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It commonly affects multiple joints in the hands, wrists, and feet, often in a relatively symmetric pattern.\nWithout adequate control, ongoing inflammation can damage cartilage and bone, leading to joint deformity and loss of function. RA can also affect other parts of the body, including the lungs, eyes, skin, and blood.",[68,74,78,82,86],{"key":69,"title":70,"html":71,"icon":72,"updatedAt":73},"","Overview","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">RA is a chronic inflammatory disease caused by an abnormal immune response against the body’s own tissues, particularly the synovial lining of the joints.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">It most commonly affects the metacarpophalangeal, proximal interphalangeal, wrist, and foot joints, although the knees, ankles, shoulders, and elbows may also be involved. Pain, swelling, and morning stiffness are typical features.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">RA is a systemic disease and can also cause rheumatoid nodules, interstitial lung disease, eye inflammation, anemia, vasculitis, and other extra-articular manifestations.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Modern RA care emphasizes early diagnosis, early treatment, and a treat-to-target approach in which disease activity is monitored regularly and therapy is adjusted until remission or low disease activity is achieved.\u003C\u002Fspan>\u003C\u002Fp>","⚕️","2026-09-19",{"key":69,"title":75,"html":76,"icon":77,"updatedAt":73},"Causes and Risk Factors","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">The exact cause of RA is not fully understood. It is thought to result from an interaction between genetic susceptibility, abnormal immune responses, and environmental factors.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Associated factors include family history, smoking, age and sex, obesity, and other environmental or immune-related influences.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">RA can cluster in families, but it is not inherited in a simple way. Having a relative with RA does not mean that another family member will necessarily develop the disease.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Smoking is one of the best-established modifiable risk factors, particularly for some autoantibody-positive forms of RA.\u003C\u002Fspan>\u003C\u002Fp>","🧬",{"key":69,"title":79,"html":80,"icon":81,"updatedAt":73},"Signs and Symptoms","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">RA symptoms vary from person to person. Common manifestations include:\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cul class=\" list-paddingleft-2\" style=\"list-style-type: disc;\">\u003Cli>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Pain and swelling in multiple joints\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Stiffness after waking or after prolonged inactivity\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Involvement of the small joints of the hands, wrists, and feet\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Similar joints affected on both sides of the body\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Reduced joint movement\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Fatigue, reduced appetite, or low-grade fever\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003C\u002Ful>\u003Cp style=\"margin: 7px 0;text-align: justify;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Morning stiffness is a characteristic symptom and often improves gradually with movement.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">If inflammation remains uncontrolled for a long time, structural joint damage and deformity may develop. However, severe deformities are less common when RA is diagnosed and treated effectively at an early stage.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Some patients also develop rheumatoid nodules, lung disease, eye inflammation, anemia, or other systemic complications.\u003C\u002Fspan>\u003C\u002Fp>","📋",{"key":69,"title":83,"html":84,"icon":85,"updatedAt":73},"Diagnosis","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">There is no single test that can diagnose RA by itself.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Doctors consider the pattern of joint involvement, swelling, duration of symptoms, inflammatory markers, autoantibodies, and imaging findings.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Common tests include rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), C-reactive protein, erythrocyte sedimentation rate, complete blood count, and liver and kidney function tests.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">X-rays, musculoskeletal ultrasound, or MRI may also help assess inflammation and joint damage.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">RF and anti-CCP are important diagnostic markers, but a positive RF test alone does not establish a diagnosis. RF can be positive in other autoimmune diseases, chronic infections, and some healthy people. Some patients with RA are negative for both RF and anti-CCP.\u003C\u002Fspan>\u003C\u002Fp>","🩺",{"key":69,"title":87,"html":88,"icon":89,"updatedAt":73},"Treatment","\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">The goal of RA treatment is not simply to relieve pain but to suppress inflammation early enough to prevent irreversible joint damage.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">The 2025 EULAR recommendations state that DMARD treatment should begin as soon as RA is diagnosed and should aim for sustained remission or low disease activity. If there is insufficient improvement within about three months or the treatment target has not been reached by six months, therapy should generally be adjusted.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"color: rgb(15, 17, 21); background-color: rgb(255, 255, 255); font-size: 16px;\">\u003Cstrong>Disease-Modifying Antirheumatic Drugs\u003Cstrong> (DMARDs)\u003C\u002Fstrong>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Methotrexate remains a key initial treatment for many patients. Leflunomide or sulfasalazine may be considered when methotrexate cannot be used or tolerated.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 16px;\">\u003Cstrong>Biologic DMARDs and Targeted Synthetic DMARDs\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 16px;\">\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">If conventional DMARD therapy does not achieve the treatment target, a biologic DMARD may be added.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Biologic therapies include TNF inhibitors, IL-6 pathway inhibitors, abatacept, rituximab, and other agents.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">JAK inhibitors are targeted synthetic DMARDs and may also be considered for selected patients. However, treatment decisions should take into account individual risks such as cardiovascular disease, blood clots, serious infection, and malignancy. The 2025 EULAR recommendations specifically emphasize these safety considerations when JAK inhibitors are used.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"color: rgb(15, 17, 21); background-color: rgb(255, 255, 255); font-size: 16px;\">\u003Cstrong>Glucocorticoids and Analgesics\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"color: rgb(15, 17, 21); background-color: rgb(255, 255, 255); font-size: 16px;\">\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Nonsteroidal anti-inflammatory drugs can relieve pain and inflammation but do not prevent long-term joint damage and cannot replace DMARD therapy.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Glucocorticoids may provide rapid control of inflammation and can be used for a short period when DMARD therapy is started or adjusted. They should be tapered and discontinued as quickly as clinically feasible to reduce long-term complications.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 16px;\">\u003Cstrong>Treatment Goals\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 16px;\">\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Modern RA care follows a treat-to-target strategy.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">The goals are to achieve and maintain remission or low disease activity, relieve pain and swelling, prevent structural joint damage, preserve physical function, and reduce systemic complications.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Disease activity should be assessed regularly rather than judging treatment effectiveness only by how much the joints hurt.\u003C\u002Fspan>\u003C\u002Fp>","💊",{"author":69,"reviewedBy":69,"lastReviewed":69,"datePublished":69,"citations":91,"disclaimer":69},[],false,1792294354294]