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Overview of RA

Rheumatoid arthritis (RA) affects an estimated 1.3 million adults in the United States.[1] The condition can have a profound effect on many aspects of daily life, and is often poorly understood by those who do not have direct experience it. The good news is that important advances have been made in the management of RA: use of more effective drugs earlier in the course of RA reduces symptoms and joint damage, and allows some patients to achieve a remission (little or no active disease).[2]

RA and your joints

The symptoms of RA are familiar to many: the condition causes pain, swelling, and stiffness of joints. The joints of the wrist and hand are often involved, but RA can affect other joints as well. Joint stiffness tends to be worse in the morning or after a long rest.

To understand how RA affects joints, it first helps to understand some of the components of a healthy joint. A joint refers to a place in the body where two or more bones meet. The ends of the bones are covered in cartilage, which absorbs shock and allows the joint to work more smoothly. Surrounding the joint is a protective capsule that is lined with tissue called synovium. The synovium produces fluid that nourishes and lubricates the joint.[3]

In RA, the synovium becomes inflamed. The inflammation causes the joint pain and swelling, and can also damage bone and cartilage in the joint. This damage to bone and cartilage is thought to begin early in the course of the disease, highlighting the important of early diagnosis and treatment. Surrounding muscles, ligaments, and tendons can also be affected.

Other Effects of RA

Rheumatoid arthritis can affect the entire body, particularly if the RA becomes severe.[4] In addition to joint problems, people with RA may notice occasional fevers, fatigue, and a sense of being generally unwell. RA can lead to anemia (low red blood cell count) and, less commonly, to problems with the blood vessels, lungs, heart, and other organs.

What causes RA?

RA is an autoimmune disease. An autoimmune disease occurs when the immune system—which normally protects the body from infection—turns against some of the body’s own tissues. Other examples of autoimmune diseases are Type I diabetes, lupus, Sjogren syndrome, Grave’s Disease, and multiple sclerosis.

In the case of RA, the immune system attacks the synovium and causes inflammation. It’s unclear what starts this process, but some combination of genetic and environmental factors is likely to play a role. Factors that increase the likelihood of RA include being female, smoking, and having a family history of rheumatoid arthritis.[5] [6]

Although family history may contribute to RA, it does not entirely explain an individual’s risk. Many people with a family history of RA will never develop the condition themselves. Similarly, RA may develop in someone with no family history of the condition.

RA is not contagious (people cannot “catch” RA from someone else).

What are rheumatoid nodules?

Rheumatoid nodules are firm lumps located just under the skin. The nodules most commonly grow close to the affected joints and can be as small as a pea and as large as a chestnut. The nodules can be firmly connected to tendons or fascia under the skin or quite moveable.  Rheumatoid nodules are also often found at pressure points, including the hands, fingers, knuckles, or elbows; however, they may appear almost anywhere, including the lungs, heart, other internal organs, and even on the vocal cords, causing hoarseness.

Nodules can be asymptomatic or quite painful, but they are typically not problematic unless they interfere with daily activities by putting pressure on nerves or by limiting joint movement. Rheumatoid nodules in areas such as the heart and lungs may affect organ function.

What are the causes of rheumatoid nodules?

Rheumatoid nodules usually occur in patients with more severe disease. Nearly all patients with nodules will test positive for rheumatoid factor, and studies have suggested that when RA is linked with a positive rheumatoid factor test, it may indicate more aggressive disease.  Other risk factors that may lead to the development of rheumatoid nodules include cigarette smoking and the use of Methotrexate, a drug commonly used to treat RA.

Can rheumatoid nodules be treated?

Treatment of rheumatoid nodules is typically directed at nodules causing symptoms or functional problems.  Injections of glucocorticoids (steroids) may help shrink nodules; sometimes surgery is necessary if rheumatoid nodules become infected or cause severe symptoms.

There is no specific drug therapy directed at treating rheumatoid nodules; however, disease-modifying antirheumatic drugs (DMARDs) can reduce the size of rheumatoid nodules. If nodules are thought to be a result of methotrexate treatment, a change in medication regimen may help; however, this decision must be carefully made on an individual basis.

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The course of RA

The course of RA over a lifetime varies across individuals and is also influenced by treatment. Some people may experience a single episode that resolves within a few months or years, others may experience fluctuating symptoms (periods of few symptoms followed by periods of worse symptoms, or “flares”), and still others may have symptoms that get progressively worse.

Although there is no cure for RA, early detection and effective treatment can substantially reduce pain and disability for many patients.


[1] Helmick CG, Felson DT, Lawrence RC et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis & Rheumatism. 2008;58:15-25.

[2] Felson DT, Smolen JS, Wells G et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis & Rheumatism. 2011;63:573-586.

[3] National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Disease. Handout on Health: Rheumatoid Arthritis. Last revised April 2009.

[4] Young A, Koduri G. Extra-articular manifestations and complications of rheumatoid arthritis. Best Practice & Research Clinical Rheumatology. 2007;21:907-27.

[5] Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376:1094-1108.

[6] Hemminki K, Li X, Sundquist J, Sundquist K. Familial associations of rheumatoid arthritis with autoimmune diseases and related conditions. Arthritis & Rheumatism. 2009;60:661-668.

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