Find Rheumatoid Arthritis Doctors near you

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FAQs:

What is Rheumatoid Arthritis?

Rheumatoid arthritis is a chronic inflammatory disorder affecting more than just your joints. In some people, the condition can damage various body systems, including the skin, eyes, lungs, heart, and blood vessels. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your body's tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.

What is Juvenile Rheumatoid Arthritis?

Juvenile rheumatoid arthritis is the most common form of arthritis affecting children. It is a swelling of the joints that is characterized by heat and pain. Arthritis can be short-term, lasting just a few weeks or months and then disappearing - or it may be chronic and last for months, years, or even a lifetime.

What’s the Age of Onset for Rheumatoid Arthritis?

RA usually starts to develop between the ages of 30 and 60. But anyone can develop rheumatoid arthritis. In children and young adults — usually between the ages of 16 and 40 — it’s called young-onset rheumatoid arthritis (YORA). In people who develop symptoms after they turn 60, it’s called later-onset rheumatoid arthritis (LORA).

What Does Rheumatoid Arthritis Pain Feel Like?

A person with RA may feel intense pain in their joints during flares. This can feel like sustained pressure, a burning sensation, or a sharp pain. However, people with RA may also experience periods of remission when they feel few to no symptoms. In addition to causing joint pain, RA can affect the whole body. A person living with the condition may experience fatigue, depression, anxiety, and lose weight unintentionally. RA is a lifelong condition. As a result, the key treatment outcome for RA is managing the condition.

How is Rheumatoid Arthritis Diagnosed?

Diagnosing RA may be difficult in the early stages. This is because symptoms may be very mild, and signs of the disease may not be seen on X-rays or in blood tests. Your healthcare provider will take your medical history and give you a physical exam. Tests may also be done, such as:

1. X-ray. This test uses a small amount of radiation to create images of internal tissues, bones, and organs onto film.

2. Joint aspiration. For this test, a small fluid sample is taken from a swollen joint. It is done to look for signs of infection or gout.

3. Nodule biopsy. Tiny tissue samples are taken to look at under a microscope. This helps to check for cancer or other abnormal cells.  

4. Blood tests. These tests are done to find certain antibodies, called rheumatoid factor, cyclic citrullinated antibodies, and other signs of RA.

5. Ultrasound or MRI. These imaging tests can look for bone damage and inflammation.

What are the First Signs of Rheumatoid Arthritis?

Early signs of rheumatoid arthritis include tenderness or pain in small joints like your fingers or toes. Or you might notice pain in a larger joint like your knee or shoulder. These early signs of RA are like an alarm clock set to vibrate. It might not always be enough to get your attention. However, the early signs are important because the sooner you’re diagnosed with RA, the sooner your treatment can begin. And prompt treatment may mean you are less likely to have permanent, painful joint damage.

Is Rheumatoid Arthritis an Autoimmune Disease?

Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body. RA mainly attacks the joints, usually many joints at once. RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness).

Is Rheumatoid Arthritis Genetic?

Rheumatoid arthritis (RA) is considered to develop as a result of interactions between inherited (genetic) factors and environmental factors (things that we are exposed to in the environment such as cigarette smoking). Recent technological advances have made it possible to examine, in detail, the genetic factors that are associated with RA. To date, researchers have found over 100 genetic changes that occur more commonly in patients with RA.  The advances in this field have required a considerable investment from patients, their families, physicians, researchers, and their funding institutions.

What is the Difference Between Osteoarthritis and Rheumatoid Arthritis?

Osteoarthritis is the most common form of arthritis. Rheumatoid arthritis affects about one-tenth as many people as osteoarthritis. The main difference between osteoarthritis and rheumatoid arthritis is the cause behind the joint symptoms. Osteoarthritis is caused by mechanical wear and tear on joints. Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks the body's joints.

Is Rheumatoid Arthritis a Disability? 

RA isn’t always a disability, but it can qualify as one if a person with RA meets specific criteria. The exact criteria depend on the agency or organization you’d like to receive services or benefits from. As a rule, to be considered a disability, RA needs to be severe enough to prevent you from working. Also, your doctor needs to think it’s most likely that your RA will continue to prevent you from working for at least 12 months. Often, you’ll need to present paperwork, such as a diagnosis from your doctor, X-rays, evidence of your medications, and more. Each organization has its own rules and will let you know what information they need to process your application.

Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis affects everyone differently. In some people, joint symptoms develop over several years. In other people, rheumatoid arthritis symptoms progress rapidly. Many people have time with symptoms (flares) and then time with no symptoms (remission). Symptoms of rheumatoid arthritis include:

1. Pain, swelling, stiffness and tenderness in more than one joint.

2. Stiffness, especially in the morning or after sitting for long periods.

3. Pain and stiffness in the same joints on both sides of your body.

4. Fatigue (extreme tiredness).

5. Weakness.

6. Fever.

Causes of Rheumatoid Arthritis

Researchers do not know what causes the immune system to turn against the body’s joints and other tissues. Studies show that a combination of the following factors may lead to the disease:

1. Genes. Certain genes that affect how the immune system works may lead to rheumatoid arthritis. However, some people who have these genes never develop the disease. This suggests that genes are not the only factor in the development of RA. In addition, more than one gene may determine who gets the disease and how severe it will become.

2. Environment. Researchers continue to study how environmental factors such as cigarette smoke may trigger rheumatoid arthritis in people who have specific genes that also increase their risk. In addition, some factors such as inhalants, bacteria, viruses, gum disease, and lung disease may play a role in the development of RA.

3. Sex hormones. Researchers think that sex hormones may play a role in the development of rheumatoid arthritis when genetic and environmental factors also are involved. Studies show:

- Women are more likely than men to develop rheumatoid arthritis.

- The disease may improve during pregnancy and flare after pregnancy.

4 Stages of Rheumatoid Arthritis

Knowing the stages of RA is essential for the effective management of the disease. When you understand rheumatoid arthritis progression, you’re better equipped to anticipate what will happen next, enabling early treatment and potentially slowing down the disease progression. A comprehensive grasp of these stages also helps healthcare providers tailor specific treatments for each phase.

Early Stages of RA

The early stages of RA are critical for diagnosis and treatment. Focusing on these stages can significantly influence the course of the disease.

Stage 1: Early RA

In Stage 1, also known as Early RA, patients usually begin to experience mild symptoms. These can include joint pain and slight joint swelling, especially in smaller joints like those in the hands and feet. This early stage is critical for diagnosis, as catching the disease early can dramatically affect the treatment outcome.

SYMPTOMS

In the early stages of RA, symptoms can be subtle yet crucial indicators of the condition. Early detection plays a vital role in effectively treating RA.

- Mild joint pain, often dismissed as muscle fatigue or aging

- Slight joint swelling, especially in smaller joints like fingers and toes

- Fatigue or general feeling of being unwell

DIAGNOSIS

Diagnosis at this stage usually involves blood tests to identify markers like the rheumatoid factor and C-reactive protein. Imaging tests like X-rays or MRIs may also be performed to check for any early joint damage. Early diagnosis is crucial for preventing severe outcomes later on.

Stage 2: Antibody Formation and Mild RA

In the second stage of RA, the body begins to produce antibodies like the rheumatoid factor. Symptoms become more persistent, and joint inflammation can cause more discomfort.

SYMPTOMS

During Stage 2, symptoms become more persistent and can extend beyond the smaller joints. Early treatment at this stage can be beneficial for slowing down RA progression.

- Persistent joint pain, becoming less easy to dismiss

- More pronounced joint swelling, often noticeable upon waking

- Joint stiffness, especially in the morning

- Decreased range of motion in affected joints

DIAGNOSIS

Blood tests become increasingly important for identifying rheumatoid factor levels and other inflammatory markers. These tests help doctors confirm the presence of RA and rule out other forms of inflammatory arthritis.

Later Stages of Rheumatoid Arthritis

As RA progression continues, symptoms and joint damage become more significant.

Stage 3: Moderate RA

Stage 3 is when patients begin to experience more severe forms of joint inflammation and pain. Rheumatoid nodules, which are firm lumps under the skin, may also begin to form. As RA progresses, joint damage becomes more pronounced, affecting both form and function.

SYMPTOMS

In Stage 3, symptoms escalate, affecting both the form and function of the joints. Rheumatoid nodules may also begin to form around the affected areas, indicating a moderate stage of the disease.

