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Rheumatoid Arthritis

What is rheumatoid arthritis? 

Rheumatoid arthritis (RA) is an inflammatory disease that can affect multiple joints in the body. RA is an autoimmune disease where the body’s immune system—which normally functions to protect us against infections—mistakenly attacks the lining of the joints.  The cause of this malfunctioning immune system is still unknown and while there is no cure for RA, there are some very effective medications and therapies to control the symptoms and results of the inflammation.  

Inflammation in the joints causes pain, stiffness and swelling.  If this inflammation continues, it can lead to damage of the joint. The inflammation can affect other organs, such as the nerves, eyes, skin, lungs or heart. 

The symptoms of RA vary widely from person to person. In many cases, RA starts in a few joints then spreads to other joints over a few weeks to months. RA can also progress extremely quickly; some people report that one morning they just could not get out of bed. 

The earliest symptoms of RA can be non-specific, including feeling unwell or tired, soreness around joints and muscles, low-grade fever, and weight loss/poor appetite. As time goes on, RA can involve more and more joints on both sides of the body, often in a “symmetrical” pattern. 

About one out of every 100 adult Canadians has RA. That’s about 300,000 Canadians. Anyone can get RA and at any age. RA affects women two to three times more often than men.  

There is no cure for RA. However, people who are diagnosed and treated early can avoid pain and damage to their joints, and lead active and productive lives. 

To learn more about your patient journey with rheumatoid arthritis, click here.

FAQs

What are early signs of RA? 

RA usually starts over a period of weeks to months, with more joints becoming affected over time. You should see your doctor if you experience one or more of the following symptoms for more than six weeks: 

  • Pain or stiffness, of multiple joints  
  • “Gelling” or stiffness of joints, especially in the morning, that lasts an hour or more 
  • Warmth or redness over joints 
  • Reduced ability to move the joints (such as difficulty making a fist, twisting objects, opening objects, climbing stairs) 
  • Fever, fatigue, weight loss or decreased appetite 
  • Lumpy growths that form under your skin, most commonly on the elbows, hands or feet 

How is RA diagnosed? 

An accurate diagnosis is very important because there are many ways to treat and manage RA. Early diagnosis and treatment can reduce the pain and disability associated with this disease.  

There are no “perfect” tests to make the diagnosis of RA. If you have signs and symptoms of RA, your doctor will examine your joints and take your medical history. If indicated, he or she may order blood tests that detect inflammation that may help confirm the diagnosis. Your health-care provider may also order X-rays to look for any signs of joint damage. If your family doctor suspects you have RA, you will be referred to a specialist. 

What are the risk factors for RA? 

The exact causes of RA are unknown, but research has shown that several things that may contribute: 

  • Family history:  Some people who develop RA have specific genes that are linked to RA. However, having genes linked to RA does not necessarily mean you will develop RA 
  • Sex: RA affects women two to three times more often than men 
  • Hormones: Some hormonal changes appear to be linked to RA.  Hormone changes during and after pregnancy, during breastfeeding and even oral contraception use may be linked to the development of RA or may relieve or trigger RA symptoms.   
  • Age: Anyone can get RA at any age, but the risk does increase with age, commonly developing between 40 and 60 years of age 
  • Environment: Infection can trigger RA in people who are have genetic links to RA. However, it is important to remember that you cannot catch or spread RA. 
  • Smoking: Numerous studies have shown that cigarette smoking is the strongest environmental risk for the development of RA and for having a more severe form of RA.      

What are the joints that can be affected by RA? 

Any joint can be affected in RA but the joints most commonly involved include: 

  • Small joints of the hand and feet 
  • Wrists
  • Elbows 
  • Shoulders 
  • Knees 
  • Ankles 

Why is treatment for RA so important? 

RA causes inflammation of the lining of certain joints. This inflammation leads to swelling, stiffness and increased warmth of the affected joint(s). It can also affect other parts of the body like the eyes, nerves, skin heart or lungs.  You can think of this inflammation like a “fire” burning in the joints. If the fire of inflammation is left “burning,” it can permanently damage the joint. Once a joint is damaged, it cannot be fixed other than through surgery. Just as you would try to put out a fire in your home with a fire extinguisher before it spreads, you want to put out the inflammation of RA as quickly and as safely as possible.  

RA is best managed by a specialist doctor, known as a rheumatologist, who is trained in dealing with inflammation of the joints.

It is important to treat RA as early as possible as research has confirmed that this improves the long-term outcomes and quality of life of people living with RA.  

Treatment

Medication 

Arthritis medications are designed to control the disease, to slow its progression and to help manage symptoms. There is a wide range of options – with new ones coming on the horizon – so understanding all possible treatments is not easy.  

These medications can be very complex, so you are encouraged to ask for in-depth explanations from your health-care team—including pharmacists, who are an excellent source of information.  

