What Increases Your Risk

The only known risk factor for rheumatoid arthritis is a possible genetic predisposition in some people. A genetic factor may affect how the immune system functions, causing inflammation and eventual destruction of the membranes lining the joints.

• Rheumatoid arthritis tends to be worse in smokers than in nonsmokers.
• Rheumatoid arthritis affects up to 1% of people in the U.S.
• Rheumatoid arthritis affects women twice as often as men.
• Rheumatoid arthritis can begin at any age, but most often begins between the ages of 30 and 50.
• While rheumatoid arthritis occurs in all racial and ethnic groups, over 5% of certain Native Americans (i.e. the Chippewa and Pima tribes) have the disease.

Symptoms

Joint pain can be an early symptom of many different diseases. In rheumatoid arthritis, symptoms often develop slowly over a period of weeks or months. Fatigue and stiffness are usually early symptoms of rheumatoid arthritis. Weight loss and low-grade fever can occur.

• Painful, swollen, tender, "hot" joints. The same joints on both sides of the body (symmetrical) are usually affected, especially the hands, wrists, elbows, feet, knees, or neck.
• Morning stiffness. Joint stiffness may develop after long periods of sleeping or sitting and lasts at least 60 minutes and often up to several hours.
• Bumps (nodules). Nodules, ranging in size from a pea to a mothball, develop in nearly one-third of people who have rheumatoid arthritis. Nodules usually form over pressure points in the body such as the elbows, knuckles, spine, and lower leg bones.

Rheumatoid arthritis can affect the hands, wrists, elbows, feet, ankles, knees, or neck. It usually affects both sides of the body at the same time, and more than three sets of joints may be affected at one time.

• Fatigue.
• A loss of appetite.
• Weight loss.
• Mild fever.

Other organ involvement may occur later in the course of the disease. In a small number of severe cases, rheumatoid arthritis may also cause damage to the heart, lungs, skin, blood vessels, nerves, and eyes. Specific joint problems may also occur later in the course of the disease.

• Hand and wrist deformities.
• Neck (cervical spine) symptoms.

Progression of the disease is more likely when:

• The rheumatoid factor blood test is positive.
• The disease fails to respond to therapy.
• Bumps (nodules) develop rapidly.
• Many joints are affected.
• X-rays show early loss of bone or cartilage.

Initial treatment

Treatment of rheumatoid arthritis should start with education about this disease, the possibility of joint damage and disability, and the risks and benefits of potential treatments. A long-term treatment plan should be developed by you and your health professional team.

Medications called disease-modifying antirheumatic drugs (DMARDs) that can actually slow or sometimes prevent joint destruction are now recommended early in the course of the disease. DMARDs can help prevent the significant joint damage that may occur in the early stages of rheumatoid arthritis. The purpose of early treatment is to:

• Relieve or reduce pain.
• Reduce joint inflammation.
• Improve daily function.
• Prevent or delay significant joint damage and deformity.
• Prevent permanent disability.
• Improve the quality of life.

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