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There are many types of arthritis (disease of the joints). This topic is about rheumatoid arthritis. If you are looking for information about how juvenile idiopathic (rheumatoid) arthritis affects young children, see the topic Juvenile Idiopathic Arthritis. If you are looking for information on the most common form of arthritis in older adults, see the topic Osteoarthritis.
Rheumatoid arthritis (RA) causes the joints to become swollen, stiff, and painful (inflamed).
Over time, this inflammation may destroy the joint tissues. This can limit your daily activities and make it hard for you to walk and use your hands.
Rheumatoid arthritis is more common in women than in men. It often begins between the ages of 40 and 60.
The exact cause is not known. But rheumatoid arthritis is an autoimmune disease. This means that the body's natural defense system attacks the joints. The disease may run in some families.
The main symptoms of rheumatoid arthritis are pain, stiffness, and swelling in the joints of the hands, wrists, elbows, feet, ankles, knees, or neck. The disease usually affects both sides of the body at the same time. In rare but severe cases, it may affect the eyes, lungs, heart, nerves, or blood vessels.
Sometimes the disease can cause bumps called nodules to form over the elbows, knuckles, spine, and lower leg bones.
There is no single test for rheumatoid arthritis. Your doctor will do a physical exam and look at your joints for signs of swelling or tenderness. He or she will also ask about your symptoms and past health.
You may have blood tests, X-rays, and other tests to find out if another problem is causing your joint pain.
Treatment for rheumatoid arthritis continues throughout your life. It includes medicine, exercise, and lifestyle changes. Getting treatment early may control the condition or keep it from getting worse.
Many of the medicines used to treat rheumatoid arthritis have side effects. So it is important to have regular checkups and talk with your doctor about any problems. This will help your doctor find a treatment that works for you.
At home, there are things you can do to relieve your symptoms.
If you try medicine, exercise, and lifestyle changes for at least a few years but pain and disability get much worse, surgery may be an option. Total joint replacement of the hip and knee are the most successful.
It can be hard to live with a long-term illness that can limit your ability to do things. It is common for people with rheumatoid arthritis to feel depressed. Your mood can affect how you feel and how well you cope with pain. Be sure to seek the help and support you need from friends and family members. Professional counseling can also help.
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The cause of rheumatoid arthritis (RA) is not fully understood. Genes play a role, but experts don't know exactly what that role is. For most people with RA, the disease doesn't run in their families and they don't pass it along to their children. One or more genes may make it more likely that the body's immune system will attack the tissues of the joints. This immune response may also be triggered by bacteria, a virus, or some other foreign substance.
Other causes of joint pain include osteoarthritis, lupus, and gout.
Joint pain can be an early symptom of many different diseases. In rheumatoid arthritis, symptoms often develop slowly over a period of weeks or months. Fatigue and stiffness are usually early symptoms. Weight loss and a low-grade fever can also occur.
Joint symptoms include:
In addition to specific joint symptoms, rheumatoid arthritis can cause symptoms throughout the body (systemic). These include:
Some of the symptoms of rheumatoid arthritis may be similar to symptoms of other health conditions.
The course of rheumatoid arthritis is hard to predict. It usually progresses slowly, over months or years. In some people it doesn't get worse, and symptoms stay about the same. But in rare cases, symptoms come on rapidly, within days.
Symptoms can come and go. You may have times in your life when joint pain goes away on its own for a while. This is called remission.
If the disease progresses, joint pain can restrict simple movements, such as your ability to grip, and daily activities, such as climbing stairs. It is a common cause of permanent disability. But early treatment may control the disease and keep it from getting worse.
Rheumatoid arthritis is more likely to get worse when:
The ongoing inflammation caused by rheumatoid arthritis affects the tissues that line joints. It causes a breakdown in cartilage and loosens ligaments and tendons that support the joints. The resulting joint destruction can lead to deformed joints.
The pain, stiffness, fatigue, and whole-body (systemic) symptoms of rheumatoid arthritis can be disabling. Over time, the deformity caused by the disease can lead to difficulty with daily activities. Specific joint problems may also occur later in the course of the disease.
The hands and wrists and feet may be deformed. The hands are the most common location for deformities.
Inflammation of the knees, if not controlled by treatment, can cause erosion of cartilage and can later lead to the need for knee replacement surgery.
Rheumatoid arthritis can also damage the cervical spine, or neck. This damage can limit how easily you can move your neck. In rare cases, the damage can pinch a nerve or affect the spinal cord and cause numbness, pain, weakness, or paralysis in the arms or legs.
In a small number of severe cases, the disease may damage other organs, such as the eyes and lungs.
