Rheumatoid Arthritis

Rheumatoid arthritis, often shortened to RA, is an autoimmune disease: the immune system attacks the lining of your joints instead of only defending you against infection. It usually shows up as pain, swelling and long morning stiffness in the same small joints on both sides of the body, and it can make you feel unwell all over, not just in the joints.

What rheumatoid arthritis is, and what it is not

RA is a disease of the immune system that happens to centre on the joints. The joints most often involved are the knuckles and small joints of the hands, the toes and the wrists, along with elbows, shoulders, knees and ankles, and typically the same joints on both sides. Because the whole immune system is involved, RA can also bring fatigue, low-grade fever and weight loss, and the inflammation can reach other organs, including the nerves, eyes, skin, lungs and heart. It belongs to the wider family of autoimmune diseases.

It is not the same as osteoarthritis, even though the two are often confused. Osteoarthritis comes from changes in the joint tissues themselves, becomes more common with age and joint loading, and its stiffness after rest usually eases within about 30 minutes. RA’s morning stiffness tends to last 30 minutes or more, its pattern is symmetric, and it can involve organs beyond the joints. The treatments are very different, which is why sorting out which arthritis is present is the main job of an early assessment. Our arthritis and chronic pain page maps the wider territory.

Signs and symptoms

• Pain, swelling and stiffness in several joints at once, often the same joints on both sides of the body
• Morning stiffness, sometimes called gelling, that lasts 30 minutes or more
• Trouble with everyday grips and movements, such as opening jars or turning taps
• Fatigue out of proportion to activity, sometimes with low-grade fever or weight loss
• Firm lumps under the skin (rheumatoid nodules), most commonly on the elbows, hands or feet
• Symptoms that flare and settle but keep returning over weeks
• Less commonly, inflammation of the eyes, skin, lungs or other organs

RA looks different from person to person: some people have long quiet stretches between flares, while others have symptoms that build steadily, which is part of why diagnosis can take time.

What raises the risk

Some things cannot be changed:

• Being female: females are affected two to three times more often than males
• Age, with onset most often between 40 and 60, although RA can start at any age
• Family history of rheumatoid arthritis

Others can often be worked on, usually with support from a health care team:

• Smoking, which Arthritis Society Canada describes as the strongest environmental risk for developing RA
• Gum disease, which is linked to higher risk and can be addressed with dental care

How rheumatoid arthritis is diagnosed in Canada

RA is usually suspected by a family doctor or nurse practitioner and confirmed with a rheumatologist. Assessment includes an examination of the joints and blood tests, including tests for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies, along with markers of inflammation. X-rays or ultrasound may be used to look for joint inflammation and damage. No single test settles it: the pattern of joints, the timing of stiffness and the test results are read together.

Treatment and day-to-day management

Clinical research for Rheumatoid Arthritis is enrolling. See the current studies ↓

Rheumatologists describe a window of opportunity in early RA: strong evidence supports starting disease-modifying treatment within about the first two years, when it has the greatest potential to limit joint damage and disability. That is why a new pattern of joint pain and long morning stiffness is assessed in weeks rather than months where possible. A health care team may discuss:

• Disease-modifying antirheumatic drugs (DMARDs), the core of RA care, which calm the immune attack rather than only easing symptoms. Conventional DMARDs such as methotrexate are usually tried first
• Biologic DMARDs, medicines that block specific immune signals, used when conventional DMARDs are not enough
• Targeted synthetic DMARDs, tablets such as JAK inhibitors that act inside immune cells
• Non-steroidal anti-inflammatory drugs for pain and inflammation, and corticosteroids for short periods or during flares
• Physiotherapy, occupational therapy, joint protection strategies and support for staying active and at work

Which medicines to use, in what order, and when to change course are decisions for you and your own rheumatology team, weighed against your other conditions and priorities.

When to talk to a doctor

• If you have had pain, swelling or stiffness in several joints for more than six weeks, book an assessment with a health care provider.
• If morning stiffness regularly lasts 30 minutes or more, mention it specifically: it helps separate inflammatory arthritis from other joint problems.
• If a single joint suddenly becomes very painful, hot, red or swollen and you feel feverish or unwell, get medical care the same day. Go to an emergency department or call 911 if you feel very unwell, because a joint infection needs urgent treatment.
• If you live with RA and develop new breathlessness, chest pain, or eye pain and redness, contact your health care team promptly, since RA can affect organs beyond the joints.

Why clinical research matters for rheumatoid arthritis

Modern treatment has changed the outlook for RA, but real questions remain. Not everyone reaches remission. It is still hard to predict which medicine will work for which person, so treatment can involve trial and error while joints stay inflamed. It is not settled when medicines can safely be reduced once RA is quiet. Trials in Canada and internationally are testing new targeted medicines, comparing treatment strategies head to head, and studying whether intervening very early, even before RA is definite, changes the course of the disease, something the evidence does not yet support.

Taking part in a study usually means extra assessments and close monitoring by a research team. Participation is voluntary, informed consent comes first, and you can withdraw at any time without affecting your regular care. No one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Arthritis Society Canada: rheumatoid arthritis
• Public Health Agency of Canada: rheumatoid arthritis in Canada
• Arthritis Research Canada
• Canadian Rheumatology Association