Rheumatoid arthritis

What is rheumatoid arthritis?

Your immune system normally fights germs. In RA, it attacks the thin lining inside your joints, called the synovium. The lining becomes inflamed and thick, and over time it can damage the cartilage and bone in the joint¹.

RA usually affects the same joints on both sides of the body, such as both wrists or both hands¹. It can also affect other parts of the body, including the eyes, lungs, heart, and blood^1,3. RA is an autoimmune disease, which means the body is reacting against itself. It is different from osteoarthritis, which is the breakdown of joint tissue over time.

Symptoms of rheumatoid arthritis

Symptoms often start slowly and can come and go. Periods when symptoms get worse are called flares⁴. Common symptoms include:

• Pain, swelling, warmth, and tenderness in the joints, often in the hands, wrists, and feet¹
• Stiffness that lasts longer than 30 minutes after you wake up or rest¹
• The same joints affected on both sides of the body¹
• Trouble making a fist, buttoning a shirt, or combing your hair¹
• Feeling very tired, a low fever, or a loss of appetite¹

Joint symptoms that last more than 6 weeks can be a sign of ongoing inflammation³.

Causes and risk factors

No one knows exactly why the immune system starts attacking the joints. Researchers think a mix of genes and things in the environment starts the process, sometimes years before symptoms appear¹. Things that raise the chance of getting RA include:

• Being a woman. Women get RA about 2 to 3 times as often as men¹.
• Older age, though RA can start at any age¹
• A family member with RA¹
• Smoking, especially over many years^1,4
• Obesity, gum disease, and some lung diseases¹

How rheumatoid arthritis is diagnosed

There is no single test for RA, and early RA can look like other joint conditions². A rheumatologist puts several pieces together:

• Your story: when symptoms started, which joints hurt, how long morning stiffness lasts, and any family history²
• A physical exam of your joints, skin, and lungs²
• Blood tests, such as rheumatoid factor (RF) and anti-CCP, which look for antibodies linked to RA, plus tests that measure inflammation (ESR and CRP) and a blood count²
• Imaging, such as X-rays or ultrasound, to look for swelling or joint damage²

Some people have RA even when their blood tests are normal².

Treatment options

Treatment aims to ease pain and swelling, lower inflammation, and prevent or slow joint damage². Starting treatment early can help protect your joints^3,4. Your plan may include:

• Disease-modifying antirheumatic drugs (DMARDs), which calm the immune system and are usually the first medicine for RA^3,4
• Biologic medicines or targeted pills (JAK inhibitors) if DMARDs alone don’t control inflammation³
• Anti-inflammatory medicines, and steroids at the lowest dose that works, to ease pain and swelling²
• Physical and occupational therapy to keep joints moving and make daily tasks easier²
• Surgery, for joints that are badly damaged²

No single medicine works for everyone, and many people change treatment at least once over the years³. Regular blood tests help check how a medicine is working and watch for side effects².

Living with RA and when to get care

Day-to-day habits can help alongside medicine. Staying active with low-impact exercise like walking or swimming, keeping a healthy weight, and quitting smoking all support joint health^3,4.

Request an appointment with a rheumatologist or call 646-389-0001 if you have joint pain, swelling, or morning stiffness that lasts more than a few weeks, or if a current RA medicine is not working well for you. Many RA medicines can raise the risk of infection². If you take one and have a fever or signs of infection, call the clinician who prescribes it the same day.

How Madison Medical Care helps

Kevin Yip, MD, is board-certified in internal medicine and rheumatology by the American Board of Internal Medicine. He trained in rheumatology at Hospital for Special Surgery and NewYork-Presbyterian/Weill Cornell, after residency at NYU.

• Request an appointment online or call 646-389-0001. Our Patient Support Team aims to contact you within 2 business days.
• Tell us where you’ve had care before. We request your prior records, including past blood tests and X-rays, so Dr. Yip can review them before your visit.
• Your first visit is 30 minutes, in person at 30 E 23rd St, Floor 7. Dr. Yip examines your joints, talks through your results, and makes a plan with you. Follow-up visits are 15 minutes.
• We can send a visit summary to your primary care clinician when you ask.

Madison Medical Care is self-pay and does not bill insurance. We can’t see patients who have Medicare or Medicaid. Blood tests, imaging, and prescriptions go through your own insurance.