Rheumatoid arthritis (RA)

Overview

Rheumatoid arthritis (RA) is a long-term autoimmune disease. The immune system attacks the lining of the joints (the synovium), causing pain, swelling and stiffness, most often in the hands, wrists and feet on both sides of the body.

Without treatment, ongoing inflammation can damage cartilage and bone. Early diagnosis and disease-modifying treatment may help control inflammation and protect joints. RA can also affect the eyes, lungs, heart and blood vessels.

Watch and learn

Video: “What is Rheumatoid Arthritis? | Johns Hopkins Rheumatology” from Johns Hopkins Rheumatology on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube

Video: “Rheumatoid Arthritis - Mayo Clinic” from Mayo Clinic on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube

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Symptoms

• Painful, swollen, warm joints, often the same joints on both sides
• Morning stiffness lasting more than 30 to 60 minutes
• Fatigue, low-grade fever or feeling unwell
• Firm bumps under the skin (rheumatoid nodules)
• Reduced grip strength or trouble with daily tasks

Causes and risk factors

• Autoimmune: the exact trigger is not known
• Genetic risk (family history)
• Smoking, a strong known risk factor
• More common in women and often begins in middle age

How it is diagnosed

• Blood tests: rheumatoid factor (RF) and anti-CCP antibodies; ESR and CRP to measure inflammation; blood counts and liver and kidney tests before starting medicines
• Imaging: X-rays of hands and feet; ultrasound or MRI may show early inflammation
• Exam: a joint count of tender and swollen joints and review of how long symptoms have lasted

Treatment, step by step

Treatment is tailored to you. Medicines are described here in general terms; your rheumatologist will explain the specific options, benefits, risks and monitoring for your situation.

1. Lifestyle and self-care

   Regular activity, joint protection, not smoking, a healthy weight and good sleep may help. Your rheumatologist may refer you to physical or occupational therapy.

   • Therapeutic exercise & walking
   • Tai chi, gentle movement & aquatic therapy
   • Anti-inflammatory nutrition & weight management
   • Lifestyle & Diet for Rheumatic Disease
   • Physical & Occupational Therapy for Arthritis

2. Disease-modifying medicines (DMARDs and biologics)

   Conventional DMARDs such as methotrexate are usually started early. If disease stays active, a biologic or targeted synthetic DMARD may be added. Short courses of corticosteroids or NSAIDs may bridge symptoms.

   • DMARDs (Disease-Modifying Antirheumatic Drugs)
   • Biologic Medications
   • Corticosteroids
   • NSAIDs

3. Joint injections and infusions

   A corticosteroid injection may calm a single flaring joint. Some biologics are given by infusion. Infusions are currently given at a partner hospital; in-office infusions at GSMC are planned. Call 732-202-3000 for details.

   • Joint Injections

4. Referral and team care

   Coordinated care may include physical therapy, orthopaedics for damaged joints, and other specialists if RA affects the eyes, lungs or heart.

   • Nonsurgical options

What to expect at GSMC

1. Your first visit: a rheumatologist reviews your symptoms, history and medicines and examines your joints, skin and other areas.
2. Tests: blood tests and imaging, as needed, to confirm the diagnosis and check how active the disease is.
3. Your plan: we explain your options, including lifestyle steps and medicines, and how each is monitored.
4. Follow-up: regular visits and lab checks to adjust treatment over time.

Shahzad Hussain, MD sees rheumatology patients in Brick, Toms River and Whiting. Call 732-202-3000 to schedule.

Frequently asked questions