让我们来谈谈类风湿关节炎

你是否刚刚被诊断或担心你公司uld have rheumatoid arthritis, you’re probably nervous, confused, and maybe even a little scared. That’s normal, and everyone featured on HealthCentral with a chronic illness felt just like you do now. But we—and they—are here for you. On this page alone, you’ll discover the realities and challenges of the condition, but also the best treatments, helpful lifestyle changes, where to find your rheumatoid arthritis (RA) community, and all the crucial information to help you not merely manage—but thrive. We’re sure you’ve got a lot of questions...and we’re here to answer them.

What Is Rheumatoid Arthritis, Anyway?

The term "arthritis" feels familiar because: Who hasn't seen the stock image of高龄人抓膝? But in fact, the word is often used incorrectly. First, "arthritis" is a catchall term; there isn’t just one variety. Rheumatoid arthritis (RA) is the second most-common type, affecting approximately 1.3 million people in the United States, 70% of whom are women, according to the Arthritis Foundation. Second, RA doesn’t affect only the retirement set, nor does it hit just knees and hands. RA is an autoimmune disorder that causes systemic inflammation, which primarily infiltrates the joints but also has effects beyond them. While it can occur at any time, RA typically develops between ages 40 and 60. That being said, RA can also affect children via a condition called juvenile idiopathic arthritis.

To really understand RA, it helps to have an image in your mind of how joints work. So, picture this: Joints contain several structures that allow you to move easily.

• When healthy, the ends of the bones in a joint are protected from rubbing together by an elastic slippery material calledcartilage(yep, the same stuff your ear is made of).
• The entire joint is surrounded by a capsule, known as the滑膜囊。
• 组织的薄层称为synovial membranelines the sac.
• The membrane secretes lubricatingsynovial fluid, which reduces friction, protecting the cartilage and joints during movement.

But here’s what happens when RA strikes: The immune system essentially misfires and sets its sights on the synovial membrane, attacking as if it’s a foreign invader.

In the early stages, the synovial membrane becomes inflamed and thickened, causing pain and limiting joint movement. Some people report feeling a warm or even burning sensation around the affected joints as well as a stiffness that makes movement slow. Over time, untreated inflammation can damage cartilage and bones. The space between bones can become smaller, causing joints to become unstable, misaligned, more painful, and sometimes even immobile.

Eventually, inflammatory tissue begins to build up, sometimes causing nodules to form around the area, most commonly along the back of the forearms, elbows, joints, and pressure points such as sacrum, occiput, and heel. These nodules will fluctuate with disease activity. However, if you imagine someone with arthritis in their hands, the very firm nodules at the furthest finger joints are actually those seen in Osteoarthritis and not rheumatoid arthritis. And while RA is known for causing joint pain and inflammation, it can spark other symptoms throughout your body, including dry eyes, chest pain, and osteoporosis.

Worth noting: Before you feel any joint pain, it’s common to experience general, nonspecific RA symptoms; unfortunately, they’re the kind that seem to go with一切–fever, fatigue, loss of appetite—so linking them with RA doesn’t often happen. And that tightness you feel in your joints may only be an issue in the morning (making it seem like not such a big deal). With rest, any synovial fluid you have is soaked up by the cartilage, much like a sponge absorbs water. As you move, the cartilage is "squeezed," and the fluid bathes the joint. First thing in the a.m., there’s just not going to be a lot of extra fluid to keep things loose. But the more you move, the more fluid is released.

What Causes Rheumatoid Arthritis in the First Place?

Scientists believe that the overactive immune response that precipitates RA is triggered by a complex interaction between genetic and environmental factors. Ital on thecomplexpart, because not even the top minds in medicine have figured out the exact cause of rheumatoid arthritis. As they continue to chip away at the mystery, a few specific correlations have been identified or are currently being investigated:

• 遗传学：某些基因增加开发风湿性关节炎的风险。For example, the genetic marker HLA-DR4 has been found in 60% to 70% percent of people of European ancestry with RA. But, what’s a “genetic marker”? It’s any variation in your DNA that may indicate an increased risk of developing a specific condition. However, simply having the gene does not mean that you have RA or that you will develop it. Because there are so many other factors that impact the development of rheumatoid arthritis and because the gene alone cannot confirm diagnosis or predict it in the future, docs do not perform genetic testing when diagnosing RA.

