What is the worse arthritis you can get?

Overview — Rheumatoid arthritis

There may be periods where symptoms become worse, known as flare-ups or flares.

A flare can be difficult to predict, but with treatment it’s possible to decrease the number of flares and minimise or prevent long-term damage to the joints.

Some people with rheumatoid arthritis also experience problems in other parts of the body, or more general symptoms such as tiredness and weight loss.

When to get medical advice

See a GP if you think you have symptoms of rheumatoid arthritis, so they can try to identify the underlying cause.

Diagnosing rheumatoid arthritis quickly is important, because early treatment can prevent it getting worse and reduce the risk of joint damage.

Causes of rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease. This means your immune system (which usually fights infection) attacks the cells that line your joints by mistake, making the joints swollen, stiff and painful.

Over time, this can damage the joints, cartilage and nearby bone.

It’s not clear what triggers this problem with the immune system, although you’re at an increased risk if:

you are a woman
you have a family history of rheumatoid arthritis
you smoke

Treating rheumatoid arthritis

There’s no cure for rheumatoid arthritis. However, early diagnosis and appropriate treatment enables many people with the condition to have periods of months or even years between flares. This can help them to lead full lives and continue regular employment.

The main treatment options include:

medicine that is taken long term to relieve symptoms and slow the progress of the condition
supportive treatments, such as physiotherapy and occupational therapy, to help keep you mobile and manage any problems you have with daily activities
surgery to correct any joint problems that develop

Depending on how much pain, stiffness or joint damage you have, daily tasks may become difficult or take you longer to do. You may have to adapt the way you do everyday tasks.

Complications of rheumatoid arthritis

Having rheumatoid arthritis can lead to several other conditions that may cause additional symptoms and can sometimes be life threatening.

Possible complications include:

carpal tunnel syndrome
inflammation of other areas of the body (such as the lungs, heart and eyes)
an increased risk of heart attack and stroke

Making sure that rheumatoid arthritis is well controlled can help to reduce your risk of these complications.

Video: rheumatoid arthritis

In this video, a rheumatologist describes the effects of rheumatoid arthritis and the symptoms and treatments.

Media last reviewed: 4 April 2023
Media review due: 4 April 2026

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Rheumatoid Arthritis

Rheumatoid arthritis is a type of arthritis where your immune system attacks the tissue lining the joints on both sides of your body. It may affect other parts of your body too. The exact cause is unknown. Treatment options include lifestyle changes, physical therapy, occupational therapy, nutritional therapy, medication and surgery.

Overview

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that is chronic (ongoing). It occurs in the joints on both sides of your body, which makes it different from other types of arthritis. You may have symptoms of pain and inflammation in your:

Uncontrolled inflammation damages cartilage, which normally acts as a “shock absorber” in your joints. In time, this can deform your joints. Eventually, your bone itself erodes. This can lead to the fusion of your joint (an effort of your body to protect itself from constant irritation).

Specific cells in your immune system (your body’s infection-fighting system) aid this process. These substances are produced in your joints but also circulate and cause symptoms throughout your body. In addition to affecting your joints, rheumatoid arthritis sometimes affects other parts of your body, including your:

Who gets rheumatoid arthritis?

Rheumatoid arthritis affects more than 1.3 million people in the United States. It’s 2.5 times more common in people designated female at birth than in people designated male at birth.

What’s the age of onset for rheumatoid arthritis?

RA usually starts to develop between the ages of 30 and 60. But anyone can develop rheumatoid arthritis. In children and young adults — usually between the ages of 16 and 40 — it’s called young-onset rheumatoid arthritis (YORA). In people who develop symptoms after they turn 60, it’s called later-onset rheumatoid arthritis (LORA).

Symptoms and Causes

What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis affects everyone differently. In some people, joint symptoms develop over several years. In other people, rheumatoid arthritis symptoms progress rapidly. Many people have time with symptoms (flares) and then time with no symptoms (remission).

Symptoms of rheumatoid arthritis include:

Pain, swelling, stiffness and tenderness in more than one joint.
Stiffness, especially in the morning or after sitting for long periods.
Pain and stiffness in the same joints on both sides of your body.
Fatigue (extreme tiredness).
Weakness.
Fever.

Does rheumatoid arthritis cause fatigue?

Everyone’s experience of rheumatoid arthritis is a little different. But many people with RA say that fatigue is among the worst symptoms of the disease.

Living with chronic pain can be exhausting. And fatigue can make it more difficult to manage your pain. It’s important to pay attention to your body and take breaks before you get too tired.

