Rheumatoid arthritis (RA) is an ongoing, or chronic, autoimmune disorder. It occurs when the immune system—which normally offers protection from infection and disease—attacks healthy tissues in the joints. While doctors and researchers aren’t sure what starts this process, it may be genetically linked. The genes themselves don't actually cause RA, but they may sensitize the body, causing it to react to various factors, including bacterial or viral infections, which trigger the disease.1
Unlike osteoarthritis, which results from wear and tear on the joints, RA affects the lining of the joints, resulting in painful inflammation and swelling that may eventually result in joint deformity and erosion of the bones. This is due to damage to cartilage, which serves as a shock absorber and cushion within the joints.2 RA simultaneously affects the joints on both sides of the body, which also differentiates it from other types of arthritis. In addition to affecting the fingers, hands, wrists, knees, ankles, feet and toes, RA may also cause medical problems in the heart, lungs, nerves, eyes and skin.3
Affecting nearly 1.5 million people in the United States, RA is 2.5 times more common in women than in men.4 People usually develop RA between the ages of 30 and 60, though it may occur at any age.5 When RA afflicts young adults (between the ages of 16 and 40), it’s called young-onset rheumatoid arthritis (YORA). When people older than 60 develop RA, it’s referred to as later-onset rheumatoid arthritis (LORA).6
Signs and symptoms of RA
The first signs and symptoms of rheumatoid arthritis often include:7
- Swelling, stiffness and pain in more than 1 joint
- Stiffness in the morning or after sitting for extended periods
- Stiffness and pain in the same joints on both sides of the body
- Fatigue, weakness and fever
Early RA usually affects smaller joints first, specifically, the ones that attach the fingers to the hands and the toes to the feet. As RA progresses, its symptoms may spread to the wrists, knees, ankles, elbows, hips and shoulders.8
A significant number of people with RA (approximately 40%) may also experience signs and symptoms that have nothing to do with their joints. Affected areas may include the skin, eyes, heart and lungs, kidneys, nerve tissue and blood vessels.9
Rheumatoid arthritis has separate kinds of symptom episodes–called flares–which may occur as 2 different varieties: predictable flares that have a known trigger and the unpredictable type with no discernible trigger.10 Flares of the predictable type may be triggered by stress, poor sleep, overexertion or a bacterial or viral infection.11
When to see a doctor about RA
During flares, when the joints are especially stiff and achy, people may find relief through over-the-counter pain relievers and bed rest or by simply taking it easy. However, after a day or 2, if pain and swelling are still present, it may be time to call the doctor.12
RA may be mild, moderate, or severe, with symptoms that vary from person to person.13 The progression of the disease doesn’t follow an exact timeline, but, without treatment, RA may worsen over time and progress through these specific stages:14
Stage 1 – In this early stage of RA, tissue around the joints is inflamed. There may be some pain and stiffness, but X-rays don’t show any bone destruction.
Stage 2 – Inflammation starts to damage joint cartilage, and there may be increased stiffness with a decreased range of motion.
Stage 3 – Severe inflammation damages the bones, causing more pain, increased stiffness and less range of motion than in stage 2.
Stage 4 – In this stage, inflammation stops, but joints continue to get worse with severe pain, swelling, stiffness and loss of mobility.
What are treatments for RA?
Joint damage due to RA usually occurs within the first 2 years of diagnosis, so treating it during this time may help prevent long-term problems.15 With treatments for rheumatoid arthritis ranging from medicines and therapy to lifestyle changes and surgery, a doctor considers the patient’s age, health, medical history and severity of symptoms when deciding which treatment to recommend.16
Early treatment with certain medications may reduce swelling and inflammation, ease joint pain and slow down or even stop, the progression of RA.17 These medications include:18
- Non-steroidal anti-inflammatory drugs (NSAIDs) – over-the-counter drugs like aspirin, ibuprofen, naproxen and acetaminophen
- COX-2 inhibitors – another variety of NSAIDs
- Corticosteroids – may be administered orally, intravenously, intramuscularly or injected directly into joints
- Disease-modifying antirheumatic drugs (DMARDs) – modify the immune system to slow the progress of RA
- Janus kinase (JAK) inhibitors – an alternative type of DMARD
- Biologics – target the molecules that cause inflammation in the joints
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Sources:
1“Rheumatoid Arthritis,” Mayo Clinic, last accessed July 17, 2023,
2“Rheumatoid Arthritis,” Cleveland Clinic, last accessed July 17, 2023,
3“Rheumatoid Arthritis,” Mayo Clinic.
4“Rheumatoid Arthritis,” Cleveland Clinic.
5“Rheumatoid Arthritis,” Cleveland Clinic.
6“Rheumatoid Arthritis,” Cleveland Clinic.
7“Rheumatoid Arthritis,” Cleveland Clinic.
8“Rheumatoid Arthritis,” Mayo Clinic.
9“Rheumatoid Arthritis,” Mayo Clinic.
10“Understanding Rheumatoid Arthritis Flares,” Arthritis Foundation, last accessed July 17, 2023,
11“Understanding Rheumatoid Arthritis Flares.”
12“Understanding Rheumatoid Arthritis Flares.”
13Cathy Lovering, “The 4 Stages and Progression of Rheumatoid Arthritis,” Healthline, last accessed July 17, 2023,
14“Rheumatoid Arthritis,” Cleveland Clinic.
15“Rheumatoid Arthritis,” Cleveland Clinic.
16“Rheumatoid Arthritis,” Cleveland Clinic.
17“Rheumatoid Arthritis,” Cleveland Clinic.
18“Rheumatoid Arthritis,” Cleveland Clinic.
This information is provided for educational purposes only. It is not to be used for medical advice, diagnosis or treatment. Consult your healthcare provider if you have questions or concerns.
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