Rheumatoid arthritis is one of the common types of arthritis and affects millions of people in the country. An autoimmune disease, it causes joint pain and damage due to the immune system mistakenly attacking the body’s tissues. The inflammation associated with rheumatoid arthritis affects the tissue that lines the joints and is called synovium. The joint damage caused by the condition usually affects both sides of the body, and this is one of the ways the doctors distinguish rheumatoid arthritis from other types of arthritis like osteoarthritis.

Symptoms
A chronic inflammatory disorder, the condition affects more than just the joints. For some people, it can affect a variety of body systems, including the skin, eyes, lungs, heart, bone marrow, and blood vessels. While osteoarthritis causes wear and tear damage, rheumatoid arthritis damages the lining of the joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

Rheumatoid arthritis is marked by inflammation and pain in the joints during flare-ups or exacerbations. Other times are known as periods of remission, when the symptoms disappear. The signs and symptoms of rheumatoid arthritis include but are not limited to the following:

• Tender, warm, and swollen joints
• Joint stiffness that usually worsens in the mornings and after inactivity
• Fatigue
• Fever
• Loss of appetite

The condition tends to affect the smaller joints in the early stages, particularly the finger and toe joints. As the disease progresses, the symptoms often spread to the wrists, elbows, shoulders, knees, ankles, and hips. Severe rheumatoid arthritis can also result in joint deformity and cause the joints to shift out of place.

Causes
Rheumatoid arthritis is caused due to the immune system attacking the synovium, which is the lining of the membranes that surround the joints. This causes inflammation that thickens the synovium, which can destroy the cartilage and bone within the joint over time. Although the cause of the autoimmune reaction is not yet known, several things can contribute to elevating the risk of developing rheumatoid arthritis. The following are some of the risk factors of the disease:

• Genes
  Genes are linked with rheumatoid arthritis, but they do not directly cause the condition. That being said, they can make an individual more prone to viral or bacterial infections that can increase the risk of the condition.
• Age
  Rheumatoid arthritis can affect people at any age, but it most commonly begins in middle age.
• Hormones
  This form of arthritis is more common among women as compared to men, and a probable cause is the effects of the hormone estrogen. However, this link has not been proven. Women who have never been pregnant or have recently given birth are more likely to get rheumatoid arthritis.
• Smoking
  Research suggests that people who smoke face an increased risk of developing rheumatoid arthritis, and the condition may also be more severe among them as compared to non-smokers.
• Environment
  Exposure to a toxic chemical or to silica can add to the risk of developing rheumatoid arthritis.
• Obesity
  People who are overweight or obese, particularly women under the age of 55, are more likely to get rheumatoid arthritis.

Treatment options
There is no cure for rheumatoid arthritis, but several treatment methods can help manage the symptoms and prevent complications. If the inflammation alleviates, joint and organ damage can be prevented. Read on to know the various treatments for the condition.

Medications

• Disease-Modifying Antirheumatic Drugs (DMARDs) : The main goal of medications for rheumatoid arthritis is to block inflammation to prevent joint damage. DMARDs are used to slow the progression of the disease and prevent permanent tissue and joint damage.
• Biologic agents : Biologic agents are DMARDs that work by blocking specific inflammatory pathways set out by immune cells. This reduces inflammation that can lead to joint damage. Doctors prescribe biologic DMARDs in combination with non-biological DMARDs when the latter are not effective enough to treat the symptoms alone. Also called biologic response modifiers, these are not recommended for people with compromised immune systems or with an infection, as they elevate the risk of infections.
• Janus kinase inhibitors : When DMARDs or biologic response modifiers do not provide the desired results, doctors may prescribe these medications. They affect the activity of immune cells to soothe the autoimmune reaction and prevent inflammation that causes joint and tissue damage.
• Acetaminophen : Acetaminophen is an Over-the-Counter (OTC) medication that is available as an oral medication and a rectal suppository. It can alleviate mild to moderate pain but has no anti-inflammatory effects, and it also increases the risk of serious liver problems.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) : NSAIDs are among the most commonly used rheumatoid arthritis medications as they help prevent inflammation. Although some NSAIDs are available OTC, strong NSAIDs need a prescription. Additionally, these medications can cause side effects like stomach bleeding and irritation, ulcers, and kidney damage, which can prove fatal in rare cases. For this reason, kidney functioning is monitored in patients taking NSAIDs in the long-term, especially if they have an underlying kidney disease.
• Opioids : These strong medications are used to treat severe pain in patients and are available only with a prescription. They can be taken orally or through intravenous injections, but they can be habit-forming, so patients are often monitored when they are prescribed opioid medications. Also, patients of rheumatoid arthritis who take opioids need other treatments, as opioids only help manage pain and do not slow the progression of the disease or prevent inflammation.
• Corticosteroids : Also known as steroids, these medications reduce inflammation in patients of rheumatoid arthritis. They can be taken orally or injected intravenously. They also help alleviate the pain and damage due to inflammation, but they are not recommended for long-term use as they lead to severe side-effects, including osteoporosis and high blood pressure.
• Immunosuppressants : These medications fight off the damage caused by autoimmune diseases like rheumatoid arthritis, but they can make patients more susceptible to illnesses and infections. This is because they suppress the immune system and its reactions, but this also reduces its ability to stave off infections. Immunosuppressants are available in oral and injectable forms.

