher chance of having heart problems, such as a heart attack. A cardiologist can help monitor your heart to make sure that it is healthy.

What can I do on my own? — You can:

●Get support – It is normal to be sad, upset, or worried when you find out that you have RA. Many people find it helpful to talk with others who are going through similar things. Support groups can happen in person or online.

Sometimes, these feelings can be overwhelming. Feeling worried or upset most of the day can be a sign of depression or anxiety. Your doctor or nurse can talk to you about treatments that can help. This might include talking to a counselor, taking medicine, or both.

●Stay active – This is very important. You might want to avoid physical activity because you are in pain. But that can make things worse. It will make your muscles weak and your joints stiffer than they already are. Staying active can help you feel less tired and have less pain. It also might help you sleep better. Walking and swimming can be good activities that are easy on your joints.

●Eat a healthy diet – People with RA are at risk for heart disease, so avoid fatty foods. Instead, eat lots of fruits and vegetables.

●Quit smoking – Smoking further increases your risk for heart disease.

●Go to all your doctor's appointments – It's also important to get all of the vaccines your doctors recommends.

●Use ice or heat – This can help if your joints hurt or are stiff.

•Put a cold gel pack, bag of ice, or bag of frozen vegetables on the area that hurts every 1 to 2 hours, for 15 minutes each time, as needed. Put a thin towel between the ice (or other cold object) and your skin.

•Put a heating pad on the painful area for no more than 20 minutes at a time. Do not go to sleep with a heating pad. This can cause burns.

What if I want to get pregnant? — It is possible to have a safe, healthy pregnancy with RA. But talk to your doctor or nurse before you start trying to get pregnant. This is because:

●Some of the medicines used to treat RA are not safe for a developing fetus. You might need to switch medicines before you get pregnant.

●There are things you should do to help prevent problems during pregnancy.

The symptoms of RA often get a lot better during pregnancy. But they can get worse again after giving birth.

When should I call the doctor? — Call your doctor or nurse if you have been taking a medicine to treat RA for several weeks and are not starting to feel better.

More on this topic

Patient education: Rheumatoid arthritis and pregnancy (The Basics)
Patient education: Disease-modifying antirheumatic drugs (DMARDs) (The Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (The Basics)
Patient education: Oral steroid medicines (The Basics)
Patient education: Steroid injection (The Basics)
Patient education: Managing acute pain at home (The Basics)
Patient education: Hand pain (The Basics)
Patient education: Osteoarthritis (The Basics)
Patient education: C-reactive protein test (The Basics)
Patient education: Erythrocyte sedimentation rate (The Basics)

Patient education: Rheumatoid arthritis symptoms and diagnosis (Beyond the Basics)
Patient education: Rheumatoid arthritis treatment (Beyond the Basics)
Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics)
Patient education: Rheumatoid arthritis and pregnancy (Beyond the Basics)