What are rheumatoid arthritis flare symptoms?

The symptoms of a rheumatoid arthritis flare aren’t much different from the symptoms of rheumatoid arthritis. But people with RA have ups and downs. A flare is a time when you have significant symptoms after feeling better for a while. With treatment, you’ll likely have periods of time when you feel better. Then, stress, changes in weather, certain foods or infections trigger a period of increased disease activity.

Although you can’t prevent flares altogether, there are steps you can take to help you manage them. It might help to write your symptoms down every day in a journal, along with what’s going on in your life. Share this journal with your rheumatologist, who may help you identify triggers. Then you can work to manage those triggers.

What causes rheumatoid arthritis?

The exact cause of rheumatoid arthritis is unknown. Researchers think it’s caused by a combination of genetics, hormones and environmental factors.

Normally, your immune system protects your body from disease. With rheumatoid arthritis, something triggers your immune system to attack your joints. An infection, smoking or physical or emotional stress may be triggering.

Is rheumatoid arthritis genetic?

Scientists have studied many genes as potential risk factors for RA. Certain genetic variations and non-genetic factors contribute to your risk of developing rheumatoid arthritis. Non-genetic factors include sex and exposure to irritants and pollutants.

People born with variations in the human leukocyte antigen (HLA) genes are more likely to develop rheumatoid arthritis. HLA genes help your immune system tell the difference between proteins your body makes and proteins from invaders like viruses and bacteria.

What are the risk factors for developing rheumatoid arthritis?

There are several risk factors for developing rheumatoid arthritis. These include:

Family history: You’re more likely to develop RA if you have a close relative who also has it.
Sex: Women and people designated female at birth are two to three times more likely to develop rheumatoid arthritis.
Smoking:Smoking increases a person’s risk of rheumatoid arthritis and makes the disease worse.
Obesity: Your chances of developing RA are higher if you have obesity.

Diagnosis and Tests

How is rheumatoid arthritis diagnosed?

Your healthcare provider may refer you to a physician who specializes in arthritis (rheumatologist). Rheumatologists diagnose people with rheumatoid arthritis based on a combination of several factors. They’ll do a physical exam and ask you about your medical history and symptoms. Your rheumatologist will order blood tests and imaging tests.

The blood tests look for inflammation and blood proteins (antibodies) that are signs of rheumatoid arthritis. These may include:

Erythrocyte sedimentation rate (ESR) or “sed rate” confirms inflammation in your joints.
C-reactive protein (CRP).
About 80% of people with RA test positive for rheumatoid factor (RF).
About 60% to 70% of people living with rheumatoid arthritis have antibodies to cyclic citrullinated peptides (CCP) (proteins).

Your rheumatologist may order imaging tests to look for signs that your joints are wearing away. Rheumatoid arthritis can cause the ends of the bones within your joints to wear down. The imaging tests may include:

X-rays.
Ultrasounds.
Magnetic resonance imaging (MRI) scans.

In some cases, your provider may watch how you do over time before making a definitive diagnosis of rheumatoid arthritis.

What are the diagnostic criteria for rheumatoid arthritis?

Diagnostic criteria are a set of signs, symptoms and test results your provider looks for before telling you that you’ve got rheumatoid arthritis. They’re based on years of research and clinical practice. Some people with RA don’t have all the criteria. Generally, though, the diagnostic criteria for rheumatoid arthritis include:

Inflammatory arthritis in two or more large joints (shoulders, elbows, hips, knees and ankles).
Inflammatory arthritis in smaller joints.
Positive biomarker tests like rheumatoid factor (RF) or CCP antibodies.
Elevated levels of CRP or an elevated sed rate.
Your symptoms have lasted more than six weeks.

Management and Treatment

What are the goals of treating rheumatoid arthritis?

The most important goal of treating rheumatoid arthritis is to reduce joint pain and swelling. Doing so should help maintain or improve joint function. The long-term goal of treatment is to slow or stop joint damage. Controlling joint inflammation reduces your pain and improves your quality of life.

How is rheumatoid arthritis treated?

Joint damage generally occurs within the first two years of diagnosis, so it’s important to see your provider if you notice symptoms. Treating rheumatoid arthritis in this “window of opportunity” can help prevent long-term consequences.

Treatments for rheumatoid arthritis include lifestyle changes, therapies, medicine and surgery. Your provider considers your age, health, medical history and how bad your symptoms are when deciding on a treatment.

What medications treat rheumatoid arthritis?

Early treatment with certain drugs can improve your long-term outcome. Combinations of drugs may be more effective than, and appear to be as safe as, single-drug therapy.