• Being a woman:Since women get the disease three times more often than men, some experts believe hormonal factors may play a role in causing rheumatoid arthritis. It has been shown that estrogen can rev up the B cells (those are the white blood cells that attack the synovial membrane) and thus exacerbate autoimmune diseases like RA.

• Viruses and infections:虽然我们知道，RA是由于免疫系统攻击人体的健康组织，医疗陪审团还在外面对cause for that response。Some researchers believe that healthy cells may get mixed up in the action when the body senses danger from a virus or infection; when the immune system kicks into gear and attacks the germs (aka an immune response), the body’s own tissue may get assaulted, too. That's when autoimmune diseases like RA pop up, and healthy joints fall under siege.

难道我有风湿性关节炎的症状是什么？

There’s a reason you’re often shown an illustration of a disembodied hand when discussing RA with your doctor! Rheumatoid arthritis most often hits the small joints of the hands and wrists first, where you may feel warmth, swelling, or tenderness. The joint pain of RA has been described in all sorts of ways—deep, dull, aching, throbbing, warm, hot, tender. However, most agree that the pain is typically worse in the early mornings. It can take at least 30 to 45 minutes for joints to loosen and feel better, and it generally worsens again after periods of inactivity.

也就是说,类风湿性关节炎的迹象lso extend to your elbows, shoulders, knees, hips, ankles, feet, and neck. RA symptoms also tend to occur symmetrically; that is, joints on both sides of the body are usually affected at the same time. In some cases, other organ systems—including the eyes, heart, and lungs—may become inflamed too, leading to blurred vision, fluid build-up around the heart or lungs, along with chest pain and shortness of breath. (Right now, though, take a long, deep breath: RA is a serious illness, but complications can be controlled and even prevented. More on that below.)

很多人都体会到年（这是不可预测的那样）在天漫长的发作症状，这可能缓解句号隔开，当你的RA症状消退。事实上，随着女性RA谁是怀孕通常体验过怀孕的所有RA相关的症状完全沉寂，因为激素和免疫系统调节身体状态。这些症状通常会返回全部力量产后，因为身体恢复正常的荷尔蒙平衡和免疫系统的功能。

Early symptoms of RA may include:

• 疲乏无力
• Low-grade fever
• General feeling of poor health
• Loss of appetite and weight loss
• 紧关节,通常身体的两侧,that may be warm to the touch

With long-term, untreated rheumatoid arthritis, these additional symptoms may occur:

• Stiffness (especially after waking up)
• 硬而无痛的皮肤肿块，被称为类风湿结节，在手，肘，膝，或脚趾可以在大小范围从豌豆到橘子
• Bent and misshapen joints
• 口干
• 红，眼睛发痒
• Chest pain and breathing difficulty (in advanced cases where inflammation affects heart and lungs)

When to Call Your Doctor or Rheumatologist

Make an appointment with a doctor if you're experiencing morning stiffness with any of the other early symptoms of RA, including fevers and weight loss. If you are not diagnosed, a primary-care doctor can refer you to a rheumatologist to run the necessary tests for rheumatoid arthritis. If you have rheumatoid arthritis and you experience a major flare or new symptoms, you should contact your rheumatologist or primary-care doctor to get help.

怎么做医生诊断类风湿关节炎？

RA is diagnosed based on your medical history, a physical examination, and laboratory and imaging tests (e.g., X-rays).

Laboratory tests that may be used to help diagnose rheumatoid arthritis include:

• Anti-cyclic citrullinated peptide (anti-CCP) antibody:Antibodies are proteins made by your body to fight off foreign substances. Anti-CCP is an antibody present in most RA patients. This simple blood test looks for the presence and level of the antibody.
• Complete blood count (CBC):This common test is used to measure levels of red blood cells, white blood cells, and platelets in the blood. A low red blood cell count can be an indication of the chronic inflammation seen in.
• C-reactive protein (CRP):Your blood is drawn, then checked for the presence of the CRP protein, which is produced by your liver and can be found in your blood in response to inflammation.
• Erythrocyte sedimentation rate (ESR):After a sample of your blood is added to a tube, a technician measures the rate at which the red blood cells fall to the bottom of the tube. A fast sedimentation indicates inflammation, with blood cells clumping together and falling quicker.
• Rheumatoid factor:又称乳胶凝集试验，该验血来检测这种抗体，这是在谁拥有RA大多数患者升高的水平。
• X-rays:从X射线产生的图像显示，RA的炎症已在你的关节造成的损害的量。
• MRI：磁共振成像用的磁场，射频，和计算机技术得到是如此敏感的图像质量，他们可以检测RA损害六个月以上的显示出来的X射线之前。
• 超声：Sometimes referred to as ultrasonography, this is a very sensitive test that exposes both the bone erosion that happens in RA damage as well as the presence of inflammation.
• Synovial fluid analysis:In this test, which is performed when a joint has pain, inflammation, or swelling, fluid is drawn from the joint to help determine a potential diagnosis. It could be an infection, gout, or arthritis, among other things. It’s important for docs to get this right because, obviously, gout—for example—has a completely different treatment plan than RA.