Surgery
When medications are unable to prevent or slow down joint damage due to rheumatoid arthritis, a doctor may suggest surgery to repair the damaged joints. Surgery may help restore the patient’s ability to use the joint and improve range of motion, apart from reducing pain. Having said that, the risk of bleeding, pain, and infection is associated with opting for surgery to treat the condition, so one should discuss their options with a doctor before making a decision.

Natural remedies
Along with medications, incorporating certain lifestyle changes or opting for natural remedies can yield better results:

Sleep
Getting enough sleep is extremely important for patients of rheumatoid arthritis. Sleep quality influences the levels of and sensitivity to pain, along with a person’s ability to move. Uninterrupted sleep for at least 8 hours every night is necessary, and one can take a nap during the afternoon if they are unable to get a good night’s sleep.

Yoga
Yoga offers individualized exercises for specific body parts and potential benefits from breathing and meditation. Studies have found that practicing yoga for 6 weeks can improve mood, fatigue, and chronic pain acceptance in people with rheumatoid arthritis. Yoga may also reduce pain and inflammation associated with rheumatoid arthritis and increase the quality of life among patients.

Exercise
Many people with rheumatoid arthritis avoid exercising for fear of aggravating the symptoms, but regular exercise is beneficial. Also, finding the time, energy, and motivation can be difficult, especially when one is in pain. However, research has shown that patients who exercise experience less pain than those who don’t. Exercise can also help boost mood, improve joint function, and prevent muscle wasting and weakness. Here are some of the specific exercises that can help people with rheumatoid arthritis:

• Hydrotherapy: Hydrotherapy or exercising in water has positive effects on patients with rheumatoid arthritis, as it can help reduce pain and joint tenderness. Hydrotherapy also improves mood and overall wellbeing, as with any other form of exercise.
• Tai chi : This is a traditional Chinese martial art that helps improve muscle function and stiffness and reduces pain and stress in patients with rheumatoid arthritis.
• Biking : This helps maintain cardiovascular health, increases leg strength, and reduces morning stiffness.
• Walking : It is the easiest and most convenient form of exercise to maintain a healthy heart rate. Walking can loosen the joints and reduce pain. Walking every day for 30 minutes can also boost mood, and if one does not feel like stepping out, the treadmill works well too.
• Massage
  Massage can be done by a family member, a trained therapist, or by oneself to help improve the symptoms of rheumatoid arthritis. A study showed that after a month of regular moderate-pressure massage, people with rheumatoid arthritis experienced less pain, more grip strength, and increased range of motion over those who received light pressure massage.
• Probiotic supplements
  Probiotics are good bacteria that benefit gut health, and foods like yogurt, sauerkraut, and kimchi are probiotic foods. Probiotic supplements can also be effective for managing the symptoms of rheumatoid arthritis. A study found that taking probiotic supplements daily for 8 weeks lowered inflammation.
• Heat and cold therapy
  One can apply an ice pack on inflamed joints to help ease swelling, while cold therapy can help numb the pain and relax muscle spasms. Research suggests that cryotherapy or cold therapy may reduce pain in people with rheumatoid arthritis, but more studies are needed to prove this. One can also use a hot towel, heating pad, or hot water bag to help relax tense muscles and relieve pain and stiffness.

Beneficial foods for rheumatoid arthritis
Patients with rheumatoid arthritis should include anti-inflammatory foods in their diet as they fight inflammation and relieve pain and swelling in the joints. Some of them are:

• Omega-3 fatty acids
  Omega-3 fatty acids have anti-inflammatory qualities, and fatty fish like mackerel, herring, salmon, and tuna are among the richest sources of omega-3 fats. One can also take fish oil supplements and walnuts and almonds, flaxseeds, yogurt, and chia seeds. These nuts and seeds can be added to salads, smoothies, or a trail mix.
• Antioxidants
  Antioxidants help reduce inflammation and alleviate pain. Fresh fruits and vegetables, nuts, and green tea are packed with antioxidants, so people with this joint condition should include these in their regular diet.
• Fiber
  Fibrous foods reduce the level of inflammation and improve digestive health as well. One can get fiber from foods like fresh fruits and vegetables, whole grains, beans, nuts and seeds, and berries.
• Flavonoids
  Flavonoids are natural compounds present in plant foods that have anti-inflammatory properties and reduce pain and swelling. Some foods rich in flavonoids are berries, green tea, grapes, broccoli, soy, and dark chocolate.
• Mediterranean diet
  A Mediterranean diet is rich in anti-inflammatory foods and is beneficial for people with rheumatoid arthritis. It includes whole grains, olive oil, fresh fruits and vegetables, and red wine, and one can also consume lean meats.
• Paleo diet
  The paleo diet focuses more on proteins and less on carbohydrates, and it is known to reduce inflammation. So, one can add lean meats and vegetables and fruits to their diet.

Patients should avoid foods that cause inflammation, including white flour, white sugar, fried foods, red meat, and dairy products.

Understanding the symptoms of rheumatoid arthritis can facilitate early diagnosis and timely treatment to manage the symptoms. Also, the treatments are more effective when the condition is detected at an early stage. Additionally, patients should discuss with a doctor before taking up a special diet, home remedy, or starting a medicine.