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In a healthy person, the immune system fights invaders, such as bacteria and viruses. With an autoimmune disease like RA, the immune system mistakes the body’s cells for foreign invaders and releases inflammatory chemicals that attack, in the case of RA, the synovium. That’s the tissue lining around a joint that produces a fluid to help the joint move smoothly. The inflamed synovium gets thicker and makes the joint area feel painful and tender, look red and swollen and moving the joint may be difficult.

Researchers aren’t sure why some people develop RA. They think that these individuals have certain genes that are activated by a trigger in the environment, like a virus or bacteria, or physical or emotional stress or some other external factor.

In the early stages, people with RA may not see redness or swelling in the joints, but they may experience tenderness and pain.
These symptoms are clues to RA:

• Joint pain, tenderness, swelling or stiffness that lasts for six weeks or longer.
• Morning stiffness that lasts for 30 minutes or longer.
• More than one joint is affected.
• Small joints (wrists, certain joints in the hands and feet) are typically affected first.
• The same joints on both sides of the body are affected.

Many people with RA get very tired (fatigue) and some may have a low-grade fever. RA symptoms may come and go. Having a lot of inflammation and other symptoms is called a flare. A flare can last for days or months.

Getting an accurate diagnosis as soon as possible is the first step to treating RA effectively. A doctor with specialized training in treating arthritis (called a rheumatologist) is the best person to make a correct diagnosis, using medical history, a physical examination and lab tests.

Medical history. The doctor will ask about joint symptoms (pain, tenderness, stiffness, difficulty moving), when they started, if they come and go, how severe they are, what actions make them better or worse and whether family members have RA or another autoimmune disease.

Physical examination.  The doctor will look for joint tenderness, swelling, warmth and painful or limited movement, bumps under the skin or a low-grade fever.

Blood tests. The blood tests look for inflammation and blood proteins (antibodies) that are linked to RA:

• Erythrocyte sedimentation rate (ESR, or “sed rate”) and C-reactive protein (CRP) levels are markers for inflammation. A high ESR or CRP combined with other clues to RA helps make the diagnosis.
• Rheumatoid factor (RF) is an antibody found (eventually) in about 80 percent of people with RA. Antibodies to cyclic citrullinated peptide (CCP) are found in 60 to 70 percent of people with RA. However, they are also found in people without RA.

Imaging tests. RA can cause the ends of the bones within a joint to wear down (erosions). An X-ray, ultrasound, or MRI (magnetic resonance imaging) scan can look for erosions. But if they don’t show up on the first tests that could mean RA is in an early stage and hasn’t damaged bone yet. Imaging results can also show how well treatment is working.

The goals of RA treatment are to:

• Stop inflammation or reduce it to the lowest possible level (put disease in remission).
• Relieve symptoms.
• Prevent joint and organ damage.
• Improve function and overall well-being.
• Reduce long-term complications.

To meet these goals, the doctor will follow these strategies:

• Early, aggressive treatment – to reduce or stop inflammation as quickly as possible.
• Targeting remission or another goal (treat-to-target) – work toward little or no signs or symptoms of active inflammation
• Tight control – keep inflammation at the lowest level possible using conventional DMARDs, as well as biologics DMARDs (disease modifying Anti Rheumatic Drugs)