There are many medications to decrease joint pain, swelling and inflammation, and to prevent or slow down the disease. Medications that treat rheumatoid arthritis include:

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs decrease pain and inflammation. They include products like:

Ibuprofen (Advil®, Motrin®).
Naproxen (Aleve®).
Aspirin.

COX-2 inhibitors

COX-2 inhibitors are another kind of NSAID. They include products like celecoxib (Celebrex®). COX-2 inhibitors have fewer bleeding side effects on your stomach than typical NSAIDs.

Corticosteroids

Corticosteroids, also known as steroids, also can help with pain and inflammation. They include prednisone and cortisone.

Disease-modifying antirheumatic drugs (DMARDs)

Unlike other NSAIDs, DMARDs actually can slow the disease process by modifying your immune system. Your provider may prescribe DMARDs alone and in combination with steroids or other drugs. Common DMARDs include:

Methotrexate (Trexall®).
Hydroxychloroquine (Plaquenil®).
Sulfasalazine (Azulfidine®).
Leflunomide (Arava®).

Janus kinase (JAK) inhibitors

JAK inhibitors are another type of DMARD. Rheumatologists often prescribe JAK inhibitors for people who don’t improve taking methotrexate alone. These products include:

Tofacitinib (Xeljanz®).
Baracitinib (Olumiant®).

Biologics

If you don’t respond well to DMARDs, your provider may prescribe biologic response agents (biologics). Biologics target the molecules that cause inflammation in your joints. Providers think biologics are more effective because they attack the cells at a more specific level. These products include:

Etanercept (Enbrel®).
Infliximab (Remicade®).
Adalimumab (Humira®).
Anakinra (Kinaret®).
Abatacept (Orencia®).
Rituximab (Rituxan®).
Certolizumab (Cimzia®).
Golimumab (Simponi®).
Tocilizumab (Actemra®).

Biologics tend to work rapidly — within two to six weeks. Your provider may prescribe them alone or in combination with a DMARD like methotrexate.

What is the safest drug for rheumatoid arthritis?

The safest drug for rheumatoid arthritis is one that gives you the most benefit with the least amount of negative side effects. This varies depending on your health history and the severity of your RA symptoms. Your healthcare provider will work with you to develop a treatment program. The drugs your healthcare provider prescribes will match the seriousness of your condition.

It’s important to meet with your healthcare provider regularly. They’ll watch for any side effects and change your treatment, if necessary. Your healthcare provider may order tests to determine how effective your treatment is and if you have any side effects.

Will changing my diet help my rheumatoid arthritis?

When combined with the treatments and medications your provider recommends, changes in diet may help reduce inflammation and other symptoms of RA. But it won’t cure you. You can talk with your doctor about adding good fats and minimizing bad fats, salt and processed carbohydrates. No herbal or nutritional supplements, like collagen, can cure rheumatoid arthritis. These dietary changes are safer and most successful when monitored by your rheumatologist.

But there are lifestyle changes you can make that may help relieve your symptoms. Your rheumatologist may recommend weight loss to reduce stress on inflamed joints.

People with rheumatoid arthritis also have a higher risk of coronary artery disease. High blood cholesterol (a risk factor for coronary artery disease) can respond to changes in diet. A nutritionist can recommend specific foods to eat or avoid to reach a desirable cholesterol level.

When is surgery used to treat rheumatoid arthritis?

Surgery may be an option to restore function to severely damaged joints. Your provider may also recommend surgery if your pain isn’t controlled with medication. Surgeries that treat RA include:

Knee replacement.
Hip replacement.
Other surgeries to correct a deformity.

5 Warning Signs That Rheumatoid Arthritis Is Getting Worse

These tips and clues may help you gauge the severity of your rheumatoid arthritis.

By Cathy Garrard and Eric Metcalf, MPH Medically Reviewed by Alexa Meara, MD
Reviewed: March 12, 2021

Rheumatoid arthritis, also known as RA, is a joint disease characterized by inflammation and pain. The condition is also three times more likely to impact women, according to research published in the journal Rheumatology International. And one of the trickiest things about treating rheumatoid arthritis is that this autoimmune disease doesn’t progress the same in everyone who has it. Some people will be able to manage their symptoms entirely, while others will see their disease grow worse. RELATED: 8 Things I Didn’t Know About Rheumatoid Arthritis Until It Happened to Me Despite all the research that’s been done, who may develop severe rheumatoid arthritis and joint damage and whose joint damage will slow over time still remain somewhat of a medical mystery. “I don’t know when I see someone over the first two or three visits how serious it will be,” says John J. Cush, MD, a professor of internal medicine and rheumatology at UT Southwestern Medical Center in Dallas. RELATED: 6 Things About Rheumatoid Arthritis That Are Difficult to Explain or Understand

