Is this topic for you?
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
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) causes
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.
What causes rheumatoid arthritis?
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.
What are the symptoms?
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
Sometimes the disease
can cause bumps called nodules to form over the elbows, knuckles, spine, and
lower leg bones.
How is rheumatoid arthritis diagnosed?
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.
How is it treated?
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.
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.
- Rest when you are tired.
your joints from injury by using devices like special kitchen tools or
- Use splints, canes, or walkers to ease pain and take
stress off your joints if your symptoms are severe.
- Eat a
- Exercise regularly.
- Stay at a healthy
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.
Health Tools help you make wise health decisions or take action to improve your health.
Actionsets are designed to help people take an active role in managing a health condition.
- Arthritis: Managing Rheumatoid Arthritis
- Dental Care: Brushing and Flossing Your Teeth
- Foot Problems: Finding the Right Shoes
Learning about rheumatoid arthritis:
- What is rheumatoid arthritis?
- What causes it?
- What are the symptoms?
- What increases my risk of getting it?
- What happens with rheumatoid arthritis?
- How does a normal joint work?
- What else could be causing my symptoms?
- How is rheumatoid arthritis diagnosed?
- What do doctors look for in diagnosing rheumatoid arthritis?
- What's the difference between rheumatoid arthritis and osteoarthritis?
- What steps can I take to help control the disease?
- What medicines can I take for rheumatoid arthritis?
- What treatments besides medicines might be used for rheumatoid arthritis?
- Why is early treatment important?
- When should I consider surgery for rheumatoid arthritis?
- Are there home treatments for rheumatoid arthritis?
- What type of doctor can best treat my rheumatoid arthritis?
- Why is it important that I work closely with my health professionals?
Living with rheumatoid arthritis:
- How will rheumatoid arthritis affect my daily activities?
- Can I exercise if I have rheumatoid arthritis?
- How can I manage rheumatoid arthritis?
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
Joint symptoms include:
- Painful, swollen, tender, stiff
joints. The same joints on both sides of the body
(symmetrical) are usually affected, especially the
hands , wrists, elbows,
feet , ankles, knees, or neck.
stiffness. Joint stiffness may develop after long periods of sleeping or
sitting. It usually lasts at least 1 hour and often up to several
- Bumps (nodules). Rheumatoid nodules ranging in
size from a pea to a mothball develop in nearly one-third of people who have
Nodules usually form over pressure points in the body
such as the elbows, knuckles, spine, and lower leg bones.
In addition to specific joint symptoms, rheumatoid arthritis can cause
symptoms throughout the body (systemic). These include:
- A loss of
- Weight loss.
- Mild fever.
Some of the symptoms of rheumatoid arthritis may be similar
to symptoms of
other health conditions.
- Comparing Rheumatoid Arthritis and Osteoarthritis
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:
- A rheumatoid factor blood test is
- A blood test for the antibody CCP (cyclic citrullinated
peptide) is positive.
- The disease fails to respond to
- Bumps (nodules ) form rapidly.
joints are affected.
- X-rays show early
loss of bone or
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
The hands and wrists and feet may be deformed. The hands are the most common location for
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
Most women with rheumatoid arthritis can become pregnant and have a healthy baby.
Things that may increase
your risk for rheumatoid arthritis include:1
- Being female. Rheumatoid arthritis affects
women 2 to 3 times as often as men.
middle-aged. Rheumatoid arthritis can begin at any age, but
it most often begins in adulthood.
- Smoking cigarettes.
Call your doctor immediately if you have:
- Sudden, unexplained swelling and pain in any
joint or joints.
- Joint pain associated
with a fever or rash.
- Pain that is so severe that you cannot use
- Back or neck pain along with weakness in your arms or legs.
- Loss of bowel or bladder control.
Call your doctor within the next few days if
- Joint pain that continues and
has not improved for over 6 weeks.
- Side effects that occur with
large doses of
nonsteroidal anti-inflammatory drugs (NSAIDs) or other
medicine used to treat your arthritis. NSAIDs include ibuprofen (Advil) and naproxen (Aleve).
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.
Who to see
Early arthritis symptoms can be
family medicine doctor.
Rheumatoid arthritis can be treated by:
- A rheumatologist.
- A family medicine doctor or an internist who consults with a rheumatologist.
