Overview
Diagnosis
Rheumatoid arthritis can be difficult to diagnose in the early stages because its initial symptoms often resemble those of many other conditions. During a physical exam, a healthcare professional checks the joints for swelling, redness and warmth. Muscle strength and reflexes also may be assessed to look for signs of inflammation or joint involvement.
Blood tests play an important role in confirming the diagnosis. Many people with rheumatoid arthritis have an elevated erythrocyte sedimentation rate or C-reactive protein level, which signals increased inflammation. Other tests check for rheumatoid factor and anti-cyclic citrullinated peptide antibodies, both of which can support the diagnosis.
Imaging tests help understand how the condition is affecting the joints. X-rays are commonly used to track changes over time, while MRI scans and ultrasound tests offer a more detailed look at joint damage and inflammation. These tools help determine how advanced the condition is and guide decisions about treatment.
Treatment
There is no cure for rheumatoid arthritis, but early treatment can help prevent or slow joint damage. Research shows that starting disease-modifying antirheumatic drugs early increases the chances of achieving remission. Regular follow-up with a healthcare team is essential to monitor symptoms, assess treatment response and watch for side effects.
Treatment often includes medicines tailored to the severity and duration of symptoms. Nonsteroidal anti-inflammatory drugs can reduce pain and swelling. Some require a prescription, and side effects may include stomach upset, heart issues and kidney problems.
Corticosteroids such as prednisone are sometimes used for quick relief of inflammation and pain. Although effective, they can cause serious side effects when used long term, such as thinning bones, weight gain, diabetes and vision problems. Because of this, the goal is usually to taper off these medicines once symptoms improve.
Conventional disease-modifying antirheumatic drugs can slow the progression of the disease and protect joints and tissues from further damage. Common options include methotrexate, leflunomide, hydroxychloroquine and sulfasalazine. Side effects vary depending on the medicine and may include liver-related issues or lung infections.
Biologic agents are another treatment option and are often used along with conventional DMARDs. These medicines target specific parts of the immune system. While they can be effective, they may also increase the risk of infections such as tuberculosis or fungal infections, requiring close monitoring.
If conventional and biologic DMARDs are not effective, targeted synthetic DMARDs may be considered. These include medicines such as baricitinib, tofacitinib and upadacitinib. Some, particularly at higher doses, may raise the risk of blood clots, heart-related events or certain cancers.
Therapy is another key part of managing rheumatoid arthritis. A physical or occupational therapist can recommend exercises to keep joints flexible and suggest ways to perform daily activities with less strain. Assistive devices, such as specially designed kitchen tools or buttonhooks, can make everyday tasks easier.
Surgery may be an option if medicines are not able to prevent or slow joint damage. Procedures may involve repairing or replacing a damaged joint. Surgical treatment can help restore function and reduce pain when other treatments are no longer effective.
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