What Is the Best Treatment for RA?

The goal of treatment is super simple: to keep you moving in all the ways you need to. That means reducing—and ideally stopping—the pain and inflammation that can eventually lead to joint damage. When RA is diagnosed early (check those symptoms!) and you’re aggressive with treatment, you're more likely to avoid complications later.

Treat-to-Target (T2T) is a newish treatment strategy that sets remission or minimal disease activity as the objective. How it works: Disease activity is frequently monitored and if the target (remission!) is not met, meds and doses are adjusted right then and there, at your appointment. How exactly? Docs follow a predetermined protocol, which could include medication, therapy, dietary changes, RA-friendly exercises, surgery, or a combination of treatment options.

RA的药物：你有选项

There are more rheumatoid arthritis medications and treatment choices now available than ever before, which makes it easier to find the best treatment plan for you.

RA药物包括（上市，一般情况下，在你的RA是否是轻度，中度或重度排序）：

NSAIDS

Nonsteroidal anti-inflammatory drugs (NSAIDs) do not slow the progression of RA, but your doctor may prescribe large doses of one to treat the chronic pain due to inflammation. Common NSAIDs include ones you know:

• Aspirin (Bufferin, Bayer)
• Celecoxib (Celebrex)
• Disalcid（双水杨酯）
• Ibuprofen (Advil and other brands)
• Naproxen (Aleve and other brands)
• RELAFEN（萘丁美酮）
• COX-2 inhibitors, a subclass of NSAIDs that have a lower risk of internal bleeding or stomach ulcers—a common side effect of other NSAIDs that are used in large doses for a long time. If youdoneed high doses of those other NSAIDs, it should be a short-term fix.

DMARDs

这些疾病的抗风湿药物（因此：DMARDs治疗）的帮助下通过阻断炎症保留关节。由于潜在的副作用不可预知的风险的DMARDs，如胃部不适，感染，脱发，和肝损伤，你必须密切定期（每周，每隔几个月）的实验室测试服用这些药物时监控。的DMARD包括：

• Trexall (methotrexate)
• Azulfidine (sulfasalazine)
• Arava (leflunomide)
• Plaquenil (hydroxychloroquine)

Biologics

Also known as biologic response modifiers, these medications are designed to control certain parts of the immune system—in fact, they’re a type of antibody. But instead of locking onto bacteria or a virus, they target, then shut down, the proteins that fuel inflammation. (Cool, right?) Today, there are many different biologics available, so doctors categorize them based on the cells they put a bull’s-eye on.

• Tumor necrosis factor inhibitors (TNF-inhibitors)—such as Humira (adalimumab), Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), and Remicade (infliximab)—put the brakes on tumor necrosis factor, a naturally occurring substance that is overproduced in people with RA; it’s the main cause for the first inflammation a person with RA gets. They’re delivered by self-injection or IV infusion, depending on the drug.
• B细胞抑制剂, like Rituxan (rituximab), are administered through an IV and kill B-lymphocytes that can spark inflammation.
• Interleukin-1 (IL) blockers一样KINERET（阿那白滞），是每日自注射;他们的目标白介素1，在主体中的炎症性化合物。
• Interleukin-6 inhibitors, such as self-injected Kevzara (sarilumab) and IV-administered or self-injected Actemra (tocilizumab), stop interleukin-6 proteins from attaching to cells and triggering inflammation.
• T-Cell inhibitors, like Orencia (abatacept), latch on to the surface of T-cells (aka inflammation-causing white blood cells). A doctor will give you this medicine via IV.

