Rheumatoid Arthritis Diagnosis & Treatment

Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis, affecting about one percent of the U.S. population. It causes muscle stiffness, pain, and swelling, mostly in the hands, wrists, and feet. Pain is usually symmetrical; you may feel it in both knees or both wrists. You may also have symptoms elsewhere in your body. RA can affect your skin, eyes, lungs, heart, kidneys, salivary gland, nerve tissue, bone marrow, and blood vessels. For this reason, we often work with a team of specialists to give you the best possible care. RA symptoms are not constant; they may go away for a while, then flare up again. Over time, arthritis can cause your joints to deform or shift out of place.

People diagnosed with RA often think that it is incurable and disability is inevitable. But this is not necessarily true. If we diagnose the condition early enough, and provide aggressive treatment, we can help with symptoms, stop the disease from progressing, and sometimes even reverse some of the damage.

Unfortunately, people with RA do not always get diagnosed quickly. If left untreated, RA can progress to the point where it affects your ability to function. People with advanced RA may not be able to grip a pen, lift a child, or dress or bathe themselves. If RA is left for too long, it can be debilitating.

Doctors do not know what causes RA, but we do know some factors that increase your risk.

Gender: Women are more likely to develop RA than men.
Family history: If a parent or other close relative has RA, you may be more likely to have the condition.
Smoking: If you smoke, it can make you more likely to get RA and can make your symptoms more severe.
Environment: If you have been exposed to asbestos or silica, you may be more likely to develop RA.
Obesity: Being overweight or obese can increase your chance of developing RA, especially if you are a woman under age 55.

RA affects people of all ages, and in slightly different ways:

Juvenile idiopathic arthritis (JIA): Also called juvenile rheumatoid arthritis, it affects children up to age 16.
RA: In its most common form, it affects people in their 30s to 50s. Symptoms increase gradually until it is difficult to function normally. We often diagnose RA at a more advanced stage because people tend to “put up with” symptoms for a while as the disease progresses.
Elderly-onset RA, also called late-onset RA, usually starts when you are between ages 60 and 65. If you get RA at this age, the symptoms often appear quickly.

Diagnosis and Treatment

To diagnose RA, we start with a medical history and physical exam. This normally provides all the information we need. If we are fairly certain you have RA, we may also do blood work to confirm the diagnosis. Sometimes, we use imaging tests such as X-rays, magnetic resonance imaging (MRI), or ultrasounds for additional information.

Our treatment goals are to suppress inflammation, decrease your pain, and prevent deformity and disability. Typically, we start with disease-modifying antirheumatic drugs (DMARDs). You may not feel the effects of DMARDs for several months. While we wait for DMARDs to take effect, we may offer a “bridge medication” of corticosteroid medications, such as prednisone. Steroids can reduce inflammation and pain, and can slow joint damage. They take effect in a matter of hours. We may also use steroids for acute symptoms. Another option is nonsteroidal anti-inflammatory drugs (NSAIDs), which relieve pain and reduce inflammation. Over-the-counter NSAIDs include aspirin, Advil, Motrin, and Aleve.

Physical and occupational therapy is an important part of RA treatment. Physical therapists can teach you exercises to keep your joints flexible and increase your range of motion. They can also make recommendations about new ways to complete everyday tasks, such as tying your shoes.

If necessary, we can send you to an orthopedic surgeon for a procedure to repair damaged joints. Hip and knee replacements are the most common. In addition, we can repair tendons, remove inflammation from the lining of the joint, or fuse joints, when appropriate.

Why Mount Sinai

Mount Sinai has some of the most experienced and well-trained rheumatologists in the New York area. We have advanced facilities, including a therapeutic infusion center for biologics. We work closely with physical therapists, orthopedic surgeons, and other specialists throughout the Mount Sinai Health System to provide you with the best possible care. In addition, our doctors participate in research studies, enabling qualified patients to participate in clinical trials providing the very latest treatment approaches.

One of the key studies Mount Sinai is involved with is TARGET. This study looks at how treatments for RA can affect the heart, specifically cardiac inflammation. The study is funded by the National Institutes of Health.