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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The cause of rheumatoid arthritis is not known. Many factors are involved in the abnormal activity of the immune system that characterizes rheumatoid arthritis. These factors include genetics (heredity), hormones (explaining why the disease is more common in women than men), and possibly infection by a bacterium or virus. Other environmental factors known to increase the risk for developing rheumatoid arthritis include tobacco smoking, silica exposure, and periodontal (gum) disease.

Although rheumatoid arthritis can have many different symptoms, joints are always affected. Rheumatoid arthritis almost always affects the joints of the hands (such as the knuckle joints), wrists, elbows, knees, ankles, and/or feet. The larger joints, such as the shoulders, hips, and jaw may be affected. The vertebrae of the neck are sometimes involved in people who have had the disease for many years. Usually at least two or three different joints are involved on both sides of the body, often in a symmetrical (mirror image) pattern. The usual joint symptoms include the following:

• Stiffness: The joint does not move as well as it once did. Its range of motion (the extent to which the appendage of the joint, such as the arm, leg, or finger, can move in different directions) may be reduced. Typically, stiffness is most noticeable in the morning and improves later in the day.
• Inflammation: Redness, tenderness, and warmth are the hallmarks of inflammation.
• Swelling: The area around the affected joint is swollen and puffy.
• Nodules: These are hard bumps that appear on or near the joint. They often are found near the elbows. They are most noticeable on the part of the joint that juts out when the joint is flexed.
• Pain: Pain in rheumatoid arthritis has several sources. Pain can come from inflammation or swelling of the joint and surrounding tissues or from working the joint too hard. The intensity of the pain varies among individuals.

These symptoms may keep you from being able to carry out your normal activities. General symptoms include the following:

• Malaise (a "blah" feeling)
• Fever
• Fatigue
• Loss of appetite
• Weight loss
• Myalgias (muscle aches)
• Weakness or loss of energy

The symptoms usually come on very gradually, although in some people they come on very suddenly. Sometimes, the general symptoms come before the joint symptoms, and you may think you have the flu or a similar illness.

The following conditions suggest that rheumatoid arthritis is quiet, referred to as "in remission":

• Morning stiffness lasting less than 15 minutes
• No fatigue
• No joint pain
• No joint tenderness or pain with motion
• No soft-tissue swelling

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