(RA; Arthritis, Rheumatoid)
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- Genetic factors—Certain genes that play a role in the immune system are associated with RA development.
- Defects in the immune system can cause ongoing inflammation.
- Environmental factors—Certain infectious agents, such as some viruses or bacteria, may increase susceptibility to RA.
- Other factors—Some evidence suggests that hormonal factors may promote RA development in combination with genetic factors and environmental exposure.
- Family members with RA
- Sex: female
- Ethnic background: Pima Indians
- Heavy or long-term smoking
Joint pain and stiffness that is:
- Most prominent in the morning
- Lasts for at least half an hour
- Red, warm, or swollen joints
- Joint deformity
- Mild fever, tiredness
- Loss of appetite
- Small lumps or nodules under the skin
- Nervous system
- Blood vessels
Blood tests to determine if you have an autoimmune disease:
- Rheumatoid factor (RF)
- Anti-citrullinated protein antibody
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Imaging tests, such as x-rays
- Relieve pain
- Reduce inflammation
- Slow down joint damage
- Improve functional ability
Disease-modifying anti-rheumatic drugs (DMARDS)—to slow the course of the disease; used early in the course of the disease to prevent long-term damage:
- Methotrexate (such as, Rheumatrex)
- Hydroxychloroquine (such as, Plaquenil)
- Sulfasalazine (such as, Azulfidine)
- Leflunomide (such as, Arava)
- Cyclosporine (such as, Neoral)
- Penicillamine (such as, Cuprimine)
- Gold (such as, Ridaura)
- Minocycline (such as, Minocin)
Immunosuppressive drugs (only used when other DMARDS are ineffective):
- Azathioprine (such as, Imuran)
- Cyclophosphamide (such as, Cytoxan)—rarely used
- Chlorambucil (such as, Leukeran)—rarely used
- Acetaminophen (such as, Tylenol)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen
Biologic response modifiers—drugs that interfere with the autoimmune response; includes tumor necrosis factor (TNF)-inhibitors, such as:
- Etanercept (such as, Enbrel)
- Infliximab (such as, Remicade)
- Adalimumab (such as, Humira)
- Golimumab (such as, Simponi)
- Certolizumab (such as, Cimzia)
Rest and Exercise
- Zipper extenders
- Long-handled shoehorns
- Specially designed kitchen tools
- Maintain a balance between rest and exercise.
- Attempt mild strength training.
- Participate in aerobic exercise (such as, walking, swimming, dancing).
- Avoid heavy-impact exercise.
- If you smoke, quit.
- Control weight.
- Participate in a physical therapy program.
American College of Rheumatology http://www.rheumatology.org
Arthritis Foundation http://www.arthritis.org
Canadian Orthopaedic Association http://www.coa-aco.org
Canadian Rheumatology Association http://rheum.ca
Rheumatoid arthritis (RA). EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated September 3, 2010. Accessed September 10, 2010.
Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at: http://www.niams.nih.gov/Health%5FInfo/Rheumatic%5FDisease/default.asp. Published January 1998. Updated May 2004. Accessed June 18, 2008.
Tanaka E, Saito A, et al. Impact of shoulder, elbow, and knee joint involvement on assessment of rheumatoid arthritis using the American College of Rheumatology Core Data Set. Arthritis Rheum. 2005;53:864-871.
Verstappen SM, Bijlsma JW, et al. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys. Arthritis Rheum. 2004;51:488-497.
4/16/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Zautra AJ, Davis MC, Reich JW, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J Consult Clin Psychol. 2008;76:408-421.
1/4/2011 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Tumor necrosis factor (TNF) blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi). US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm175843.htm. Updated August 31, 2009. Accessed November 4, 2009.
1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Anis A, Zhang W, Emery P, et al. The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study. Rheumatology (Oxford). 2009;48:1283-1289.
1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Aletaha D, Neogi T, Silman AJ, Funovits J, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580-1588.
- Reviewer: Marcin Chwistek, MD
- Review Date: 09/2012
- Update Date: 09/30/2012