What is Rheumatoid arthritis?

Scientists estimate that about 2.2 million people, or 1 percent of the U.S. adult population, have rheumatoid arthritis. Interestingly, some recent studies have suggested that the overall number of new cases of rheumatoid arthritis may actually be going down. Scientists are now investigating why this may be happening.

Rheumatoid arthritis occurs in all races and ethnic groups. Although the disease often begins in middle age and occurs with increased frequency in older people, children and young adults also develop it. Like some other forms of arthritis, rheumatoid arthritis occurs much more frequently in women than in men. About two to three times as many women as men have the disease.

Rheumatoid arthritis is an inflammatory disease, in which there is destruction of joints, that causes pain, swelling, stiffness, and loss of function in the joints. It has several special features that make it different from other kinds of arthritis. For example, rheumatoid arthritis generally occurs in a symmetrical pattern. This means that if one knee or hand is involved, the other one is also. The disease often affects the wrist joints and the finger joints closest to the hand. It can also affect other parts of the body besides the joints. In addition, people with the disease may have fatigue, occasional fever, and a general sense of not feeling well (malaise).

Considered by some to be an autoimmune disorder in which immune complexes are formed in joints and excite an inflammatory response (complex mediated hypersensitivity).

Many scientists think that something must occur to trigger the disease process in people whose genetic makeup makes them susceptible to rheumatoid arthritis. An infectious agent such as a virus or bacterium appears likely, but the exact agent is not yet known. Note, however, that rheumatoid arthritis is not contagious: A person cannot "catch" it from someone else.

Another feature of rheumatoid arthritis is that it varies a lot from person to person. For some people, it lasts only a few months or a year or two and goes away without causing any noticeable damage. Other people have mild or moderate disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions. Still others have severe disease that is active most of the time, lasts for many years, and leads to serious joint damage and disability.

Although rheumatoid arthritis can have serious effects on a person's life and well-being, current treatment strategies-including pain relief and other medications, a balance between rest and exercise, and patient education and support programs-allow most people with the disease to lead active and productive lives. In recent years, research has led to a new understanding of rheumatoid arthritis and has increased the likelihood that, in time, researchers can find ways to greatly reduce the impact of this disease.

Features of Rheumatoid Arthritis:

  • Tender, warm, swollen joints.
  • Symmetrical pattern. For example, if one knee is affected, the other one is also.
  • Joint inflammation often affecting the wrist and finger joints closest to the hand; other affected joints can include those of the neck, shoulders, elbows, hips, knees, ankles, and feet.
  • Fatigue, occasional fever, a general sense of not feeling well (malaise).
  • Pain and stiffness lasting for more than 30 minutes in the morning or after a long rest.
  • Symptoms that can last for many years.
  • Symptoms in other parts of the body besides the joints.
  • Variability of symptoms among people with the disease.

A normal joint (the place where two bones meet) is surrounded by a joint capsule that protects and supports it. Cartilage covers and cushions the ends of the two bones. The joint capsule is lined with a type of tissue called synovium, which produces synovial fluid. This clear fluid lubricates and nourishes the cartilage and bones inside the joint capsule.



In rheumatoid arthritis, the immune system, for unknown reasons, attacks a person's own cells inside the joint capsule. White blood cells that are part of the normal immune system travel to the synovium and cause a reaction. This reaction, or inflammation, is called synovitis, and it results in the warmth, redness, swelling, and pain that are typical symptoms of rheumatoid arthritis. During the inflammation process, the cells of the synovium grow and divide abnormally, making the normally thin synovium thick and resulting in a joint that is swollen and puffy to the touch.

As rheumatoid arthritis progresses, these abnormal synovial cells begin to invade and destroy the cartilage and bone within the joint. The surrounding muscles, ligaments, and tendons that support and stabilize the joint become weak and unable to work normally. All of these effects lead to the pain and deformities often seen in rheumatoid arthritis. Doctors studying rheumatoid arthritis now believe that damage to bones begins during the first year or two that a person has the disease. This is one reason early diagnosis and treatment are so important in the management of rheumatoid arthritis.

There is no treatment that can cure or reverse rheumatoid arthritis. However, there are medications that can relieve its symptoms and slow or halt its progression.