People who have rheumatoid arthritis seem to develop plaque deposits in arteries (atherosclerosis) earlier than people who do not have rheumatoid arthritis. Inflammation may play a role in speeding up plaque development. When plaque develops in the arteries in the heart, it is called coronary artery disease (CAD) and it increases the risk of a heart attack. When plaque develops in the arteries in the neck, it increases the risk of stroke.
Rheumatoid arthritis and some of the medicines used to treat it can increase the risk of osteoporosis.
It is common for people with rheumatoid arthritis to feel depressed. These feelings may be caused by pain and progressive disability.
Most women with rheumatoid arthritis can become pregnant and have a healthy baby.
Things that may increase your risk for rheumatoid arthritis include:
Call your doctor immediately if you have:
Call your doctor within the next few days if you have:
Watchful waiting is a wait-and-see approach. It is reasonable to try home treatment for mild joint pain and stiffness. If there is no improvement after 6 weeks, or if any other symptoms are present, call your doctor.
Early treatment can slow and sometimes prevent significant joint damage. So if you have symptoms similar to rheumatoid arthritis, see your doctor to find out if you have rheumatoid arthritis. Early diagnosis and treatment allows for possible reduction of joint pain, slows joint destruction, and reduces the chance of permanent disability.
Early arthritis symptoms can be diagnosed by:
Rheumatoid arthritis can be treated by:
Supportive treatment can be provided by:
No single lab test can diagnose rheumatoid arthritis. Instead, doctors look at symptoms and physical signs and then rule out other diseases that can cause similar symptoms.
A medical history and physical exam are usually done to help find the cause of joint pain. The pattern and nature of joint symptoms are the most important clues to the diagnosis.
Diagnosis is based on a set of classification criteria. The criteria include the results of these tests:
Other tests are used to help monitor and manage rheumatoid arthritis. These include:
Because rheumatoid arthritis can lead to severe joint destruction and disability over time, regular checkups are important to see if treatment is working or needs to be adjusted.
Rheumatoid arthritis is most often treated with medicine, exercise, and lifestyle changes. Treatment may help relieve symptoms and control the disease, but there is no cure. Treatment for rheumatoid arthritis usually continues throughout your life, but it will vary depending on:
The goal of treatment is to help you maintain your lifestyle, reduce joint pain, slow joint damage, and prevent disability.
Treatment of rheumatoid arthritis should start with education about the disease, the possibility of joint damage and disability, and the risks and benefits of potential treatments. A long-term treatment plan should be developed by you and your team of doctors.
Early and ongoing treatment of RA with medicines called disease-modifying antirheumatic drugs (DMARDs) can slow or sometimes prevent joint destruction. Other medicines may be combined with DMARDs to relieve symptoms. These medicines include:
Be safe with medicines. Read and follow all instructions on the label.
For more information, see Medications.
Treatment for rheumatoid arthritis usually continues throughout your life. Your doctor will want to closely monitor your condition. A rheumatologist should evaluate you regularly. Depending on your symptoms and treatment, this could be done as often as every 2 to 3 months or every 6 to 12 months. Testing, such as blood tests, may be done more often.
During each follow-up visit, your doctor will assess:
In some cases, the disease does not respond to the first several treatments. When this happens, the disease may be treated with much higher doses of medicines or with different combinations of medicines.
Surgery may be considered when the joints—especially the hips, knees, or feet—are severely damaged or deformed and are causing extreme pain. Surgery may include total joint replacement or other techniques to improve joint function. For more information, see Surgery and Other Treatment.
Exercise, physical therapy, and lifestyle changes can help relieve joint pain. Many people with RA benefit from self-care plans that balance rest and activity. You can take steps at home to relieve your symptoms and help control your disease. For more information, see Living With Rheumatoid Arthritis.
Living with rheumatoid arthritis often means making changes to your lifestyle. You can do things at home, such as staying active and taking medicines, to help relieve your symptoms and prevent the disease from getting worse.
You can also plan for those times when the disease symptoms may be more severe. It is important to work closely with your health professionals, who may include a physical therapist or counselor, to find ways to reduce pain.
The disease itself causes fatigue. And the strain of dealing with pain and limited activities also can make you tired. The amount of rest you need depends on how bad your symptoms are.
You may need to change the way you do certain activities so that you are not overusing your joints. Try to find different ways to relieve your joint pain.
Keep moving to keep your muscle strength, flexibility, and overall health.
People with rheumatoid arthritis have an increased risk of plaque in the arteries (atherosclerosis). Smoking increases this risk even more. Smoking may also lower your response to treatment.footnote 1 So, if you're a smoker, quit. For more information on how to quit, see the topic Quitting Smoking.
Try to eat a variety of healthy foods. Dietary needs are not the same for all people who have rheumatoid arthritis. To be sure you get the nutrients you need, you can ask a registered dietitian to help you make a plan.