Supportive treatment can be provided by:
- An orthopedic surgeon, if surgery is needed.
- A physical therapist.
- An occupational
- Getting counseling.
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.
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:
- Anti-cyclic citrullinated peptide antibody (ACPA or anti-CCP) test (helps confirm diagnosis and may
show your risk of having severe symptoms)
- C-reactive protein (may help to assess disease activity)
- Erythrocyte sedimentation rate
(may help to assess disease activity)
- Rheumatoid factor
Other tests are used to help monitor and manage rheumatoid arthritis. These include:
- Antinuclear antibody assay.
- Bone density test, to check for bone loss (osteoporosis).
- Complete blood count.
- Eye exam.
- Imaging tests such as magnetic resonance imaging (MRI) or X-rays.
- Joint fluid analysis.
- Kidney function tests.
- Liver and
muscle enzyme tests.
- Tissue type
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 stage (active or in
remission) and severity of your
- Your treatment history.
- The benefits and risks
of treatment options.
- Your preferences for treatment options, such
as cost, side effects, and daily schedules.
The goal of treatment is to help you maintain your
lifestyle, reduce joint pain, slow joint damage, and prevent disability.
Making a plan
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.
Treatment with medicines
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:
- Medicines that reduce swelling, including ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn).
- Medicines that relieve pain, such as acetaminophen, codeine, and hydrocodone.
- Corticosteroids for early treatment, to control flare-ups, or to help manage the disease.
Be safe with medicines. Read and follow all instructions on the label.
For more information, see Medications.
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
During each follow-up visit, your doctor will assess:
- The amount of joint pain.
- How long
morning stiffness lasts.
- The number of actively inflamed
- How well you are functioning.
- Results of lab tests.
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
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 and lifestyle changes
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.
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
- Arthritis: Managing Rheumatoid Arthritis
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
Rest when you're tired
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.
- With severe symptoms, you may need long periods
of rest. You might need to rest a joint by lying down for 15 minutes several
times a day to relax. Try to find a balance between daily
activities that you must do or want to do and the amount of rest you need to do those activities.
- Plan your day carefully, including
rest periods. Pace your activities so that you don't get
Protect your joints
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
- Joint pain and stiffness may improve with heat
therapy, such as:
- Taking warm showers or baths after long
periods of sitting or sleeping.
- Soaking hand joints in warm wax
- Sleeping under a warm electric blanket.
assistive devices to reduce strain on your joints,
such as special kitchen tools or doorknobs.
- Choose the right shoes that fit well and will not cause joint problems.
- Use splints, canes, or
walkers to reduce pain and improve function.
Keep moving to
keep your muscle strength, flexibility, and overall health.
- Physical therapy may be recommended by
Exercise for arthritis takes three forms—stretching,
strengthening, and conditioning. Exercise can improve or maintain quality of life for people who have rheumatoid arthritis. Your specific joint problem may
guide the type of activity that will help the most. For example:
- Swimming is a good activity if
you have joint problems in your knees, ankles, or
- Bicycling and walking are good activities if your
joint problems are not in your legs or feet.
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.1 So, if you're a smoker, quit. For more information on how to quit, see the topic Quitting Smoking.
Eat healthy foods
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.
- Be sure to get enough
vitamin D to protect your bones against osteoporosis.
For more information, see the topic
- Lose weight, if you are
overweight. For more information, see the topic
- People who have rheumatoid arthritis also have an increased
risk of heart disease. But healthy lifestyle changes, such as exercise and a
healthy diet, may reduce your risk.
For more information, see:
Take care of your teeth and gums
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.
- Dental Care: Brushing and Flossing Your Teeth
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:
- Relieve or reduce pain.
- Reduce joint inflammation. Signs of joint
inflammation include swelling, tenderness, and limited range of
- Prevent or delay significant
joint damage and deformity.
- Improve quality of life.
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.
Medicines to slow the disease
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
Commonly used nonbiologic DMARDs
- Antimalarials such as
hydroxychloroquine or chloroquine
Less commonly used nonbiologic DMARDs
- Gold salts
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.2, 3
Medicines to relieve symptoms
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. NSAIDs are used to
control pain and may help reduce inflammation. They don't control the disease
or stop it from getting worse. NSAIDs may be combined with DMARDs.
such as prednisone. These medicines are used to reduce disease
activity and joint inflammation. But using only corticosteroids for an extended time is not considered the best treatment. Corticosteroids are
often used to control symptoms and flares of joint inflammation until DMARDs
reach their full effectiveness.
