Rheumatoid arthritis
Also called: RA
An autoimmune disease in which the immune system attacks the lining of joints, causing painful, swollen, stiff joints — usually symmetrically in the hands and feet — and, untreated, permanent joint damage.
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About 0.5–1% of adults; three times more common in women.
What happens in the body
Autoantibodies (RF, anti-CCP) and immune cells inflame the synovium, which thickens (pannus) and erodes cartilage and bone.
Causes
- Autoimmune; genetic susceptibility (HLA-DR4) plus environmental triggers
Risk factors
- Female sex
- Smoking
- Family history
- Age 30–60
Symptoms
- Painful swollen joints in hands, wrists and feet
- Morning stiffness lasting over an hour
- Fatigue
- Rheumatoid nodules
- Fever and weight loss
Diagnosis — tests and examinations
- Blood tests: rheumatoid factor, anti-CCP, CRP/ESR
- Ultrasound or X-ray of hands and feet
Treatment
Medicines and medical treatment
- Start disease-modifying drugs early: methotrexate (first-line), sulfasalazine, hydroxychloroquine, leflunomide
- Biologics (anti-TNF, tocilizumab, abatacept, rituximab) and JAK inhibitors if needed
- Short-term steroids to control flares
- NSAIDs for symptoms
Operations and procedures
- Joint replacement or tendon surgery for damaged joints
Self-care, home remedies and lifestyle
- Stop smoking
- Regular exercise and physiotherapy
- Occupational therapy and joint protection
- Vaccinations before immunosuppression
Possible complications
- Joint deformity
- Cardiovascular disease
- Lung disease
- Osteoporosis
- Infections from treatment
Prevention
- Not smoking
Outlook
Early aggressive treatment achieves remission or low disease activity in most patients.
When to see a doctor
See a doctor promptly for swollen joints lasting more than a few weeks.
Sources and further reading
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