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Home >> Arthritis 

Rheumatoid arthritis (RA)

(rew-ma-toyd are-thry-tis)

Rheumatoid arthritis (RA) occurs in one person in 100 and most commonly affects women between the ages of 40-50. It is an important cause of disability.

In RA there is inflammation of the lining of the joints which causes joint damage (Figure 6), which starts early and progresses slowly with time. It also has a major effect on what people can do, commonly causing people to have to give up their work. Modern treatments can slow down the progression of RA and have considerably improved the outcome over the past 10 years.

The causes of RA are unclear, but there is evidence of genetic predisposition to the disease. RA is rare in young people; in men peak incidence is at age 60-70 years, in women it increases in incidence in the mid 20s to reach a fairly constant level at 45-75 years, being slightly greater at 65-75 years.

Typically, the condition most commonly affects the finger joints, knuckles and wrists, feet and ankles, progressing to the elbows, knees, shoulders and the hips and less commonly the cervical spine. RA generally follows a symmetrical pattern, meaning that if one knee or hand is involved, the other one is also affected.

A joint affected by Rheumatoid Arthritis

Joints commonly affected by Rheumatoid Arthritis

In addition, people with RA may have fatigue, and a general sense of not feeling well (malaise). Other features include lumps (rheumatoid nodules) under the skin in areas subject to pressure (e.g. back of elbows).

RA affects people differently. For a few 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 forms of the disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions, and may result in gradually progressive problems.

Still others have a severe form of the disease that is active most of the time, lasts for many years or a lifetime, and leads to serious joint damage and disability. However, modern treatment can reduce inflammation and joint damage and improve the long-term outcome. As shown in the diagrams above, there are important differences in the way OA and RA affect the hands and wrists. These differences are covered in detail in the hand and wrist section.

Symptoms of rheumatoid arthritis?

Symptoms of RA differ from person to person but can generally include:

  • Joint tenderness, warmth, and swelling. Both sides of the body are usually affected at the same time. This is also called a "symmetrical pattern" of inflammation. For example, if one knee is affected, the other one is also. This is in contrast to osteoarthritis, where it is possible for only one knee to be affected.
  • Pain and stiffness lasting for more than 1 hour in the morning or after a long rest.
  • Joint inflammation in the wrist and finger joints closest to the hand (although joints of the neck, shoulders, elbows, hips, knees, ankles, and feet can be affected as well).
  • Fatigue, an occasional fever, and a general sense of not feeling well (called malaise).
  • Symptoms that last for an extended period of time.
  • Symptoms in other parts of the body, not just in the joints.

RA causes inflammation of the joint lining, which can lead to pain, swelling, stiffness, and loss of function. It also can cause inflammation of your tear glands, salivary glands, the lining of your heart and lungs, and the lungs themselves.

As RA progresses, about 25% of people with the disease develop small lumps of tissue under the skin, called rheumatoid nodules. These rheumatoid nodules usually aren't painful. The nodules may form under the skin of the elbow, hands, the back of the scalp, over the knee, or on the feet and heels. They can be as small as a pea to as large as a walnut.

Although RA is often a chronic disease, the severity and duration of the symptoms may unpredictably come and go. For people with a severe case of RA, the disease is generally active, lasts for many years, and leads to serious joint damage and disability. Periods of increased disease activity, or worsening of symptoms, are called flare-ups or flares. Periods of remission are when the symptoms fade or disappear.

If you are experiencing any of the symptoms described above, it is important to find out from a doctor if you have RA. Early diagnosis may reduce the pain, joint damage, and disability that occurs in some RA patients.

Where do symptoms of osteoarthritis typically appear?

Although OA can occur in any joint, most often it occurs in the following areas:

  • Fingers. OA of the fingers is often hereditary, meaning it runs in families. Fingers may ache or be stiff and numb. The base of the thumb joint is commonly affected. Fingers can become enlarged and gnarled. Small, bony knobs (called Heberden's nodes) may also appear on the end joints of the fingers. Similar knobs (called Bouchard's nodes) can appear on the middle joints of the fingers. More women than men have OA of their fingers. Women become especially susceptible to OA after menopause.
  • Knees. Because knees are primary weight-bearing joints, they are very commonly affected by OA. They may be stiff, swollen, and painful, making it hard to walk, climb, and get in and out of chairs and bathtubs.
  • Hip. OA in the hip can cause pain, stiffness, and severe disability. In addition to your hip, you may feel the pain in your groin, inner thigh, or knees. This can lead to difficulty moving, bending, and walking.
  • Spine. OA of the spine can cause stiffness and pain in the neck or in the lower back, as well as weakness or numbness in your arms or legs.



This quick guide is supported by Pfizer.