- Analgesics (pain relievers). These don't reduce
inflammation but may help with pain control. They include:
- Acetaminophen with codeine (such as
Tylenol with codeine).
- Acetaminophen with hydrocodone (such as
What to think about
- Some DMARDs can take up to 6
months to work.
- In some people, a certain DMARD may not work at all. So a
different DMARD will be used.
- If you're taking DMARDs, it's a good idea to have a rheumatologist manage your care.
- Many DMARDs have serious side effects. You will need regular blood and urine tests to check the drug's effects on
blood-producing cells (bone marrow), the kidneys, and the liver.
- If you have other conditions such as high blood pressure or high cholesterol, your doctor may recommend that you take medicine to control them.
Be safe with medicines. Read and follow all instructions on the label.
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:
to replace part or all of a joint, such as the hip or knee.
which uses a small lighted instrument to remove debris or inflamed tissue from a joint.
- Carpal tunnel release, to relieve pressure on the median nerve in the wrist.
- Cervical spinal fusion, to treat severe neck pain and
- Finger and hand surgeries, to correct
joint problems in the hand.
- Foot surgery such as phalangeal head resection.
- Synovectomy, to
remove inflamed joint tissue.
What to think about
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.
- Rheumatoid arthritis usually affects multiple
joints, particularly smaller joints, such as finger joints, which are needed
for many daily activities. Surgical treatment may not be an option for all of
the affected joints.
- Joint surgery or replacement can relieve
disabling pain and restore enough motion to allow you to do your daily
activities. But it will seldom restore the joint to normal.
Before you decide to have surgery, consult with an
orthopedic surgeon who is experienced in joint surgery
for rheumatoid arthritis.
- Questions About Joint Surgery
Other types of treatment that may
help you control some of the symptoms of
rheumatoid arthritis include:
- Physical therapy, to improve joint
function. Physical therapy includes exercise, hot and cold therapy, and
- Occupational therapy. This helps you learn how to maintain
movement in the joints while carrying out the activities of daily living.
- Assistive devices such as household aids or mobility aids. For
more information and a catalog, contact the Arthritis Foundation at www.arthritis.org.
- Behavioral modification techniques to reduce pain and
stress. These include
biofeedback and relaxation therapy, such as
breathing exercises and
- Counseling. It can
help you cope with long-term pain and disability.
Complementary and alternative medicine therapies
Although not proved in scientific studies, complementary therapies are
used by many people to relieve symptoms and
improve their quality of life. These therapies include:
- Acupuncture. This treatment is used to
relieve pain and treat certain health conditions. It is done by inserting very
thin needles into the skin at specific points on the body.
- Massage. It can help relieve stress and reduce
pain. But don't massage swollen or painful joints.
- Transcutaneous electrical nerve stimulation (TENS).
This therapy uses electrical current delivered through electrodes to
the skin for pain relief.
- Herbs and dietary supplements. If you decide to
use herbs or dietary supplements, be sure to tell your doctor.
- Herbs such as the oil of evening primrose, borage seed, or blackcurrant seed may help relieve symptoms and improve function without significant side effects. Another herb called Tripterygium wilfordii (thunder god vine) also seems to relieve symptoms but may have side effects such as increased infection.4
- Essential fatty acids (such as fish oil) may provide some
relief of symptoms.5
- The dietary supplements glucosamine and chondroitin are sometimes used to
try to relieve joint pain. But there is not evidence that they are effective for rheumatoid arthritis.
Organization National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (U.S.) www.niams.nih.gov
- Dealing With Medicine Side Effects and Interactions
- Juvenile Idiopathic Arthritis
- Work Closely With Your Doctor
O'Dell JR (2012). Rheumatoid arthritis. In L Goldman, A Schafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 1681–1689. 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.
Cameron M, et al. (2011). Herbal therapy for treating rheumatoid arthritis (Review). Cochrane Database of Systematic Reviews (2).
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. (2012). 2012 update of the 2008 American College of
Rheumatology recommendations for the use of
disease-modifying antirheumatic drugs and
biologic agents in the treatment of
rheumatoid arthritis. Arthritis Care and Research, 64(5): 625–639.
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.