Rheumatoid Arthritis: Understanding, Managing, and Living With It

This article was originally published in the Asian Hospital & Healthcare Management Magazine.

Rheumatoid arthritis (RA) is a chronic, systematic autoimmune disease causing joint inflammation and potential organ damage. Early diagnosis and treatment are crucial to slowing progression. Advances in DMARDs, biologics, and targeted therapies have transformed RA management, enabling outcomes. Comprehensive care, lifestyle adjustments, and emotional support help patients maintain fulfilling lives.

Introduction:

Rheumatoid arthritis (RA) may first appear as joint ache and stiffness, but it's anything but simple. As the American College of Rheumatology explains, RA is an autoimmune condition in which your immune system turns on your own tissues, primarily those lining the joints triggering persistent inflammation that damages cartilage, bone, and can impact various organs.

Senior rheumatologist Dr. Shawn Baca, of Rheumatology Associates in South Florida, wants patients to understand one vital truth that: "Rheumatoid arthritis is not just bad arthritis." It's systemic. It can affect your lungs, kidneys, even cause blood vessel inflammation known as vasculitis. “It's a very specific disease,” he says, not to be confused with general wear-and-tear arthritis.

As Dr. Amish J. Dave from Seattle emphasizes: “This is a chronic condition. You can get it to a good place, but you won’t cure it.” He adds that long-term remission is rare, “probably less than 5%” and most patients will remain on some form of therapy throughout their lives.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis is an autoimmune disorder in which the body’s immune system mistakenly attacks healthy joint tissue. This misdirected immune response leads to chronic inflammation that damages cartilage, bones, and surrounding tissues. Unlike osteoarthritis, which is linked to wear and tear, RA is a systemic disease, it can also affect the heart, lungs, eyes, and even skin.

Leading specialists emphasize that RA is not simply “arthritis” but a complex, body-wide condition. “It’s a very specific disease, and it can impact nearly every organ system,” explains Dr. Shawn Baca, a rheumatology specialist. “Recognizing that early is key to slowing progression.” He adds.

The Autoimmune Mechanism Behind RA

In RA, the immune system confuses normal joint lining, called the synovium, for a threat. White blood cells flood the joint spaces, releasing chemicals that inflame and erode tissues. This ongoing inflammation thickens the synovial lining, causing pain, swelling, and ultimately permanent damage to joints and supporting structures.

This same overactive immune response can travel beyond the joints, leading to complications such as lung scarring, heart inflammation, or vascular issues. Because it’s systemic, RA requires a whole-body approach to treatment and management.

Early Signs to Watch For

Catching RA early dramatically improves long-term outcomes. Subtle early symptoms often appear months before diagnosis and may include:

• Morning stiffness lasting longer than 30 minutes
• Tender joints in the fingers, wrists, or knees
• Unexplained fatigue or low energy
• Mild swelling in smaller joints
• Low-grade fevers or a general sense of malaise

Because these symptoms can mimic stress or aging, many people delay seeking help—missing the window for the most effective intervention. 

Fully Developed Symptoms

As RA progresses, its symptoms become more pronounced:

• Swollen, warm joints that are painful to touch
• Symmetrical pain (e.g., both wrists or both knees)
• Reduced range of motion
• Visible deformities in fingers and hands over time
• Systemic complications such as anaemia, weight loss, or shortness of breath if internal organs are involved

How RA Is Diagnosed

Diagnosing RA requires a combination of clinical evaluation and testing, as there’s no single definitive test. Rheumatologists typically:

• Review medical history and symptoms to identify patterns of pain and swelling.
• Conduct a physical exam to check for joint tenderness, swelling, and symmetry.
• Order blood tests to look for markers of inflammation and autoimmunity, such as: ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) for inflammation
• Rheumatoid factor (RF) and anti-CCP antibodies for autoimmune activity
• Use imaging tools such as X-rays, ultrasound, or MRI to detect early joint erosion or synovial thickening.

Blood tests are important for diagnosing RA and may show markers of inflammation, such as ESR and CRP. A positive Rheumatoid Factor (RF+) is another common indicator, though it is not required for a diagnosis, as many people with RA do not have this marker in their blood. Similarly, anti-CCP (cyclic citrullinated peptide) antibodies are highly specific for RA and can help identify the disease early, even in patients who do not yet show symptoms. High levels of anti-CCP are often associated with more severe disease and a higher risk of joint damage.

Both RF and anti-CCP are part of the diagnostic and classification guidelines for RA. However, some patients may be negative for both markers, a condition referred to as seronegative RA. This means the absence of these specific antibodies does not rule out RA, and diagnosis may still be made based on symptoms, imaging, and other blood tests.

To further aid in diagnosis, doctors may use a points system developed by the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR). This system assigns points based on test results and symptoms to help determine if you have rheumatoid arthritis.

Early referral to a rheumatologist is crucial. Research shows that starting treatment within the first 12 weeks of symptom onset can slow disease progression and prevent irreversible damage although it does not cure it.

Dr. Amish J. Dave says of rheumatoid arthritis “it doesn’t necessarily go away and a lot of people think that if they do everything right, they can just push it into remission, and they don’t have to worry about it”. But “this is a chronic condition. You can get it to a good place, but you won’t cure it.”, he goes on to say.