- Severe pain in the affected joints

- Visible rheumatoid nodules, usually under the skin near the elbow and hands

- Carpal tunnel syndrome due to inflammation around the wrist

- Evidence of joint damage in imaging studies

DIAGNOSIS

Diagnosis becomes more straightforward as the symptoms become severe. Blood tests will typically show high levels of inflammatory markers, and imaging studies will often show clear evidence of joint damage.

Stage 4: Severe RA

This is the most severe stage of RA, marked by significant joint damage and deformity. The condition can severely limit mobility and result in acute RA symptoms, significantly affecting the patient’s quality of life.

SYMPTOMS

Stage 4 is the most severe form of RA, leading to significant and often irreversible joint damage and deformity. Patients at this stage experience acute rheumatoid arthritis symptoms that can severely limit daily activities.

- Extreme joint pain and swelling

- Significant joint deformity, often visible even without imaging

- Decreased range of motion to the point of disability

- Chronic fatigue and a pervasive feeling of being unwell

DIAGNOSIS

At this stage, blood tests and imaging studies will show severe damage, with high levels of inflammatory markers like C-reactive protein. X-rays will often reveal extensive joint damage, and MRIs may show loss of joint tissue.

Risk Factors for Rheumatoid Arthritis

Although the exact cause of RA is unknown, some risk factors linked to the condition include:

1. Age: People are most likely to get diagnosed with RA in their 60s.

2. Sex: Rates of RA are highest among women.

3. Genetics: The human leukocyte antigen (HLA) DRB1 gene is linked to a higher risk of RA and more severe RA symptoms.

4. Obesity: Obesity can put you at a greater risk for RA.

5. Smoking: Studies have shown that smoking increases the risk of RA.

6. Gum disease: Gum disease is linked to a higher risk of RA.

7. Lung disease: People with lung disease have a higher risk of RA.

Other risk factors are still being studied and might increase the risk of RA. This includes risk factors related to childbirth and environmental surroundings.

Foods to Avoid With RA

Just as there are foods that can help your RA symptoms, there are also foods that can make them worse. Some of these foods can increase inflammation in your body, and many are high in fat, sugar, and salt, which can make it harder to manage your weight and keep your heart healthy.

1. Processed foods

High in salt, sugar, and unhealthy fats, processed foods can cause inflammation, weight gain, and heart problems. Not only are they bad for RA, but they're also bad for your overall health.

2. Red meat and processed meats

These contain high levels of saturated fat, which can increase inflammation and have negative effects on heart health. Processed meats, such as deli meat, sometimes also contain preservatives that can cause inflammation.

3. Fried foods

These are high in omega-6 fatty acids and saturated fats that cause inflammation and worsen heart health.

4. Refined sugars and carbohydrates

Sugary foods, such as pastries, candies, and sweetened beverages, can make your body release inflammatory messengers called cytokines. The same is true for refined carbohydrates such as white bread, white rice, and white pasta, which your body quickly digests into simple sugars.

5. Salt

Not only is too much salt bad for your blood pressure, but if you have RA and take steroids, your body may hold on to it more easily. Aim for less than 1,500 milligrams a day.

6. Alcohol

Alcohol doesn’t mix well with your RA medicines and can also cause inflammation.

Best Foods for Rheumatoid Arthritis

If you have rheumatoid arthritis (RA), you might wonder how your diet affects your condition and if there's anything you can eat to help your symptoms. There's no specific diet that treats RA, but some foods can help lower inflammation (irritation, pain, swelling) in your body. They can also help you manage your weight, which is important to avoid excess pressure on your joints. And because they're good for you, these foods can help you feel better overall.

1. Beans

Beans are packed with fiber, which can help lower your levels of C-reactive protein (CRP), a sign of inflammation. Beans also give you protein to keep the muscles around your joints strong. Red, kidney, and pinto beans are also good sources of nutrients such as folate, magnesium, iron, and potassium, all of which can give your heart and immune system a boost.

2. Broccoli

Broccoli and other green leafy veggies, such as spinach, Brussels sprouts, kale, and Swiss chard, are full of vitamins A and C, which protect you from free radical damage. Free radicals are unstable molecules that can damage your body's cells and cause and worsen RA. Broccoli is also a great source of calcium, which keeps your bones strong.