For more information, see:
People who have rheumatoid arthritis tend to get gum disease. Some experts think that infection that enters the body through the mouth may make rheumatoid arthritis worse, although this has not been proved. You can help prevent gum disease through good basic dental care.
Medicines are the main treatment for rheumatoid arthritis. The types of medicines used depend on how severe your disease is, how fast it is progressing, and how it affects your daily life.
If your symptoms ease, you and your doctor will decide if you can take less medicine or stop taking medicine. If your symptoms get worse, you will have to start taking medicine again.
Medicines are used to:
Medicines called disease-modifying antirheumatic drugs (DMARDs) can slow or sometimes prevent joint destruction. Starting treatment early with DMARDs can reduce the severity of the disease. DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs). These medicines are usually taken over a long period to help control the disease.
DMARDs can be thought of as nonbiologic or biologic, depending on how they are made and how they act in the body. But they are all used to block harmful responses from the body's immune system. DMARDs are sometimes combined with one another or with other medicines. By combining medicines, you may be able to take lower doses of individual medicines. This may reduce your risk of side effects.
Some medicines for rheumatoid arthritis may cause birth defects. If you are pregnant or are trying to become pregnant, talk with your doctor about your medicines.
Disease-modifying antirheumatic drugs (DMARDs) are usually started within 3 months of your diagnosis. They are used to control the progression of RA and to try to prevent joint damage and disability. DMARDs are often given in combination with other medicines.
Commonly used nonbiologic DMARDs
Less commonly used nonbiologic DMARDs
Biologic DMARDs (biologics)
There is a newer biologic drug called tofacitinib (Xeljanz) for adults who have moderate to severe rheumatoid arthritis. This medicine is for people who have not responded well to methotrexate or who cannot take it. Tofacitinib is taken by mouth. It reduces the symptoms of rheumatoid arthritis and allows people to be more active. But the long-term safety of this medicine is still being studied.footnote 2, footnote 3
Surgical treatment for rheumatoid arthritis is used to relieve severe pain and improve function of severely deformed joints that don't respond to medicine and physical therapy.
Total joint replacement (arthroplasty) can be done for many different joints in the body. Its success varies depending on which joint is replaced.
Surgeries considered for people who have severe rheumatoid arthritis include:
Joint surgery often restores near-normal movement in a person who has osteoarthritis in just one or two joints. But this is not the case for people affected by rheumatoid arthritis.
Before you decide to have surgery, consult with an orthopedic surgeon who is experienced in joint surgery for rheumatoid arthritis.
Other types of treatment that may help you control some of the symptoms of rheumatoid arthritis include:
Complementary medicine therapies are used by many people to relieve symptoms and improve their quality of life, even though there isn't strong scientific evidence that they help. These therapies include:
Find out about the safety of any complementary product or practice you want to try. Most mind and body practices—such as acupuncture and massage—are safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.
Talk with your doctor about any complementary health practice that you would like to try or are already using. Your doctor can help you manage your health better if he or she knows about all of your health practices.
O'Dell JR (2013). Treatment of rheumatoid arthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1137–1160. Philadelphia: Saunders.
Fleischmann R, et al. (2012). Placebo-controlled trial of tofacitinib monotherapy in rheumatoid arthritis. New England Journal of Medicine, 367(6): 495–507.
Von Vollenhoven RF, et al. (2012). Tofacitinib or adalimumab versus placebo in rheumatoid arthritis. New England Journal of Medicine, 367(6): 508–519.
Gomez FE, Kaufer-Horwitz M (2012). Medical nutrition therapy for rheumatic disease. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 901–922. St Louis: Saunders.
Other Works Consulted
O'Dell JR (2013). Treatment of rheumatoid arthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1137–1160. Philadelphia: Saunders.
Singh JA, et al. (2016). 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care and Research, 68(1): 1–25. DOI: 10.1002/acr.22783. Accessed April 14, 2016.
Steultjens EEMJ, et al. (2009). Occupational therapy for rheumatoid arthritis. Cochrane Database of Systematic Reviews (1).
Sweeney SE, et al. (2013). Clinical features of rheumatoid arthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1109–1136. Philadelphia: Saunders.
Yasuda GT, et al. (2013). Rheumatoid arthritis. In JE Pizzorno, MT Murray, eds., Textbook of Natural Medicine, 4th ed., pp. 1769–1784. St. Louis: Elsevier.
Current as ofJune 10, 2018
Author: Healthwise StaffMedical Review: Anne C. Poinier, MD - Internal MedicineE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineMartin J. Gabica, MD - Family MedicineKathleen Romito, MD - Family MedicineNancy Ann Shadick, MD, MPH - Rheumatology
Current as of:
June 10, 2018
Medical Review:Anne C. Poinier, MD - Internal Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Nancy Ann Shadick, MD, MPH - Rheumatology
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