Fire in the Joints

Living with Rheumatoid Arthritis

/ Author:  / Reviewed by: Joseph V. Madia, MD

Katie had just graduated from college and landed her first job with an advertising agency. Life was good. She didn't have a care in the world.

Then rheumatoid arthritis changed everything.

Katie writes in her blog, "Rheumatoid Arthritis is one of those infamous invisible diseases…if you’re lucky. If you’ re lucky, the doctors diagnose you in a timely manner so physical aspects of the disease don’t begin to mutilate your body. If you’re not lucky, your fingers and toes begin to curl up and take on a new form which you cannot control.

It repulses you to look at your own joints and limbs. You want to crawl into bed and cover your head without ever making a public appearance again. Unfortunately you can’t do this as you’re a single 23 year old girl with bills to pay."

What is rheumatoid arthritis?

Living with rheumatoid arthritis, or RA as it's abbreviated, can keep a person on a merry-go-round of pain, stiffness and sometimes disability. RA is an autoimmune disease, meaning that somehow the body gets confused and starts attacking itself.

The incurable disease causes the joints and areas around the joints to swell up and get stiff. The cause of RA is unknown.

Very briefly, RA:

  • Can strike at any age
  • Attacks more women than men
  • Usually affects joints on both sides of the body
  • Causes pain in the wrists, fingers, knees, feet and ankles most often
  • May cause other physical illnesses
  • Can cripple, deform and destroy joints

What are the symptoms of RA?

The disease usually develops slowly. Symptoms of RA are similar to other diseases and may include any or a combination of the following:

  • Fatigue
  • Loss of appetite
  • Low fever
  • Swollen glands
  • Weakness

Next comes the pain, swelling and stiffness. "I thought I had a high resistance for pain. But nothing prepared me for RA," says Dawn, talking on a patient support forum.

As the disease progresses, the pain arrives. You may experience:

  • Morning stiffness that usually lasts more than an hour
  • Joints becoming warm, tender and stiff when not used - even for a short period of time, as little as an hour
  • Pain in the joints on both sides of the body
  • Swollen joints that often feel warm and spongy to the touch
  • Pain and swelling in your fingers, wrists, elbows, shoulders, hips, knees, ankles, toes, jaw, and neck

Over time, joints lose their range of motion and may become deformed.

Other RA symptoms can include:

  • Chest pain when taking a breath
  • Eye burning, itching and discharge
  • Nodules under the skin (usually a sign of more severe disease)
  • Numbness, tingling or burning in the hands and feet

How is RA diagnosed?

A blood test called the anti-CCP antibody test diagnoses RA. This test also distinguishes RA from other types of arthritis.

Your doctor may also order other tests as part of identifying RA. These may include:

  • Complete blood count
  • C-reactive protein
  • Erythrocyte sedimentation rate
  • Joint ultrasound, X-rays or MRI
  • Rheumatoid factor test, which is positive in about 75 percent of people with symptoms
  • Synovial fluid analysis

Throughout treatment, regular blood or urine tests should be done to learn how well medicines are working and whether the drugs are causing any side effects.

How is RA treated?

Most RA specialists believe it's best to start treating RA aggressively within the first two years, what's called "the window of opportunity." This therapy could stop the disease and keep it from heading into its ugliest stages.

"I am a strong believer in the window of opportunity, which probably spans two years after symptom onset," says Salahuddin Kazi, M.D., associate professor of internal medicine and chief of rheumatology at the Dallas VA Medical Center in an Arthritis Foundation article. "If RA goes untreated for two years, the majority of people with RA will develop joint erosion, indicating disease progression."

RA medications

A number of drugs are available to treat RA. They may be used alone or in combination. Common prescription strength medications include:

  • Rheumatrex
  • Arava
  • Azulfidine
  • Plaquenil
  • Celebrex (which carries a strong warning regarding risks of heart disease and stroke)

Anti-inflammatory medicines including aspirin and nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen, are also used for RA.

Steroids may be prescribed to reduce joint swelling and inflammation. Because of serious side effects, these medications should be taken at low dosages and only for the shortest time possible.

Other agents

Due to the complexity and often severity of the disease, RA may also be treated with biologic agents. They are usually given when the more common medications don't work.

Biologic agents work with the immune system. While effective, biologic agents carry the risk of serious side effects, so close monitoring is required.


When the disease progresses to the point that patients can no longer function very well, surgery can help. The first option involves removing joint linings, called the synovium.

Total joint replacement may be needed eventually and can include replacing the total knee, hip, ankle and shoulder. Other operations are also available to keep an RA patient independent.

Physical therapy

To delay the loss of function, a physical therapist may prescribe range-of-motion exercises and other exercise programs. Other treatments involve protecting the joints with heat and cold treatments, splints or orthotic devices to support and align joints.

Special machines can be used to apply deep heat or electrical stimulation to reduce pain and improve joint mobility.

An occupational therapist may be brought in to teach you how to protect and use your joints. These professionals can also help you perform day-to-day tasks at work and at home. 

Along with these therapies, resting between activities, as well as 8 to 10 hours of sleep per night, are recommended.

Living with RA

Unfortuately RA can lead to other problems, and treatment medications may cause serious side effects in some.

That's why it's so important to be under the care of a physician who can treat, guide and support you for many years. Physicians who specialize in treating RA are called rheumatologists.

The outlook

Treatment for rheumatoid arthritis has improved over the years, and new medications are coming online all the time. The course of the disease varies from person to person. Some may have an initial bout, then it fades away. Others may see a steady worsening of RA.

Many people with RA work full-time. However, after many years, about one in ten people living with RA will become severely disabled, and unable to do simple daily living tasks such as washing, dressing, and eating.

Don't wait to talk to you doctor

If you, a friend or a loved one has symptoms you suspect may be RA, see your doctor right away. The sooner RA is diagnosed and treatment begins, the more likely further damage to the joints can be prevented.

Review Date: 
May 5, 2011