3. Cherries

Chemicals called anthocyanins are powerful antioxidants that can fight free radicals and help lower inflammation. They also give cherries their bright color. You can also find them in other purple and red fruits, such as raspberries and blueberries.

4. Citrus fruits

Oranges, grapefruits, and limes are great sources of vitamin C, which boosts your immune system and fights inflammation-causing free radicals.

5. Fish

Salmon, herring, sardines, mackerel, tuna, and anchovies provide omega-3s that can reduce inflammation and protect your heart health.

6. Nuts

Don't like fish? Walnuts, canola oil, and soybeans are good sources of plant-based omega-3 fatty acids.

7. Green tea

This tasty drink offers polyphenols, which are antioxidants that may lower inflammation and slow cartilage destruction.

8. Extra-virgin olive oil

Olive oil contains polyphenols of about 30 different kinds. Choose extra-virgin olive oil. It comes from the first pressing of the olive and has the most good-for-you nutrients.

9. Whole grains

Eating more whole grains instead of processed ones (think brown rice instead of white) can help lower CRP levels. Whole grains are also higher in fiber, which fills you up and makes it easier to manage your appetite. That can help you stay at a healthy weight so you don’t have extra pressure on your joints.

10. Red peppers

Red peppers are brimming with vitamin C. Vitamin C helps your body make collagen, which is part of your cartilage, tendons, and ligaments that cushion your joints and hold them together.

11. Canned salmon

Salmon is rich in omega-3 fatty acids. Canned salmon is convenient, but it also has an added benefit — varieties canned with bones have calcium and vitamin D, which help strengthen your bones. The tiny fish bones are soft and easy to eat.

Rheumatoid Arthritis Supplements

Getting enough essential vitamins and minerals is important for your health. When you have RA, certain vitamins and minerals are even more important, such as:

- Calcium

- Chromium

- Folate 

- Iron 

- Magnesium

- Selenium

- Vitamin A

- Vitamins B1, B2, B3, B6, and B12

- Vitamin C

- Vitamin D

- Vitamin E

- Vitamin K

- Zinc

If you can't get enough of these from your diet, your doctor might recommend taking a supplement. Some research shows that other nonessential nutritional supplements may benefit RA:

1. Boron. A trace element naturally found in foods, boron has been shown to fight inflammation. Research shows that people who have high-boron diets have a very low incidence of arthritis, and there's evidence that people with RA can benefit. The best sources of boron are fresh fruits and vegetables and, depending on where you live, drinking water.

2. Fish oil. Just like eating fatty fish, taking a fish oil supplement can help you get omega-3 fatty acids that lower inflammation. If you're not able to get enough fish oil from your diet, your doctor may suggest a fish oil supplement.

3. Gamma-linolenic acid (GLA). Your body uses this omega-6 fatty acid to make anti-inflammatory agents. This is different from other omega-6 fatty acids that can increase inflammation. GLA is found in evening primrose oil, black currant oil, and borage oil supplements. Some research shows that taking GLA can help improve symptoms of RA.

4. S-adenosylmethionine (SAMe). Several studies show SAMe, a substance that occurs naturally in your body's tissues, is as effective as anti-inflammatory painkillers for relieving pain, swelling, and stiffness in the joints -- but with fewer side effects.

5. Turmeric. Turmeric is a root related to ginger. Turmeric contains curcumin, which has antioxidant and anti-inflammatory benefits. Several studies have found that it can help reduce pain and swelling in RA.

There are many other supplements people might use to help with RA. But there's not enough research to confirm these benefits. Medical care, medication, a healthy diet, and exercise are the best evidence-backed treatments for RA. Never use nutritional supplements as a substitute for professional medical care, and always ask your doctor before taking a new supplement to make sure it's right for you.

How to Treat Rheumatoid Arthritis

There is no cure for rheumatoid arthritis. However clinical studies indicate that remission of symptoms is more likely when treatment begins early with medications known as disease-modifying antirheumatic drugs (DMARDs).

MEDICATIONS

The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had rheumatoid arthritis.

1. NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen and naproxen sodium. Stronger NSAIDs are available by prescription. Side effects may include stomach irritation, heart problems, and kidney damage.

2. Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain, and diabetes. Doctors often prescribe a corticosteroid to relieve symptoms quickly, to gradually taper off the medication.

3. Conventional DMARDs. These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine. Side effects vary but may include liver damage and severe lung infections.

4. Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, sarilumab, and tocilizumab.

5. Biologic DMARDs are usually most effective when paired with a conventional DMARD, such as methotrexate. This type of drug also increases the risk of infections.

6. Targeted synthetic DMARDs. Baricitinib, tofacitinib, and upadacitinib may be used if conventional DMARDs and biologics haven't been effective. Higher doses of tofacitinib can increase the risk of blood clots in the lungs, serious heart-related events, and cancer.

THERAPY

Your doctor may refer you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks that will be easier on your joints. For example, you may want to pick up an object using your forearms.

Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a hand grip helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.

SURGERY

If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and improve function.

Rheumatoid arthritis surgery may involve one or more of the following procedures:

1. Synovectomy. Surgery to remove the inflamed lining of the joint (synovium) can help reduce pain and improve the joint's flexibility.

2. Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.

3. Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.

4. Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.

Surgery carries a risk of bleeding, infection, and pain. Discuss the benefits and risks with your doctor.

When to See a Rheumatologist

A rheumatologist is an internist or pediatrician who has received further training in the diagnosis and treatment of diseases such as arthritis and autoimmune disease. Autoimmune diseases are simply diseases that occur when your body mistakenly attacks itself. The diseases can involve any organ system, including the skin, lungs, kidney, GI tract, muscles, and even eyes, and can also affect muscles, bones, or joints.

So, when is it important to get a rheumatology referral? We always recommend speaking to your healthcare team if you think a rheumatology evaluation is necessary.

1. Signs and Symptoms

Recurrent fevers, joint swelling, fatigue, rash, anemia, weakness, and/or unexplained weight loss are signs and symptoms that may warrant a referral to rheumatology if no other explanation is found. Since many different diseases can cause the symptoms above, it is important to first communicate with your primary care provider. They may order initial lab tests that help in establishing a diagnosis.

2. Joint Pain

If you have been having joint pain, such as stiffness in the morning that lasts for more than 30 minutes, you may want to seek a rheumatology referral for evaluation for inflammatory arthritis. In addition, recurring joint swelling, especially in the knuckles, wrists, ankles, and feet, would be another reason to reach out for a rheumatology referral.

3. Skin Changes

Some types of rashes may be associated with rheumatic disease, so it is recommended to see a rheumatologist if you or your primary care provider suspect an autoimmune etiology, especially if you have other symptoms. Hair loss, oral ulcers, and genital ulcers are other changes that may indicate a rheumatic condition.

4. Vision Changes

Patients with systemic autoimmune disease may have changes in their vision. You should see an ophthalmologist if you have sudden vision loss, blurry vision, double vision, or red/painful eyes. If the ophthalmology evaluation suspects a rheumatic condition, then that would be another reason to see a rheumatologist.

5. Abnormal Lab Tests

Keeping the patient’s history and other symptoms in mind, some abnormal lab tests, especially if they are of high value, would warrant a rheumatology workup. These may include labs that are positive or raise suspicion for diseases such as systemic lupus erythematosus, rheumatoid arthritis, vasculitis, scleroderma, gout, polymyalgia rheumatica, giant cell arteritis, just to name a few. Since the rate of false positives can be high for some of these labs, they should only be measured in the right clinical setting.

If you are experiencing unexplained systems that are repeating, it’s a good idea to talk to your primary care doctor about a rheumatology referral. There are over 100 rheumatic diseases, and rheumatologists have dedicated their careers to the study and treatment of these unique conditions. Early diagnosis and treatment can help prevent permanent damage and prevent symptoms from worsening over time.

What to Look for in a Rheumatoid Arthritis Doctor Near Me

The right rheumatologist for you may depend on your specific needs and communication style. Here are some tips to help you find the best rheumatoid arthritis doctor for you:

1. Consider the doctor’s personality and how well it meshes with yours.

2. Find a doctor you can relate to and communicate effectively with.

3. Look for a doctor you can build a long-term relationship, since some rheumatic diseases may develop into chronic conditions.

4. Consider having a loved one or friend join you at an appointment so they can help you decide if the doctor is a good fit.

Sources:

Mayo Clinic

NIH

Hopkins Medicine

Arthritis Care

CDC

WebMD

Healthline

ACR

Medical News Today

Cleveland clinic