By Dr. Jane B. Ayala, FACR and Dr. Thomas A. Rennie, FCR Board Certified in Internal Medicine and Rheumatology
Rheumatoid Arthritis, often called RA, is a chronic autoimmune disease. That means your immune system—which normally protects you from infections—mistakenly attacks your own joints. This causes inflammation in the lining of the joints (called the synovium), leading to pain, swelling, stiffness, and sometimes warmth or redness.
RA most often affects the small joints in the hands, wrists, and feet, but it can involve other joints and even organs such as the lungs, eyes, or heart. If untreated, it can lead to joint damage and deformity over time.
Evaluation and Diagnosis
When we suspect RA, we start with a thorough evaluation, which includes:
- Medical History:
- We discuss your symptoms (how long you’ve had joint pain or stiffness, which joints are involved, whether symptoms are worse in the morning, etc.).
- PEARL: prolonged morning stiffness is one the hallmarks of inflammatory arthritis
- We ask about fatigue, weight loss, or family history of autoimmune diseases.
- Physical Examination:
- We check for joint tenderness, swelling, warmth, or limited movement, range of motion.
- RA often causes symmetrical joint involvement (for example, both wrists or both knees).
- PEARL: RA affects small joints of hands and fingers, like PIPs and MCPs (but not the Distal, last joints of the fingers)
- Laboratory Tests:
- Rheumatoid Factor (RF) and Anti-CCP antibodies — these help confirm disease and may predict severity. Labs can be positive before disease and you can have disease without positive labs as well as positive labs without the disease.
- PEARL: new antibodies called 14.3.3 and MCV (Mutated Citrullinated Vimentin) are additional tests we can order.
- ESR (Erythrocyte Sedimentation Rate) and CRP (C-reactive protein) — these measure inflammation levels.
- We check for anemia or liver/kidney function before starting medication. For some meds, hepatitis and TB are also required.
- Imaging Studies:
- X-rays, ultrasound, or MRI help detect early joint inflammation or damage.
- Diagnosis is made by combining your symptoms, lab results, and imaging findings—there’s no single “RA test.”
Treatment Options
The goal of treatment is to control inflammation, relieve symptoms, prevent joint damage, and maintain quality of life.
- Lifestyle and Supportive Care:
- Exercise: Gentle movement (like walking, swimming, or stretching) keeps joints flexible. Once patient is doing well, there is no limit.
- Rest: Balance activity and rest, especially during flares.
- Healthy diet: Anti-inflammatory foods, maintaining a healthy weight. PEARL: auto-immune protocol diets can help.
- Physical or occupational therapy: Helps protect joints and improve function.
- Medications:
- Corticosteroids (like prednisone) – fast relief of inflammation, but used short-term or for flare-ups
- DMARDs (Disease-Modifying Anti-Rheumatic Drugs) – the mainstay of treatment. Examples: methotrexate, hydroxychloroquine, leflunomide, sulfasalazine.
- Biologic therapies – targeted medications that block specific immune pathways (e.g., TNF inhibitors, IL-6 blockers).
- JAK inhibitors – oral targeted medications for disease control.
- Regular Monitoring:
- RA treatment requires ongoing follow-up to check how well the medications are working and to monitor for side effects.
Outlook
With early diagnosis and modern treatment, most patients with RA can lead active, fulfilling lives and prevent long-term joint damage. The key is early and consistent care with your rheumatologist.