**By Amish Dave, MD, MPH**

What is rheumatoid arthritis? 

Rheumatoid arthritis (RA) is a chronic, inflammatory disease of the joints that, according to the Arthritis Foundation, affects more than 1.3 million Americans. It is a common autoimmune disorder where someone’s immune system mistakes the linings of their joints as “foreign,” attacking and damaging them resulting in inflammation. One patient describes RA this way:

“I’m a mother of two who has battled rheumatoid arthritis for nearly 10 years. The inflammation in my joints has caused painful nodules in my fingers and swelling in my wrists and knees. My toes often lock up and calluses form on my feet. Things that most people take for granted – like bathing, brushing their teeth, getting dressed, making meals and even driving – are very challenging for me.”  

Woman's arthritic hand turning key in door lock
Inflammation from RA typically affects joints on both sides of the body, such as both hands, wrists, knees or feet. This symmetry distinguishes it from other types of arthritis. Since RA is a systemic disease, it can sometimes affect skin, eyes, lungs, heart, blood or the nervous system.

How does it affect the body?

Immune system cells move from the blood into joints and joint-lining tissue, called synovium. Once they arrive, those immune system cells create inflammation, which wears down cartilage (the cushioning material at the end of bones). As the cartilage wears down, the space between the bones narrows. As inflammation worsens, the bones can rub against each other creating painful friction and, ultimately, eroding the joint itself. Inflammation of the joint lining creates swelling and causes fluid to build up within the joint. As the joint space fills with inflammatory cells, these can produce substances that damage the bone. This immune response is what causes joints in RA to become painful, swollen and warm to the touch.

What causes RA?

The specific cause of RA is not known and, currently, there is no known cure. The goal of rheumatologists is to put RA into remission. In rheumatoid arthritis, the immune system is triggered to attack an individual’s joints and, sometimes, other organs. Some experts suspect a virus or bacteria may change the immune system, causing it to attack the joints. Cigarette use is a known trigger for the disease. Certain genetic mutations can also make some people more likely to develop RA, which is why it can sometimes run in families.

Who does it affect?

For unknown reasons, there are higher incidences of RA among Caucasians, Native Americans and women. Women are up to three times more likely to get it than men. Women are also more likely to develop it at a younger age than men, but men may have more severe symptoms. Rheumatoid arthritis generally begins to affect people between the ages of 30 and 60, but patients can be diagnosed at any age.

How is it diagnosed?

There is no single test that shows whether someone has rheumatoid arthritis, but many patients with the disease have concerning antibodies, elevated inflammation tests and, potentially, anemia from chronic inflammation. Your primary care provider will give you a checkup, ask about symptoms and, possibly, perform X-rays and blood tests before referring you to a rheumatologist, if warranted.

How is it treated?

Treatments include medications, rest, exercise and, in some cases, surgery to correct joint damage. Medication use has to be optimized to take into account a person’s existing medication list, age, liver and kidney function, risk of developing infections, cancer history, and prior RA treatment. A rheumatologist should ultimately diagnose and manage rheumatoid arthritis. Additionally, RA treatment should take into account a person’s age, overall health, medical history and severity of the disease.

Why are rest and exercise important for RA?

People who suffer from rheumatoid arthritis need to be active but pace themselves. When joint inflammation worsens, it is important to discuss the flare-up with your rheumatologist but also rest and, in severe cases, use an aid, like joint splints or a cane. When joint inflammation improves, people with RA should engage in regular exercise to maintain joint flexibility and strengthen surrounding muscles. Gentle stretching, swimming and brisk walking can help with chronic pain. Once inflammation has subsided with treatment and joint pain has improved, I often recommend that patients initially work with a physical therapist.

Where can I learn more? 

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Amish Dave, MD, MPH, practices at Virginia Mason Bainbridge Island Medical Center Dr Amish Dave_2016and Virginia Mason Hospital and Seattle Medical Center. He is ABIM board-certified in rheumatology and internal medicine. Dr. Dave specializes in rheumatoid arthritis, lupus, psoriatic arthritis and vasculitis.