How RA Causes Swelling in Your Joints

If you struggle with rheumatoid arthritis (RA), you probably already know that this disease targets the body’s joints. But do you know why your joints feels so swollen and achy? Or what to do about it?

“Rheumatoid arthritis is a type of inflammatory arthritis where the body’s host defense, its immune system, begins to target itself,” says Howard Blumstein, M.D., a rheumatologist at Rheumatology Associates of Long Island, NY. That means your own immune cells go rogue and attack the healthy tissues in your body by mistake.

Damaging inflammation is the result. It leads to swollen joints, which may even cause your bones to grind against each other—and yes, that can be as awful-feeling as it sounds.

While RA symptoms can be physically and emotionally taxing, relief can be had, thanks to advances in treatments, new research, and certain lifestyle changes you can make. Let’s take a look at RA inflammation, which joints in the body are most likely to experience swelling, plus the types of remedies that are available to help curb both.

What Drives RA Inflammation?

While the cause of RA is still not fully understood, researchers and doctors do have a few likely suspects. “Risk factors include smoking and certain genetic factors,” says Joseph Huffstutter, M.D., a rheumatologist at Arthritis Associates in Hixson, TN. “RA can occur at any age, but is most common in females between 30 and 50 years old.”

Hallmark symptoms of RA inflammation include pain, swelling, redness, and stiffness, especially in the small joints—think your hands, wrists, and knees, says Dr. Blumstein. With RA, you may be at risk for other diseases and health problems, as well: “It can have implications on a person’s risk of other conditions such as heart disease and stroke, and [increase their] cancer risk [such as with lymphoma],” he adds.

“The common thread here is that, as a joint is affected by RA, there is thickening of the joint lining called synovitis,” explains Dr. Huffstutter. “The synovitis is inflammatory cells producing enzymes and pro-inflammatory cytokines [proteins that increase inflammation] that destroy the joint, if left untreated,” he adds.

Beyond smoking and/or having a genetic predisposition, inflammation can also be caused by environmental triggers, viral infections, hormones, stress, diet, and microbiome changes, says Dr. Ashima Makol, M.B.B.S, a rheumatologist at the Mayo Clinic in Rochester, MN.

What Areas of the Body Does RA Target?

RA can affect many parts of the body besides the joints, says Dr. Huffstutter. Namely, RA can also target the lungs, eyes, nerves, heart, and skin, adds Dr. Blumstein.

Dr. Huffstutter notes that “RA has a propensity to affect certain joints and spare others in a symmetrical fashion,” meaning that both sides of the body can be targeted at once. “The lungs can be affected, causing fibrosis and scarring. The salivary and tear glands can be affected causing extreme dryness of the eyes and mouth.”

Here are the areas that RA most often targets, causing swelling and pain in the body:

Hands

The hands are one of the most common places RA can affect. In fact, a recent study found that in 90% of RA patients, RA’s effects on the joints of the hand led to problems performing everyday activities like simply opening doors or doing laundry. “In the hands, RA causes swelling; loss of motion; pain and redness in the wrists, knuckles and the first joints of the fingers; but spares the distal finger joints,” explains Dr. Huffstutter. “There is a loss of grip strength, and over time, deformities become common.”

Elbows and Wrists

“RA commonly affects the metatarsophalangeal and interphalangeal joints of the elbows and wrists,” says Dr. Makol. “It causes pain and stiffness, which is often most prominent in the morning and after periods of inactivity.”

Feet

Like the hands, RA targets feet in a similar fashion, says Dr. Blumstein. Inflammation there affects the metatarsophalangeal joints. “In some cases, the foot symptoms may precede hand symptoms, which is why a rheumatologist will often request foot X-rays along with hand X-rays when diagnosing a person with RA in order to detect damage,” he explains. RA can also attack the small joints in the feet. “Where the toes attach [is the area that is] commonly involved with severe pain and stiffness,” adds Dr. Huffstutter.

Knees

“When we see a patient whose knees have been affected by RA, we usually see impact on all three joints in the knee—the medial, lateral, and patellofemoral joint space—which is different from osteoarthritis [or regular arthritis], which would typically only involve one or two joint spaces,” says Dr. Blumstein. This may result in difficulty walking, climbing stairs, and getting out of chairs, especially low seating positions, he adds.

Ankles

“Ankles are commonly affected, with swelling of the [ankle] joints associated with severe pain and stiffness,” says Dr. Huffstutter. “As the patient moves during the day, the pain and stiffness improves.”

Shoulders

RA can cause pain and loss of movement in the arms, including the shoulders, says Dr. Huffstutter. It can affect shoulder mobility and make movement more difficult or near impossible, he adds, especially when you’re trying to do something overhead, like getting dressed or trying to put your carry-on into a plane’s overhead bin. Age can be a factor: “The hip and shoulder joints are less commonly affected, but are often involved in patients with rheumatoid arthritis onset after the age of 60,” adds Dr. Makol.

How Is RA Joint Swelling Treated?

Joint swelling is one example of the systemic inflammation RA causes. So your doctor will focus on treating inflammation, rather than a specific swollen joint. Thankfully, you have options when it comes to treating RA.

• Analgesics (for pain). Analgesics are medications that help relieve pain. Many are available over-the-counter (OTC) at your local drugstore, and some, including nonsteroidal anti-inflammatory drugs (NSAIDs), can also help tame inflammation (more on that, next). For RA pain relief, medications include: Bayer (aspirin) and Tylenol (acetaminophen), as well as non-prescription-strength NSAIDs like Advil (ibuprofen) and Aleve (naproxen). COX-2 inhibitors like Celebrex (celecoxib), which are Rx-strength NSAIDs, can also be used to treat RA pain.

• NSAIDs (for inflammation). NSAIDs are medications that curb inflammation, says Dr. Blumstein. For swelling reduction, over-the-counter NSAIDs like Aleve (naproxen) and Motrin (ibuprofen) are recommended, as well as prescription-strength NSAIDs including Celebrex (celecoxib) and Voltaren (diclofenac). “Unlike analgesics, which just affect pain levels, these medications also can reduce other symptoms of RA like joint swelling and stiffness,” adds Dr. Blumstein.

• Corticosteroids. Steroids (such as prednisone) can offer short-term relief for inflammation. However, they have many possible negative side effects because they suppress the immune system. This not only increases your susceptibility for infection, but can also put you at risk for potential side effects including: bone loss/osteoporosis; cataract formation and increased risk of glaucoma; accelerated heart disease; infection risk; thinning of the skin and skin fragility; and weight gain. “Long-term toxicity issues limit the dose and duration of [steroid] medications,” says Dr. Blumstein. Prescription therapies for RA (listed below) may better control the inflammation, he adds, without suppressing the immune system or causing other side effects.

• DMARDs. Disease-modifying anti-rheumatic drugs help slow disease progression by suppressing the immune system. For most people with RA, “the first-line therapy prescribed will be a fairly old drug called methotrexate,” says Dr. Blumstein. This is a DMARD (brand names include Reditrex and Trexall), which is given in oral or injectable form, and is taken once per week, he explains. They are prescribed once a person with RA has an official diagnosis, and typically take a longer time to work—but are very effective, he adds.

• Biologics. Biologics are drugs that are derived from living organisms that target the immune system to decrease inflammation. These drugs have “truly revolutionized the ability to control the inflammatory response in RA,” says. Dr. Huffstutter.

  One class of biologic medication used by rheumatologists is TNF (tumor necrosis factor) inhibitors. “Tumor necrosis factor is a naturally occurring substance that is increased in inflammatory conditions like RA,” says Dr. Blumstein. “These medications block this substance and in turn reduce inflammation, and also can prevent significant consequences such as permanent joint damage.”

  Members of the TNF inhibitor class include Avsola (infliximab), Cimzia (certolizumab), Enbrel (etanercept), Humira (adalimumab), and Simponi (golimumab).

• Surgery. In certain cases, surgery may also be recommended, such as synovectomy (surgery to remove synovium) or arthroplasty (reconstruction or replacement of a joint), according to Dr. Makol.

Can Lifestyle Changes Reduce Joint Swelling in RA?

Making dietary, exercise, and mental health adjustments may help improve your RA symptoms—but you’ll likely need to do them while also taking medication, says Dr. Blumstein. “There are no significantly effective at-home remedies that would preclude the use of medications provided by a physician,” he explains.

However, you may find some relief by placing a cold or hot compress on inflamed joints, doing everything in your power to quit smoking, and maintaining a healthy weight, he suggests. In fact, research shows how shedding a few pounds might make a real difference. A study published in International Journal of Clinical Rheumatology that looked at 171 RA patients found that those who were overweight or obese who lost at least 10 pounds were three times as likely to see improvements in their symptoms compared to those who did not lose weight.

Dr. Makol notes that adding turmeric and fish oils/omega 3 supplementation have both shown to improve RA symptoms, too. However, “before using a supplement, patients must consult their rheumatologist, as drug interactions can occur,” she advises.

Other methods that may help reduce joint swelling in RA include stretching and—perhaps surprisingly—exercising. In fact, a recent study found that resistance training improved joint mobility and actually reduced cartilage breakdown.

Relief for RA Is Yours

If you’re struggling with RA joint pain and swelling, relief really is out there. Dr. Blumstein notes that it’s always important to discuss your symptoms with your doctor—so never ignore what’s ailing you. He adds that it’s also a good idea to bring questions or concerns to every visit. Write them down ahead of time so you remember them, he adds.

“While the medications used for RA can have some serious side effects, it is very important to balance the risk of meds with the risk of the disease itself,” Dr. Blumstein says. “Left untreated, rheumatoid arthritis is very serious and can result in not only permanent joint damage and disability, but also increases the risk of dying from heart disease and certain cancers like lymphoma.”