To explore this area of treatment, The Arthritis Society has developed a comprehensive expert guide that delivers detailed information on medications used to treat all types of arthritis, including RA. 

EXPLORE: Arthritis Medications – A Reference Guide

The optimal treatment is what is best in each individual case – so speak with your doctor and/or pharmacist about what kind of medications are most appropriate for you. 

Surgery  

Surgery is not common, but may be necessary after many years of severe arthritis. Surgery may be needed to relieve pain, straighten out a bent or deformed joint, restore mobility or replace a damaged joint. Sometimes the tendons and ligaments around joints, such as the hips, may need to be lengthened. The surgeon may also be asked to make recommendations on splinting and rehabilitation.  

Occupational therapy  

An occupational therapist (OT) trained in arthritis management can analyze everything you do in a day and develop a program to help you protect your joints and minimize fatigue. These healthcare professionals have advanced training from a university and are registered to practice by their provincial/ territorial association. If necessary, they can help you redesign your home or workplace to make it easier for you to work or simply get around. They can also make or recommend a number of different splints, braces, orthopedic shoes and other aids that can help reduce your pain and increase your mobility and functionality. Their goal is to prepare you to live as fully and comfortably as possible.   

Physiotherapy  

A physiotherapist (PT) can develop an individualized program to help you increase your strength, flexibility, range-of-motion and general mobility and exercise tolerance through a wide variety of therapeutic treatments and strategies. These include exercise programs, physical interventions and relaxation, in addition to advising you on other techniques for reducing pain and increasing your overall quality of life. PTs can also refer you to other health professionals and community services for further measures that will help you adapt to your changing circumstances.  

Self-Management

Protecting your joints  

You should always use your joints in ways that avoid excess stress. Techniques to protect your joints include: 

  • Pacing by alternating heavy or repeated tasks with lighter tasks. Taking a break reduces the stress on painful joints and conserves energy by allowing weakened muscles to rest. 
  • Positioning joints carefully promotes proper alignment and decreases stress on the joints. For example, squatting and kneeling may put extra stress on your hips or knees. When lifting or carrying heavy items, keep items at waist height and avoid carrying them up and down stairs. 
  • Using helpful tools and assistive devices conserves energy and makes daily tasks easier. Raise seat levels to decrease stress on hip and knee joints. Use a “reacher” to pick up items from the ground. Use a cane to decrease stress on hip and knee joints. Enlarge grips on utensils, such as spoons or peelers, to decrease stress on delicate hand joints. Other devices to consider include carts for carrying objects and jar/tap openers. 
  • Talk to your doctor about seeing an occupational therapist or physiotherapist, who may prescribe splints, braces or orthotics (shoe inserts) to help align and support your joints. 

Physical activity  

A common misconception is that a painful joint requires rest. On the contrary, not enough exercise can cause muscle weakness and worsening joint pain and stiffness. (However, when you are experiencing a flare and/or your joint(s) is swollen and hot, you should rest the joint(s) and only perform light range of motion exercise). 

Physical activity protects joints by strengthening the muscles around them. Strong muscles and tissues support those joints that have been weakened and damaged by arthritis. A properly designed program of physical activity (with advice from a health-care provider, such as a physician or a physiotherapist/occupational therapist) reduces pain and fatigue, improves mobility and overall fitness and alleviates depression. Physical activity can help someone with arthritis to lead a more productive and enjoyable life. 

There are different types of exercises you can do to lessen your pain and stiffness: 

  • Range of motion (also called stretching or flexibility exercises): Exercises that reduce pain and stiffness and keep your joints moving. To achieve the most benefit, these exercises should be done daily. 
  • Strengthening: Exercises that maintain or increase muscle tone and protect your joints. These exercises include weight training movements done with a set of “free” weights, your own body weight or weight machines. 
  • Endurance: Exercises that strengthen your heart, give you energy, control your weight and help improve your overall health. These exercises include walking, swimming and cycling. It is best to avoid high-impact exercises like step aerobics, jogging or kickboxing. 

There are many low-impact exercise options that can benefit people living with arthritis. Consult your health-care provider to find an exercise(s) that is suitable to you and your particular condition. Examples include: 

  • Tai Chi: An ancient Chinese martial art, Tai Chi is a combination of movements performed in a slow, focused manner. Though it has many variations and styles, Tai Chi is a low-impact exercise and is reminiscent of both yoga and meditation. Tai Chi could improve pain and physical function in some people as well as alleviate depression and contribute to health-related quality of life. 
  • Yoga: Numerous studies have been done on the benefits of yoga on stress and anxiety. The practice of breath control, simple meditation and stretching can improve a person’s state of mind and help them better manage their pain. Regular yoga under the guidance of a certified instructor can also boost one’s general health and increase energy levels. 
  • Aerobic Exercise: Low-impact aerobic exercise that gets your heart pumping, such as swimming, biking and brisk walking, can help improve your sleep, keep weight under control and alleviate stress and depression that is sometimes linked to RA. It can also protect you against heart disease, which is important since RA can increase the risk of this condition. 

