Rheumatoid Arthritis: A Complete Guide

Stiff fingers when you wake up. Sore knees during the day. Swollen ankles. You may be tempted to brush these off as being due to exercise, a poor night’s sleep, or even the weather: “I can feel it in my knees when it’s going to rain.”

However, these seemingly common ailments could also be due to rheumatoid arthritis, a disorder that affects close to 1.5 million Americans. 

But what exactly is rheumatoid arthritis? More importantly, what are the red flags you should be watching out for?

See below for an in-depth look at what causes rheumatoid arthritis, how it’s diagnosed, and what you can do for relief from its symptoms. 

What Is Rheumatoid Arthritis? 

Rheumatoid arthritis (RA) is an autoimmune condition that results in chronic joint inflammation and reduced joint function. Let’s break this down a bit more. 

• Autoimmune disease: when your body mistakenly attacks itself 
• Rheumatic diseases: are both autoimmune and inflammatory arthritis conditions that involve the joints, muscles, bones, and organs
• Chronic: long-lasting or frequently recurring
• Joints: the points in your body where bones meet. The majority of them (known as synovial joints) also provide shock absorption. 

Put more simply, when someone suffers from rheumatoid arthritis, their immune system perceives the lining of their joints as being foreign object. It then attacks the joints, causing joint pain, inflammation, and in severe cases even joint deformities. 

Small joints are most often affected by rheumatoid arthritis including those of the hands, wrists, and knees. And they’re affected in symmetry, meaning both sides of the body are equally affected. 

Less commonly, rheumatoid arthritis can also affect parts of the body that aren’t joints. In most of these cases, the main symptom is inflammation (though there may be others.) Other areas that can be impacted by chronic disease or ongoing immune dysfunction include: 

• Blood vessels: inflammation
• Eyes: dryness, pain, inflammation, redness, sensitivity, vision problems
• Heart: inflammation
• Lungs: inflammation and scarring (higher risk of lymphoma)
• Mouth: dryness, inflammation, irritation
• Skin: small rheumatoid nodules (bumps) under the skin
• Bones: RA doesn’t just cause the joints to degenerate, it affects all the bones in the body and is often accompanied by carpal tunnel and osteoporosis

Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis usually begins in your hands, particularly at the knuckles. In fact, one of the first things you may notice is that you have trouble sliding your rings onto your fingers. 

The earliest symptoms of RA  may start off in a seemingly innocuous fashion, with just slight stiffness in the joints, especially when you first wake up. Over weeks or even months, this morning stiffness can gradually progress to swelling or pain in the joints. 

As it progresses, rheumatoid arthritis moves on from your hands to other joints. Often, the next to be affected are the joints in your toes or wrists.

How Rheumatoid Arthritis Attacks Your Body

Like many other autoimmune diseases, rheumatoid arthritis begins with your white blood cells (also known as leukocytes). These leukocytes are part of your immune system, and their job is to protect you. They flow through your bloodstream and attack bacteria, viruses, and foreign objects. The white blood cells’ goal is to destroy invaders and keep you healthy. 

Unfortunately, white blood cells can make mistakes. And that’s exactly what happens with rheumatoid arthritis. Misguided leukocytes attack the lining of your joints, as if they were foreign bodies. In response, those joints experience inflammation and stiffness. 

Synovial Joints

Your body contains about 300 joints! Many of these are synovial joints, which allow for movement and provide shock absorption. There are several types of synovial joints:

• Ball and socket joints, such as the shoulder
• Hinge joints, such as the knee
• Pivot joints, such as the vertebrae in your neck
• Planar or gliding joints, such as those in the top of the foot
• Condyloid joints, such as those in the wrist
• Saddle joints, such as the thumb 

All synovial joints are surrounded by a soft tissue, known as the synovium, that supports and protects them. It also provides lubrication between the joints, preventing pain or damage caused by friction. 

In the case of rheumatoid arthritis, your white blood cells enter the synovium, mistaking it for a foreign invader. This causes the synovium to thicken, resulting in one of the first signs of rheumatoid arthritis: joint pain. 

Long-Term Damage

Rheumatoid arthritis, being a chronic illness, won’t simply go away. It’s long-lasting and continuous. It might seem to be alleviated for some time, only to come back in full force. 

Over time, this constant inflammation of the synovium can cause damage to both the cartilage and the bone at the joint. It can also cause a degeneration in the muscles, ligaments, and tendons in the surrounding area. 

And times when the disease is in remission can be just as bad for the body. When the inflammation goes away, the tissue surrounding the joint remains stretched out. The joint might not stay in its proper position, causing instability or even deformation. 

Diagnosing Rheumatoid Arthritis

There isn’t one perfect test that’ll say definitively that yes, you have rheumatoid arthritis. Instead, your doctor will conduct a physical exam and follow up with questions about your symptoms. They’ll ask about your joint pain and swelling. In particular, they’ll ask about joint stiffness when you first wake up and how long it lasts (one of the key signs of rheumatoid arthritis.)

If their findings point to rheumatoid arthritis, your doctor will likely refer you to a rheumatologist (a doctor who specializes in arthritis) for additional diagnostics. 

Blood Tests

Blood tests can be used to detect markers for rheumatoid arthritis. 

Rheumatoid factor (RF) is a protein produced by your immune system. It’s known to attack healthy tissue, such as the synovium. High levels of RF are associated with autoimmune disorders, including rheumatoid arthritis. 

