Myths & Facts: Rheumatoid Arthritis

RHEUMATOID ARTHRITIS (RA) is a chronic autoimmune disorder that occurs when the immune system mistakenly attacks the body’s own tissues, primarily affecting the joints in the hands, wrists and knees. This immune response leads to joint damage, resulting in long-lasting pain, swelling, balance issues and potential joint deformities. Beyond the joints, RA can also impact other organs, including the lungs, heart and eyes.¹

The likelihood of developing RA increases with age, and onset is most common among adults in their 60s. Additional risk factors include smoking (which not only elevates the risk of developing RA, but can also exacerbate the disease), a family history of RA, sex, diet, obesity, environmental factors and infections. Women who have never given birth may also face a greater risk of developing RA.²

According to the Centers for Disease Control and Prevention, arthritis affects about one in five U.S. adults. In 2022, the age-adjusted prevalence of diagnosed arthritis in adults aged 18 and older was 18.9 percent, with women (21.5 percent) more likely than men (16.1 percent) to have arthritis. Prevalence increases with age, from 3.6 percent in adults aged 18 to 34 to 53.9 percent in those aged 75 and older.³

While these statistics encompass various forms of arthritis, including osteoarthritis (OA) and psoriatic arthritis, RA remains a significant contributor to the overall arthritis burden in the United States.

Dispelling myths about RA can significantly reduce the public health burden by promoting early diagnosis, encouraging timely treatment and fostering greater public awareness.

Separating Myth from Fact

Myth: RA affects only the elderly.

Fact: While the risk of developing RA increases with age, it can occur at any age, including in young adults and children. The typical onset is between 30 and 50 years old, and nearly half of arthritis sufferers are under the age of 65.³

Myth: RA and OA are the same.

Fact: RA and OA are distinct conditions. RA is an autoimmune disease that causes joint inflammation, while OA results from the breakdown of joint cartilage over time. Understanding these differences is crucial for accurate diagnosis and treatment, since both conditions damage joints but in different ways. Research shows that people with RA have a higher chance of developing OA because the inflammation from RA can damage joints over time, making a person vulnerable to joint changes that can lead to OA.⁴

Myth: Exercise makes RA symptoms worse.

Fact: Regular, appropriate exercise can benefit individuals with RA by strengthening muscles around joints, improving flexibility and reducing pain. Exercise also helps enhance energy and stamina by decreasing fatigue and improving sleep.⁵ According to Steven Blair, PED, FACSM, exercise epidemiologist and prior director of epidemiology at the Cooper Institute for Aerobics Research in Dallas, Texas, “Skeletal muscle is the largest organ in the body and is intricately tied with protein turnover and synthesis and many other metabolic and biochemical functions. Activating skeletal muscle has many important health benefits we are only beginning to understand.”⁶

Myth: RA affects only the joints.

Fact: RA causes a person’s immune system to attack healthy tissue. Without treatment, RA can have wide-ranging effects. RA affects different parts of the body in many ways:⁷

• Skin: Up to 20 percent of people with RA develop rheumatoid nodules under the skin and near pressure points.⁸ These are small, firm bumps made of inflammatory tissue. While they are often painless and generally not a cause for concern, they can cause discomfort if a person places pressure on them, such as when kneeling.
• Mouth: People with RA may experience xerostomia, or dry mouth.⁷ RA can also cause saliva ducts to narrow or close, leading to an uncomfortable feeling of dryness and difficulty eating and swallowing. Another complication is the increased risk of developing Sjögren’s disease, which causes dryness in the eyes and mouth, among other symptoms.⁹
• Eyes: RA can cause inflammation in the eyes, as well as dry eye syndrome, which can lead to ongoing irritation and eventually damage the cornea. Additional effects of RA on the eyes can include scleritis or inflammation of the whites of the eyes; uveitis or inflammation of the inner eye; retinal vascular occlusion or blocked blood vessels in the eye; glaucoma, which damages the optic nerve; and cataracts, which results from inflammation in the optic lens.
• Lungs: In around 80 percent of people with RA, the disease affects the lungs.⁷ This may cause no symptoms, but prolonged inflammation in the lungs can lead to pulmonary fibrosis, which can cause scarring and breathing difficulties. In addition, some RA medications can make the immune system less effective, which can make people more vulnerable to respiratory infections, including pneumonia and tuberculosis.
• Nerves: RA causes inflammation and swelling and can lead to peripheral neuropathy (nerve pain throughout the body). According to research, peripheral neuropathy may affect nearly 40 percent of people with RA and is more common among older people and those with more severe RA.¹⁰

Myth: RA is caused solely by genetic factors.

Fact: While genetics play a role, environmental factors such as smoking and air pollution also contribute to RA development. Health experts believe RA is at least partially hereditary. A person who has a direct family relative with RA may be two to five times¹¹ more likely to develop the condition. Researchers have identified several parts of the human DNA code that could relate to RA. One example involves the human leukocyte antigen (HLA) genes. Doctors have pinpointed the HLA-DRB1 gene as having an association with RA. People who have this genetic marker are more likely to develop RA than those who do not.¹² Other genes that may have an association with RA include:

• PTPN22: This gene plays a role in the development and progression of the disease.
• STAT4: This gene helps control how the body regulates and activates the immune system.
• TRAF1 and C5: These genes can cause chronic inflammation.

