It can be a real pain in the neck.
Rheumatoid arthritis, or RA, is an autoimmune disease in which the body mistakenly attacks the lining of the joints, causing painful swelling and stiffness.
About 1.3 million to 1.5 million Americans live with the chronic inflammatory disease.
RA not only affects the joints, but it can also cause problems with the eyes, blood vessels, nerves, skin, heart, lungs and other organs.
For example, the autoimmune response for RA can trigger inflammation and scarring in lung tissue, leading to interstitial lung disease.
These are the symptoms that may indicate RA — and a common habit that can aggravate the throbbing, aching sensation in the joints.
Who is most at risk for RA?
The peak onset for RA happens between the ages of 40 and 60, but people outside that range can also be diagnosed.
Women are approximately two to three times more likely than men to develop RA, mostly because of the hormonal changes they experience after giving birth and undergoing menopause.
The cause of RA is unknown — it is likely multifactorial. A family history of RA, certain genetics, environmental factors and habits like smoking increase risk.
What are the symptoms of RA?
RA commonly starts in the small joints in the hands and feet, as well as the wrists.
The knuckles and middle finger joints and the joints where the toes meet the foot are the most frequently impacted.
Because RA is often symmetrical, it typically affects the same joints on both sides of the body.
The classic RA symptoms are joint pain, swelling and prolonged morning stiffness.
Morning stiffness that lasts over 45 minutes is the hallmark of inflammatory joint disease.
People can also experience fatigue, weight loss and muscle pain.
Seek medical care if you notice swelling of the small joints in your hand, especially with extended morning stiffness.
What can worsen RA symptoms?
There are many reasons to practice good oral hygiene, such as preventing tooth decay and bad breath, but here’s another one: Severe gum disease from poor oral hygiene can exacerbate RA symptoms.
Ineffective brushing and flossing allow oral bacteria to enter the bloodstream, causing or worsening systemic inflammation.
Inflammation is the root cause of RA symptoms and complications.
How is RA diagnosed?
There are many types of inflammatory joint pain.
Take osteoarthritis, for example. It’s a degenerative joint disease that can cause morning stiffness, but it typically lasts about 10 minutes.
Osteoarthritis also primarily affects people over 50, and it can attack some joints that RA doesn’t target.
That’s why it’s so important to see a doctor who can differentiate between these complex conditions.
An X-ray, along with a physical exam and blood tests, can help tell the difference between RA and osteoarthritis.
How is RA treated?
Patients can live with joint pain for years because it’s not severe and disabling, but they don’t have to.
The prognosis for RA is better than it used to be, thanks to new treatments that let people enjoy long, active lives.
We tend to use three classes of drugs to treat RA.
Conventional synthetic disease-modifying antirheumatic drugs, or DMARDs, such as methotrexate, interfere with various immune pathways to reduce inflammation. These primarily come in pill form.
If there is no response to the meds within six weeks to three months, your doctor may switch you to biologic DMARDs, which block specific parts of the inflammatory process. This is done by injection or infusion.
The third class is targeted synthetic DMARDs, such as JAK inhibitors, which focus on certain pathways within immune cells. These are oral meds.
Patients need to see their rheumatologist every three months to get a blood test and check their response to the drugs.
If left untreated, RA can progress to bone and cartilage erosion and increase the risk of cardiovascular diseases due to chronic inflammation.
Getting diagnosed with RA might seem scary or overwhelming. The good news is that there are several effective treatment options.
Here at NYU Langone Health, we have many rheumatologists who can help you as soon as possible.
Dr. Yamen Homsi is the section chief of the Department of Rheumatology at NYU Langone Hospital in Brooklyn. He specializes in treating a wide range of rheumatic diseases, including rheumatoid arthritis, lupus and spondyloarthropathy, with a particular clinical interest in systemic sclerosis, systemic vasculitis and autoimmune myositis.