However, the RF test is not conclusive. High levels of RF can be found in healthy patients, and some patients with rheumatoid arthritis might have normal RF levels. 

Your blood could also be tested for anti-citrullinated protein antibodies (ACPAs). These antibodies are created in response to antigen variations (more on that below!) common in patients with rheumatoid arthritis. 

Imaging Tests

Imaging tests can sometimes be helpful in diagnosing rheumatoid arthritis. X-rays, ultrasounds, and magnetic resonance imagery (MRI) scans can detect joint damage. They can also reveal inflammation or erosion of the joints. 

Causes of Rheumatoid Arthritis

At the moment, researchers have yet to pinpoint exactly what causes your white blood cells to attack the synovium. But the two main possibilities that often come up are genetics and environmental factors. 

Genetic Factors

Research indicates that certain genes can play a role in the development of rheumatoid arthritis, particularly the human leukocyte antigen (HLA) genes. 

HLA genes produce a protein that helps your body distinguish between its own proteins and those from foreign bodies such as viruses or bacteria. Variations in the HLA gene may make it more difficult for white blood cells to distinguish between the two. 

Eventually, this leads to your body attacking itself. In the case of rheumatoid arthritis, this results in the attack to the synovium. 

There are other genes that may play a similar role in the development of rheumatoid arthritis, but HLA is the primary biologic factor that would put you at higher risk.   

Environmental Factors

Not everyone who suffers from rheumatoid arthritis has the HLA gene variant. In its absence, there are likely environmental risk factors that play a role. 

• Hormonal changes (particularly in women)
• Exposure to certain dusts or fibers
• Certain viral or bacterial infections
• Long-term cigarette smoking
• Obesity
• Severely stressful events
• Certain foods

Treatment for Rheumatoid Arthritis

It’s crucial to see a doctor if you suspect you may have rheumatoid arthritis. You might think it’s just an inconvenient stiffness or slight swelling. But left untreated, it could lead to long-term complications that could affect your heart, lungs, and nervous system. That’s why it’s crucial to see a doctor and seek early treatment.

At the moment, there is no known cure for rheumatoid arthritis. But symptoms can be managed with the right treatments. 

• Heat therapy, such as an electric heating pad
• Cold therapy, such as an ice pack
• Exercise
• Mindful movement, such as yoga and tai chi
• Meditation and other stress management techniques
• Acupuncture

There are also medications that can slow or even halt the progression of the disease. 

Anti-inflammatory medications, such as corticosteroids, are typically the first line of defense against rheumatoid arthritis. The goal with these is to reduce inflammation, improve mobility, and minimize joint damage.

The most promising medicinal option is known as disease-modifying antirheumatic drugs (DMARDS). These can significantly impact the progression of rheumatoid arthritis by lessening inflammation and protecting the joints. 

In the most severe cases of rheumatoid arthritis, your doctor may prescribe painkillers. These are used in conjunction with other techniques (such as those listed above) that can help with mobility and pain management. 

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be used to help with pain, swelling, or stiffness. They are typically taken orally or used in a topical gel, and they can be used in conjunction with painkillers. 

Another effective treatment of rheumatoid arthritis for more serious cases is joint replacement. This is a surgery to replace all of or part of a joint, and is considered a last resort treatment option. Talk to your doctor about possible side effects of any RA treatment. 

The Rheumatoid Arthritis-Gut Health Connection

Is it possible for your gut to play a role in the development of rheumatoid arthritis? You bet! 

Your gut houses about 80% of your immune system. And whether it’s brought on by genetic or environmental factors, at its root rheumatoid arthritis is caused by a faulty immune system. 

So what exactly is the connection? It’s a condition known as dysbiosis. 

Your gut microbiome houses the bacteria that lives in your gut. There are colonies of good bacteria (beneficial bacteria) and bad bacteria (pathogens). In an ideal world, the good bacteria outnumbers the bad bacteria. 

Unfortunately, for most people, that’s not the case. Poor dietary choices, excessive alcohol consumption, chronic stress, antibiotic usage, and other factors contribute to a bacterial imbalance known as dysbiosis. 

When your body is in dysbiosis, the bad bacteria has tipped the scales and outweighs the beneficial bacteria. This can result in digestive issues, skin conditions… and a misguided immune response. 

Studies have linked gut dysbiosis, and its colonies of pathogenic bacteria, with an increased risk of autoimmune diseases, including rheumatoid arthritis. 

One specific pathogenic bacteria, P. copri, was found more often in patients with rheumatic arthritis. This bacteria might be one of the triggers for the heightened immune response, eventually resulting in overactive white blood cells and autoimmune disorders. 

To counteract dysbiosis and ward off immune system attacks, your best course of action is to add probiotics to your diet. 

• Consume probiotic-rich food and drinks such as probiotic yogurts, kefir, miso, sauerkraut, kombucha, and pickles. 
• Add a high-quality probiotic supplement to your daily routine. 

By boosting the probiotics in your system and rebuilding the colonies of beneficial bacteria, you can get your immune system back under control. A healthy and balanced gut can reduce both the severity of symptoms and the frequency of arthritic flare-ups (and boost your overall health as well!) 

Final Thoughts

If you notice any signs of rheumatoid arthritis, you should see a healthcare professional  right away. The sooner it’s diagnosed, the sooner you can begin treatments that will alleviate symptoms and control flare-ups. 

With a mix of medical treatments and alternative practices, you can keep symptoms under control and continue to have  a rich, healthy quality of life.

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