Nonsteroidal anti-inflammatory drugs (NSAIDs). This group of medications, which includes aspirin, helps relieve pain and inflammation. Side effects may include stomach upset and stomach bleeding. Therefore, NSAIDs should always be taken with food.

Cox-2 inhibitors. This new class of medications is similar to NSAIDs, but may be less damaging to your stomach. Like NSAIDs, cox-2 inhibitors suppress an enzyme called cyclooxygenase (cox) that triggers joint inflammation and pain. Cox-2 inhibitors work selectively, suppressing only cox-2, the enzyme involved in inflammation. Two versions of cox-2 inhibitors, celecoxib (Celebrex) and rofecoxib (Vioxx), have been approved by the Food and Drug Administration for pain related to arthritis.

Corticosteroids. These medications (cortisone, prednisone and others) reduce inflammation and slow joint damage. In the short term, corticosteroids can make you feel dramatically better. However, when used for many months or years, they may become less effective and also cause serious side effects. Side effects may include easy bruising, thinning of your bones, cataracts, weight gain, a round face, diabetes and high blood pressure. Doctors will often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering you off the medication.

Disease-modifying antirheumatic drugs (DMARDs). These medications have been shown to slow or halt the progression of rheumatoid arthritis. In the past, they were used only if you had severe rheumatoid arthritis and noticeable joint destruction. Today, DMARDs are prescribed early to try to prevent destruction. When taken in proper doses, the drugs aren't as toxic as once believed. Depending on the drug used, side effects can range from blurry vision to increased susceptibility to infection.

Several of the most commonly prescribed DMARDs are hydroxychloroquine (Plaquenil), gold (Myochrysine, Solganal), sulfasalazine (Azulfidine), and minocycline (Minocin). Sometimes, a combination of DMARDs may be used if one alone isn't effective.

Because they don't relieve symptoms, DMARDs are taken in addition to an NSAID, a corticosteroid, or both. The drugs are slow-acting, so it may take a few months before you notice benefits.



TNF blockers. One of the most talked-about new medications for arthritis is the TNF blocker. TNF (tumor necrosis factor) is a cytokine, or cell protein, which acts as an inflammatory agent in rheumatoid arthritis. "Anti-TNF" medications target or block this cytokine and can help reduce pain, morning stiffness and tender or swollen joints. These medications often are taken with methotrexate.

Two TNF blockers approved for treatment of rheumatoid arthritis are etanercept (Enbrel) and infliximab (Remicade). If you have an active infection, you should not take these medications.

Studies indicate that eating large amounts of omega-3 fatty acids from cold-water fish (salmon, mackerel, herring) and plant oils may reduce joint tenderness. But check with your doctor before taking omega-3 fatty acid supplements (fish oil capsules). Two other popular therapies are the dietary supplements glucosamine and chondroitin sulfate.

By all measures, the financial and social impact of all types of arthritis, including rheumatoid arthritis, is substantial, both for the Nation and for individuals. From an economic standpoint, the medical and surgical treatment for rheumatoid arthritis and the wages lost because of disability caused by the disease add up to millions of dollars. Daily joint pain is an inevitable consequence of the disease, and most patients also experience some degree of depression, anxiety, and feelings of helplessness. In some cases, rheumatoid arthritis can interfere with a person's ability to carry out normal daily activities, limit job opportunities, or disrupt the joys and responsibilities of family life. However, there are arthritis self-management programs that help people cope with the pain and other effects of the disease and help them lead independent and productive lives.

Scientists are making rapid progress in understanding the complexities of rheumatoid arthritis-how and why it develops, why some people get it and others do not, why some people get it more severely than others. Results from research are having an impact today, enabling people with rheumatoid arthritis to remain active in life, family, and work far longer than was possible 20 years ago. There is also hope for tomorrow, as researchers continue to explore ways of stopping the disease process early, before it becomes destructive, or even preventing rheumatoid arthritis altogether.

  • John H. Klippel, M.D., Reva Lawrence, M.P.H., Amye L. Leong, Michael D. Lockshin, M.D., Kate Lorig, R.N., Dr.P.H., J. Lee Nelson, M.D., Stanley R. Pillemer, M.D., Paul H. Plotz, M.D., Paul G. Rochmis, M.D., Ronald L. Wilder, M.D., Ph.D., and Cheryl Yarboro, R.N., B.S.P.A., NIAMS, NIH - Handout on Health: Rheumatoid Arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)