Rheumatoid Arthritis

Rheumatoid arthritis, a chronic, autoimmune disease, is the most crippling form of arthritis and affects approximately 1.3 million Americans. Onset of the disease is usually middle age, but it does occur in individuals as early as age 20. Women are three times as likely to develop rheumatoid arthritis, or RA, than men. Patients with rheumatoid arthritis may also have osteoporosis, a progressive deterioration of bone density.

The hands, wrists, feet, ankles, knees, shoulders, and elbow joints are most commonly affected by this autoimmune disorder. The disease typically causes inflammation symmetrically, so the same joints are affected on both sides of the body. Symptoms of rheumatoid arthritis may begin suddenly or gradually.

The exact cause of rheumatoid arthritis is unknown, but researchers believe that heredity may contribute to the onset of the disease.

The symptoms of rheumatoid arthritis may resemble other medical conditions or problems, including acute rheumatic fever, Lyme disease, psoriatic arthritis, gout, osteoarthritis, gonococcal arthritis, and ankylosing spondylitis.

Symptoms of Rheumatoid Arthritis

The most common symptoms include:

  • Enlarged and/or deformed joints
  • Frozen joints (joints that freeze in one position)
  • Inflamed, painful joints
  • Cysts behind the knees that may rupture, causing lower leg swelling and pain
  • Hard nodules (bumps) under the skin near affected joints
  • Low-grade fever
  • Inflamed blood vessels (vasculitis)
  • Inflamed membranes around the lungs (pleurisy), the sac around the heart (pericarditis), or inflammation and scarring of the lungs themselves, that may lead to chest pain, difficulty breathing, and abnormal heart function
  • Sjögren's syndrome (dry eyes and mouth)
  • Stiff joints
  • Swollen lymph nodes
  • Eye inflammation

Evaluation

Diagnosis of rheumatoid arthritis may be difficult in the early stages, because symptoms may be very subtle and go undetected on X-rays or blood tests.

At UT Southwestern, our physicians will evaluate your complete medical history and perform a physical examination. The examination may include a number of diagnostic procedures such as X-rays and blood tests to detect certain antibodies, called rheumatoid factor, and other prominent indicators for rheumatoid arthritis.

Individuals with four or more of the following symptoms may be diagnosed with rheumatoid arthritis:

  • Morning stiffness that lasts longer than one hour for at least six weeks
  • Three or more joints that are inflamed for at least six weeks
  • Presence of arthritis in the hand, wrist, or finger joints for at least six weeks
  • Blood tests that reveal rheumatoid factor
  • X-rays that show characteristic changes in the joints

Once the test results have been reviewed, your physician will determine your specific treatment for rheumatoid arthritis based on:

  • Your age, overall health, and medical history
  • Extent of the condition
  • Your tolerance for specific medications, procedures, and therapies
  • Expectation for the course of the condition
  • Your opinion or preference

Treatment

UT Southwestern treats rheumatoid arthritis with a team approach, combined with the latest treatments and years of physician experience. We offer our patients the best in comprehensive care – through all stages of treatment.

The earlier a diagnosis is made and treatment is started, the more joint damage and impairment can be prevented. Treatment can range from simple therapies, such as diet and rest, to more aggressive therapies, including medications.

Treatment may include:

  • Exercise
  • Resting affected joints regularly
  • Nonsteroidal anti-inflammatory medications such as ibuprofen
  • Disease-modifying medications to slow bone deformation
  • Corticosteroids to reduce inflammation
  • Immunosuppressive medications to suppress inflammation
  • Physical therapy to keep the joints from "freezing" and becoming immobile
  • Heat or cold application to the joints
  • Surgery
  • Assistive devices such as canes, crutches, or walkers