Heat and cold therapy  

Taking a warm shower and using warm packs are ways to help reduce pain and stiffness. Always use a protective barrier, such as a towel, between the warm pack and the skin. Heat is ideal for: 

  • Relieving pain and stiffness 
  • Relieving muscle spasms and tightness 
  • Enhancing range of motion 

NOTE: To avoid making symptoms worse, heat should not be applied to an inflamed joint. 

Using a commercial cold pack or a homemade one (from crushed ice, ice cubes or a bag of frozen vegetables) can be helpful. Always use a protective barrier, such as a towel, between the cold pack and the skin. Cold is ideal for: 

  • Swelling 
  • Decreasing pain 
  • Constricting blood flow to an inflamed joint 

Healthy eating

Often RA results in loss of appetite and/or weight loss, which is why it is important to eat a balanced diet. Healthy eating will give you the energy to complete your daily activities as well as to promote a strong immune system, and bone and tissue health.  

Three ways to improve your nutrition include: 

  • Reduce sugar intake: Sugar added to foods contributes calories, but few other nutritional benefits. Sugar refers to white, brown, cane and raw sugar as well as syrup and honey. Instead, use dried fruits such as raisins or dates to sweeten food since they provide vitamins, minerals and fibre. Although artificial sweeteners contain few calories, it is better to minimize their use and just get used to food being less sweet. 
  • Eat more vegetables and fruit: Vegetables and fruit should make up the largest component of your diet. Try to have at least one vegetable or fruit at every meal and as a snack. Besides being an excellent source of energy, vegetables and fruit boost your fibre intake. Fibre makes you feel full and so helps you to control how much you eat. 
  • Choose “healthy fats”: The type and amount of fat you eat is important. You need some fat in your diet, but too much can be bad for your health. Fat is high in calories and some types of fat (saturated and trans fats) may increase your risk of developing heart disease. Polyunsaturated and monounsaturated fats are recommended as the main source of fat in your diet. Monounsaturated fat is found naturally in olive and canola oil, avocadoes and nuts like almonds, pistachios and cashews. Polyunsaturated fats, especially omega-3 and omega-6 fatty acids, can be found in cold-water fish (such as char, mackerel, salmon and trout), walnuts, sunflower seeds and flaxseeds. Fats that should be limited include trans fats, which are found in fried and processed foods, and saturated fats, which mainly come from animal sources of food, such as red meat, poultry and full-fat dairy products. Choose healthier dairy products (such as skim, 1 or 2% milk, low-fat yogurt and low-fat cheese). 

Relaxation and coping skills  

Developing good relaxation and coping skills can help you maintain balance in your life, giving you a greater feeling of control over your arthritis and a more positive outlook. Relaxing the muscles around a sore joint reduces pain. There are many ways to relax. Try deep breathing exercises. Listen to music or relaxation podcasts. Imagine or visualize a pleasant activity, such as lying on a beach. 

Complementary medicine 

People with a chronic disease like RA may decide to try complementary and alternative therapies to help them manage the symptoms of their condition. 

Before you try any of these treatments, always inform your health-care provider of any complementary and alternative therapies you are taking, receiving or would like to try. Your health-care provider can offer valuable advice about these treatments, especially how they may affect other medications and treatments. 

Massage 

Massaging of muscles and other soft tissues, by a professional massage therapist, may lead to a short-term decrease in stiffness and pain. Other benefits may include a reduction in stress and anxiety as well as improved sleep patterns. 

Meditation 

Meditation is a mind-body practice intended to quiet the mind by focusing on your breathing. Some studies have found that meditation, if practiced regularly, can ease pain and anxiety in individuals with RA. It can also offer people a heightened sense of calmness and control. 

Homeopathy 

Homeopathy is an alternative medical therapy that uses natural remedies from plants, animals and minerals to stimulate the body’s self-healing abilities. It can be used to relieve symptoms of a condition or illness. Although there is no scientific basis to recommend homeopathy for RA, there is low risk of harm from using these remedies 

Acupuncture 

Acupuncture, an ancient Chinese therapy for alleviating pain and treating various physical and mental health conditions, involves pricking the skin with needles. While studies on the effectiveness of acupuncture for RA symptoms are somewhat mixed, you may wish to try this treatment. It is important to find a certified practitioner.

What Now

Living well with arthritis

There is a lot you can do to take control and actively manage your arthritis. Below we have listed a few resources to help you learn more about actively managing your arthritis to live better.

Flourish

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Online Learning

Our online courses are jam-packed with helpful tips and information.  Each course is devoted to a specific issue or symptom linked to arthritis.

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Workshops and Webinars

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Contributors

This information was last updated September 2017, with expert advice from:

Bindee Kuriya, MD, SM, FRCPC
Assistant Professor, Department of Medicine, Division of Rheumatology University of Toronto

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