Effective Treatments for RA Are Available

But the good news is that in 2021, the treatments for rheumatoid arthritis are better than ever. “There are phenomenal therapies for RA, and most patients will have a completely normal life, provided they take their medications,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and a medical advisor to CreakyJoints, a support, education, advocacy, and research organization for people living with arthritis and rheumatic disease. Here are five important things to note about disease progression:

1. The Number of Swollen, Painful Joints You Have Is an Indicator of Disease Severity

The more joints that are painful and swollen, the more severe the disease may be, says Dr. Cush. Joint pain and swelling are characteristic signs and symptoms of rheumatoid arthritis. Rheumatologists consider this a very important way to measure disease severity. Your doctor should examine joints in your hands, feet, shoulders, hips, elbows, and other spots to see how many are causing problems. Symmetrical symptoms, such as having the same swollen joints on both sides of the body, are also hallmark symptoms of rheumatoid arthritis, Cush says. Dr. Domingues adds that the traditional morning stiffness and joint swelling that are characteristic symptoms of RA should be discussed with a rheumatologist as soon as possible. “Those are signs of active rheumatoid arthritis, and when it presents like that, it gives doctors an opportunity to be aggressive in early treatment or to switch to another class of drugs if symptoms are worsening.”

RELATED: People With Rheumatoid Arthritis Develop Resilience by Dealing With Disease Challenges

2. Your Lifestyle Is More Sedentary and You’re Moving Less

Regular physical activity is necessary for everyone but especially for people with RA. Research has shown that regular cardiovascular exercise and weight training can substantially improve daily function without exacerbating rheumatoid arthritis disease activity. There are numerous health benefits associated with regular physical activity — like improved muscle strength and better bone and joint health — which all help your aches and pains feel better. But rest is also needed to restore the body from the bouts of intense pain and fatigue that are characteristic of rheumatoid arthritis. But you can’t let “taking it easy” become a way of life. A sedentary lifestyle may eventually lead to increased pain, fatigue, and weakness, and a lower quality of life. RELATED: 7 of the Best Activity Apps for People With Rheumatoid Arthritis Regular exercise also has another life-enhancing benefit: It helps reduce your odds of developing cardiovascular disease. Taking good care of your ticker is essential for people with rheumatoid arthritis, because heart problems are more prevalent in people who have RA compared with the general population. “It’s heart disease that kills you, not the RA,” says Domingues. “It’s very important to talk to your primary care doctor or a cardiologist if you have RA to control your risk factors, such as high cholesterol, obesity, and diabetes.” RELATED: 8 Things People With Rheumatoid Arthritis Must Know About the COVID-19 Vaccines

3. Your Doctor Can’t Fully Appreciate Potential New Symptoms via Telemedicine

In the COVID-19 pandemic era, people with rheumatoid arthritis can’t always make it into the doctor’s office for a physical visit. But a telemedicine, or telehealth, appointment, which is unquestionably better than not checking in with health professionals at all, may not detect that the disease is progressing as well as an in-person visit. Domingues says that rheumatologists should definitely notice if joints are swollen and warm to the touch in an office consultation — signs of active inflammation — but they may not catch the severity of those symptoms on a computer screen. “If we’re not physically examining them, the communication between doctors and patients needs to be even better,” Domingues says. He says to make sure that you mention how your joints feel when you wake up, how much stiffness you experience in the morning and for how long, if you’re able to make a full fist early in the day, and if you see red, warm, or swollen joints. “Those are the pivotal signs of worsening RA,” he says. RELATED: 6 Foods to Avoid When You Have Rheumatoid Arthritis

4. Imaging Test Results Help Paint a Picture

X-rays, CT scans, MRIs, and ultrasounds are all tests that can help track and detect the severity of joint and cartilage damage. Bone erosion and destruction of cartilage can happen quickly within the first two years that you have rheumatoid arthritis, and the damage may continue to develop over time. RELATED: Rheumatoid Arthritis and Disability Applications: What to Know

5. Some Daily Activities Are Difficult

Pay close attention to how you truly feel. Rheumatoid arthritis is one of the few diseases where subjective measures of how a patient feels are among the best predictors of how well a person will respond to treatment and how much the disease will progress. Doctors may measure severity of symptoms using both the Health Assessment Questionnaire Disability Index (HAQ) and the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire.