Rheumatoid arthritis (RA) is an autoimmune disease that affects about 1.5 million people in the U.S. Autoimmune diseases cause the body’s immune system to attack healthy tissues, and in patients with rheumatoid arthritis, the immune system attacks the joints and organs, including the heart. RA occurs almost three times as often in women as it does in men. Although it can occur at nearly any age, it most commonly develops in middle age, usually between the ages of 30 and 60 years. It men, it often occurs later in life. 
The underlying cause of RA is unknown, but researchers believe it occurs as a result of a combination of factors, including genetics, hormones and environmental stimuli that trigger the immune system to act abnormally. Other potential triggers include bacterial or viral infections or smoking.
After the abnormal immune system reaction is triggered, immune cells that normally fight off pathogens and infections instead turn their attention toward the synovium, the tissue that lines the joints and helps facilitate normal joint function. The immune cells cause the synovium and joint cartilage to become irritated, eventually wearing away the cartilage and causing the synovium to become chronically inflamed. Over time, the cartilage layer completely wears away, leaving bone surfaces to rub against one another and resulting in significant pain in and around the joint, especially during motion. At the same time, inflammation of the synovium causes swelling within the joint that can wind up damaging the bone surfaces. Externally, joints affected by RA appear red and swollen and feel warm and tender when touched.
WHAT ARE THE SYMPTOMS?
Like many autoimmune disorders, the symptoms of rheumatoid arthritis can be widespread, affecting people in very different ways, especially as the disease progresses. Some of the most common symptoms of RA include :
- swollen, painful joints
- joints that appear red
- joints that feel warm to the touch
- joint stiffness, especially in the morning or after long periods of being inactive
- inability to turn the head without pain
- bilateral symptoms – symptoms that occur on one side often occur on the other as well
The course of RA can also vary from person to person. In some people, the disease progresses very rapidly, while in others it can take several years for symptoms to fully develop. RA can also cause flareups, periods when symptoms become especially severe. These flareups are typically followed by periods of remission when symptoms are less active or may completely disappear for some time.
Clinicians have not developed a cure for rheumatoid arthritis, and treatment is aimed at preventing flareups, relieving symptoms like pain and inflammation, and slowing the disease progression. Most patients find proactive management with their healthcare provider is the best option for achieving remission or otherwise relieving symptoms or long periods of time.
Several drugs are available to treat the disease, including non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation, oral or injected steroids when NSAIDs are not effective and drugs called DMARDs (disease-modifying anti-rheumatic drugs) which help slow the progression of the disease.  Despite advanced in medical treatment options, between 20 percent and 40 percent of patients do not respond favorably to RA drugs. 
Physical and occupational therapies are also an important part of treatment, offering guidance with regard to exercise, nutrition and other therapeutic options like use of self-massage and application of heat and ice to manage symptoms.
When symptoms don’t resolve and joint pain or dysfunction interferes with quality of life, joint replacement surgery may be an option for knees, hips or shoulders. Other joints like the ankle respond better to fusion surgeries. Joint replacements have an average lifespan of about 15 to 20 years, so the option is reserved for older patients and as a last resort when other treatments fail.
Lifestyle changes are another important part of symptom management. Maintaining a healthy weight reduces stress on inflamed joints, and staying active helps maintain joint mobility and decrease stiffness.