Rheumatoid Arthritis and NIH Women's Health Research

Signs, Symptoms, and Risk Factors

Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation. People with rheumatoid arthritis experience pain, swelling, and stiffness in their joints. Peripheral joints (e.g., in the fingers, wrists, and feet) are commonly affected, but proximal joints (e.g., in the shoulders, hips, and lower back) may become involved as the disease progresses. This inflammation is typically symmetric, and over time it can lead to the loss of cartilage and bone.¹ Rheumatoid arthritis can also cause inflammation in other areas of the body, such as the heart and lungs.

Aside from the characteristic inflammation, people with rheumatoid arthritis may experience other signs and symptoms, such as fatigue, loss of appetite, and a low-grade fever.² Rheumatoid arthritis can also increase the risk of cardiovascular disease and type 2 diabetes mellitus.³

Certain alleles of the HLA-DRB1 gene encode an amino acid sequence called the shared epitope, which has been associated with the development of rheumatoid arthritis. The shared epitope may explain how interactions between certain genetic and environmental factors can lead to rheumatoid arthritis. For example, cigarette smoke, which is a significant risk factor for rheumatoid arthritis, has been shown to interact with the shared epitope.⁴

Impact on Women's Health

Hormones—particularly estrogen—may also play a role in the development of rheumatoid arthritis;^{5 , 6} however, the role of hormones is complex and not fully understood. Rheumatoid arthritis occurs approximately two to three times more often in women than in men. In addition, women with rheumatoid arthritis may experience reductions in disease activity or even remission during pregnancy, a period of high estrogen exposure.² Women with rheumatoid arthritis have a longer time to conception than women who do not have this condition.⁷

Diagnosis and Treatment

Rheumatoid arthritis shares signs and symptoms with other types of arthritis and conditions that affect joints;⁸ however, the presence of anticitrullinated protein antibodies in the blood can help distinguish rheumatoid arthritis from similar conditions.⁹

Treatment generally includes the use of antirheumatic drugs,¹ and women with rheumatoid arthritis who are pregnant or breastfeeding can receive pregnancy- and lactation-compatible antirheumatics.⁵

Ongoing Research

Researchers are working to improve the strategies for preventing and treating rheumatoid arthritis across women's lives. Although treatment options during pregnancy and breastfeeding have expanded, more research is needed to understand how exposure to some rheumatoid arthritis medications before birth, particularly biologic therapies, may affect an infant's developing immune system and response to vaccines.¹⁰ Researchers are also studying genetic and molecular factors that may help identify people who are at risk of developing rheumatoid arthritis before symptoms begin and determine whether rheumatoid arthritis can be delayed or prevented.¹¹ By examining cells and tissues from affected joints, scientists hope to predict which treatments are most likely to work for individual patients. Other studies are exploring how to better identify and reduce the elevated risk of cardiovascular disease that is associated with rheumatoid arthritis.³

Researchers at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) are investigating the genetic factors that determine who is at risk of developing rheumatoid arthritis and how severe the condition will be. Identifying these genetic factors will help researchers develop new treatments. In addition, understanding what happens at the molecular level may help researchers design new tests for diagnosing rheumatoid arthritis and identify which treatments are best for specific patients.¹¹