Dr. Shawn Baca says of rheumatoid arthritis, “chances of going into remission are very low, probably less than 5%,” noting that “I have only a few patients who have been in remission over my 30 years of practice. But a majority of patients when they start medication, they end up being on some type of therapy for most of their lives.”

“There are people who can come off their medication and go into remission for long periods of time, even years, but it flares up again,” Dr. Dave said. “We think of this in the same way we think of Crohn’s  or ulcerative colitis . Relapsing rheumatoid arthritis tends to be that way too.

“The single best thing you can do is have a good relationship with a thoughtful rheumatologist who's following you over time and recognizing that there will be good months and bad months is important, and that medications can fail,” he adds. “It means that being flexible and needing to switch to a new medication might be important for you.” 

Issues that are sometimes overlooked

1. Fatigue

Rheumatoid arthritis (RA) fatigue is often described as a deep, overwhelming exhaustion that goes beyond normal tiredness. Unlike regular fatigue, it isn’t relieved by sleep, rest, caffeine, or stimulants. This exhaustion can significantly interfere with daily tasks, making even simple activities like getting dressed or preparing a meal feel daunting. The fatigue is driven by a combination of inflammation, pain, medications, and the emotional toll of living with a chronic illness.

2. Cognitive Dysfunction

Often referred to as “brain fog,” cognitive dysfunction in RA involves periods where thinking becomes clouded and concentration feels almost impossible. People may struggle with memory, finding the right words, or maintaining focus on tasks that once felt routine. This symptom is particularly frustrating because it can impact work, relationships, and confidence, and it often occurs unpredictably, adding to the challenge of managing the disease.

3. Flu-like Symptoms

Many people with RA experience flu-like symptoms even when they don’t have an infection. This can include nausea, muscle weakness, chills, or a general sense of malaise. These symptoms stem from the body’s heightened inflammatory response and can flare alongside joint pain or independently. Because they mimic viral illness, these episodes can be disorienting, leading patients to feel unwell without a clear reason or remedy.

4. Fever

Low-grade fevers are a common sign of systemic inflammation in autoimmune conditions like RA. These fevers usually hover just above normal body temperature and can come and go, often worsening during flares. In contrast, certain autoinflammatory conditions present with higher fevers, though the range can vary depending on the disease. In juvenile idiopathic arthritis, fever patterns can be more pronounced, sometimes accompanied by rashes or other systemic symptoms.

Modern Treatment Options

Treatment has advanced dramatically in the past two decades, giving patients more hope than ever before. The primary goals are to reduce inflammation, preserve joint function, and prevent organ damage.

1. DMARDs (Disease-Modifying Anti-Rheumatic Drugs)

Medications like methotrexate  remain the cornerstone of RA care. They slow the immune system’s attack, reducing inflammation and preventing joint erosion.

2. Biologic Therapies

For patients who don’t respond well to traditional DMARDs, biologics such as adalimumab or etanercept target specific immune pathways. These drugs have revolutionized RA management by reducing disease activity and improving long-term outcomes.

3. Targeted Synthetic Drugs (JAK Inhibitors)

Newer oral medications like tofacitinib block enzymes involved in the immune response and can be effective for patients who prefer non-injectable treatments.

4. Anti-Inflammatory Support

NSAIDs and corticosteroids help control pain and flare-ups but are typically used short-term due to side effects.

5. Lifestyle and Supportive Therapies

Physical therapy, weight management, and low-impact exercises such as swimming or yoga help maintain flexibility and joint strength. Occupational therapy and assistive devices can also make daily tasks easier and less painful.

Managing Day-to-Day Life with RA

Living with RA means more than taking medication, it’s about adopting a lifestyle that supports joint health and emotional resilience.

• Exercise smartly: Low-impact activities improve flexibility without straining inflamed joints.
• Eat for inflammation: Omega-3 fatty acids, fruits, vegetables, and whole grains can help reduce flare frequency.
• Prioritize stress management: Stress often worsens symptoms, so techniques like meditation or therapy can help.
• Use assistive devices: Small changes, such as ergonomic tools or adaptive clothing, reduce strain and conserve energy.

The Emotional Side of RA

The psychological burden of RA is often overlooked. Patients may experience anxiety, depression, or frustration as they navigate pain, fatigue, and lifestyle adjustments. Support groups, therapy, and building a strong care network can make a profound difference in mental health and overall well-being

A Life with Possibilities

While RA remains incurable, advances in medicine and early intervention have transformed it from a debilitating disease to a manageable chronic condition. With the right combination of treatment, lifestyle strategies, and emotional support, people with RA can lead active, fulfilling lives.

Living with RA is a journey, one that demands patience, persistence, and self-advocacy but with modern care, it is a journey full of possibilities and hope.

References:

1.   https://jamanetwork.com/journals/jama/fullarticle/1917440 
2.   https://jamanetwork.com/journals/jama/fullarticle/1103996
3.   Drugs mentioned in this article are mere examples, patients should follow their doctors’ prescription and cannot be taken without prescribed by doctor.