However, doctors have not identified how a person acquires these genes, and not everyone who has RA-associated genes develops this condition.¹³ In fact, someone’s risk for RA is more likely to be highest when they have specific genes that have links with the condition, as well as other risk factors such as smoking or obesity.

Myth: Diet and lifestyle do not impact RA.

Fact: Diet can significantly influence inflammation levels. Accumulating research suggests individual dietary factors and dietary patterns might be implicated in the risk of developing RA. Overall, a Western diet high in saturated fat, refined carbohydrates and sugar, and low in fiber and antioxidants might increase the risk of RA both directly through increasing inflammation and indirectly through increasing insulin resistance and obesity, with the latter being a known risk factor for RA. Likewise, consumption of long-chain omega-3 polyunsaturated fatty acids, derived from fish and fish oil, is associated with a reduced risk of RA probably due to their anti-inflammatory properties. The Mediterranean diet, which is rich in plant-based foods such as whole grains, legumes, fruit, vegetables and extra-virgin olive oil and low in red meat consumption, might have the potential to reduce the risk of RA. Based on current research, it is suggested that adherence to the Mediterranean diet combined with an increased consumption of fatty fish, reduced consumption of sugar-sweetened drinks and maintenance of a normal body weight contribute to reducing the risk of RA.¹⁴

When it comes to lifestyle, recent research¹⁵ suggests a significant number of RA cases might be attributable to lifestyle factors, including:

• Smoking
• Alcohol consumption
• Body mass index
• Physical activity
• Diet

The study, which was published in the journal Arthritis Care and Research, used data from two large ongoing studies: The Nurses’ Health Study and Nurses’ Health Study II. The researchers identified more than 1,200 women who had been diagnosed with RA between 1986 and 2017, as well as 107,092 who did not have RA. They also determined that 34 percent of RA cases might be preventable by prioritizing at least four out of the five identified lifestyle habits that contribute to RA. “Our finding that a high proportion (34 percent) of RA risk in the general female population is attributable to the confluence of modifiable lifestyle factors represents something of a paradigm shift in thinking about RA and autoimmune disease risk,” the researchers wrote. “Promotion of multiple healthy behaviors to minimize risk is an important message for the general population and, in particular, those at risk by virtue of family history.”¹⁶

Myth: RA symptoms and treatment are the same for everyone.

Fact: RA symptoms can vary widely among individuals, both in severity and in the specific joints affected. Diagnosis and treatment for RA used to be the same for everyone who had it, but today it’s clear that the symptoms, the way it progresses and how serious it is vary from person to person, partly based on genetics, which means individual treatments often differ as well. Patients suffering from RA may benefit from:

Disease-modifying antirheumatic drugs (DMARDs): These drugs can slow RA progression by suppressing the body’s immune system.

Biologics: This subset of DMARDs target specific proteins in the body, so they tend to have less of an effect on the immune system as a whole. They also work by suppressing the immune system.

Corticosteroids: These drugs, such as prednisone, reduce inflammation and may be given on a short-term basis to relieve joint pain and swelling. They usually aren’t recommended for long-term use.

Nonsteroidal anti-inflammatory drugs: These medicines can be given by prescription or over the counter to reduce pain and inflammation. Examples include ibuprofen and naproxen sodium.

Part of patients’ treatment for RA may also include physical or occupational therapy to learn exercises that can help keep joints flexible and muscles strong. Sometimes, if medicine does not work to control RA symptoms or if the disease is diagnosed too late, surgery may be recommended to repair or replace damaged joints.

Dispelling the Myths Now

RA is the most common form of autoimmune arthritis, affecting up to 18 million people globally and more than 1.36 million adults in the U.S.¹⁸ Dispelling myths about RA is crucial for promoting early diagnosis, especially since the joint damage RA causes is usually irreversible. According to rheumatologist Robert McLean, MD, regional medical director at Northeast Medical Group in New Haven, Conn., current treatment options can help RA patients lead fuller lives, but only if the disease is caught early.¹⁹ Dr. Mclean notes that newer anti-inflammatory drugs called TNF (tumor necrosis factor) inhibitors have shown to be particularly effective at reducing RA damage in many patients who have not seen adequate improvement from previous medications. “Some of the newer medications are more commonly known by their brand names like Enbrel and [Humira],” he said. “Using these newer medications and treating RA earlier rather than later has led to improved quality of life for many patients, compared to years ago.”

By fostering a better understanding of RA, we can reduce stigma, support those affected and empower individuals with accurate information about this common but frequently misunderstood disease. With continued research and education outreach efforts, people living with RA are more likely to recognize early symptoms, seek appropriate care and adopt lifestyle changes that can slow disease progression or even result in disease remission.