Causes and Risk Factors
RA develops when the immune system attacks the synovium, the thin membrane that lines the joints. The resulting inflammation thickens the synovium and can eventually erode cartilage and bone. Why this happens is not fully understood, but several factors increase risk:- Genetics: Certain inherited genes make the immune system more likely to react abnormally against the body's own tissues.
- Smoking: Cigarette smoking increases the risk of developing RA and tends to make the disease more severe and harder to treat.
- Sex and age: Women are affected two to three times more often than men, and onset is most common in middle age.
- Excess weight: Carrying extra weight modestly increases risk and can make treatment less effective.
Symptoms
Symptoms usually develop gradually over weeks to months and characteristically affect the same joints on both sides of the body:- Tender, warm, swollen joints: RA most often starts in the small joints of the hands, wrists, and the balls of the feet.
- Morning stiffness: Joint stiffness that lasts an hour or more after waking is a hallmark of inflammatory joint disease.
- Fatigue, low-grade fever, and loss of appetite: Because RA is a systemic disease, many people feel generally unwell, not just sore.
- Rheumatoid nodules: Firm, painless lumps may form under the skin, often near the elbows.
Diagnosis
There is no single test for RA. Your physician combines a careful joint examination with blood tests — including rheumatoid factor, anti-CCP antibodies, and inflammation markers such as the sedimentation rate and C-reactive protein — and imaging such as X-rays or ultrasound. Your physician may also order baseline blood counts and liver and kidney tests, since these are monitored regularly during treatment. Because other forms of inflammatory arthritis can look similar early on, careful evaluation matters. Early diagnosis is important: most joint damage begins within the first two years of the disease, and modern treatment can largely prevent it.Treatment
Treatment aims for remission — little or no active joint inflammation — and works best when started early:- Conventional DMARDs: Disease-modifying antirheumatic drugs such as methotrexate, hydroxychloroquine, and sulfasalazine slow the disease itself rather than just easing symptoms, and are the foundation of therapy.
- Biologic agents: TNF inhibitors such as adalimumab, etanercept, and infliximab, and other biologics such as abatacept, target specific immune pathways when conventional DMARDs are not enough.
- JAK inhibitors: Oral targeted medicines such as tofacitinib, upadacitinib, and baricitinib are another option for persistent disease.
- Symptom relief: NSAIDs and short courses of corticosteroids ease pain and swelling while the slower-acting medicines take effect.
- Lifestyle measures: Regular low-impact exercise, quitting smoking, and joint-protection techniques all improve long-term outcomes.