这些药物可以减缓RA的进展，甚至带来缓解长时间。缺点？传授的方法，你必须给自己拍摄或浏览静脉滴注中心定期，因为他们平息你的免疫系统，你可能会更容易感冒，其他感染。

Steroids

口服糖皮质激素，如DELTASONE（强的松），类风湿性关节炎症状提供快速救援，并在先进的情况下，可以防止RA相关的炎症损害您的眼睛和内脏。由于长时间使用时强的松有严重的副作用，它往往是保留对严重的突发或当其他治疗都无效。皮质类固醇注射到受影响的关节也可能会有所帮助。

Surgery

There are some RA cases—usually advanced and/or undertreated—where surgery may be a necessary consideration. Meaning: The pain is likely debilitating, and you no longer have normal joint function. There are two surgery types:

• Synovectomy.Any time swelling has gotten so bad that you’re having a hard time moving and functioning, this surgery may be performed. It removes the diseased synovial membrane from affected joints to reduce swelling and pain and help prevent further joint damage.
• Arthroplasty.这种手术替换受损的关节用机械之一，恢复关节功能或修复畸形。每年有超过一百万关节置换手术进行，主要是髋关节或膝关节，但肩，肘，并在手脚关节可更换为好。关键你的医生讨论：该类型的活动，你希望关节置换后继续。这将有助于您的文档选择合适的假体类型和植入技术，同时也让您更加深入地了解手术的风险和局限性。

治疗可以帮助其他类型

If you have RA, yes, you have a chronic illness. But there are a number of things you can do—in addition to typical meds—to help you feel your best. For this, consider assembling a medical team of specialists from a variety of fields, including psychiatry, nutrition, and radiology.Other health-related professionals may also be part of your team to assist you with the following:

• Movement.Your doctor may prescribe an exercise program or advise you to see a physical or occupational therapist. While exercise that is too vigorous may worsen your symptoms,项目与温和的练习可以增加range of motion of your joints。Some exercises are easier to perform in a pool or hot tub because water helps support the body. Talk to your doctor about which techniques would be best for you.

• 睡觉。Given how uncomfortable the condition is, more than half of people with RA have troublesleeping at night。Plus, RA-related inflammation tends to deplete energy levels faster than for those without RA—so a solid eight hours of shut-eye is even more critical. Start tonight by using pillows as extra support where needed (for example, under a painful shoulder or between stacked knees).

• Compresses.自热工作,减少肌肉紧张和机枪兵ulate blood circulation, many people with RA say that applying something warm (a fresh-from-the-dryer hoodie will do!) makes joints feel better before exercise and other physical activity. Cold compresses, on the other hand, reduce inflammation, swelling, and soreness after an RA flare.

• 外用药膏。Applying creams or lotions containing capsaicin (an extract from chili peppers!) may soothe minor joint pain. Ditto for those with camphor, menthol, or turpentine oil. Try: capsaicin-infusedCapzasin HP CrèmeorJ.R. Watkins White Cream Liniment, which has both camphor and turpentine oil.

• Splints.Your rheumatologist may prescribe splints for areas that are trouble spots for you. During severe episodes, they'll help relieve pain by immobilizing your joints.

• 饮食。While most evidence about the role of diet with RA is anecdotal, there are some studies that indicate certain foods may be helpful. In particular, the Mediterranean diet (aka the anti-inflammatory diet)—which emphasizes fish, olive oil, and vegetables—has been shown to have some impact on inflammation, likely due to the omega-3 fatty acids in certain fish. Several smaller studies also tout the helpfulness of a vegan or vegetarian diet on RA. Learn all aboutRA and diet这里。

What Triggers a Rheumatoid Arthritis Flare-up?

Like a tornado, the triggers of rheumatoid arthritis are unpredictable. The best way to gain more control? Pinpointthe culprits behind your flares。每个人的不同，但典型的罪犯包括：

• Stress
• Infections, including flu and cold, that activate your immune system
• 身体创伤，如手术或骨折
• Post-pregnancy
• 可怜的牙齿健康
• Certain foods, including processed snacks, red meat, and excess refined sugars
• 过大的运动量
• Dramatic, sudden changes in weather

Does RA Have Serious Complications?

It can. Side effects from rheumatoid arthritis are manifestations of the condition itself and come in two varieties: those from untreated or undertreated RA, and those caused by joint damage.Common complications of RAinclude:

• 心脏病。It affects more than half of all people with RA.
• 类风湿结节，这发生在30％至RA患者的40％，并且比痛苦更麻烦。
• Osteoporosis-related fractures. These are 25% to 30% more common in people with RA than the general population.
• Infections (flu, staph, pneumonia). They’re twice as common in people with RA.
• Lung disease。It develops in nearly one-fourth of RA patients.
• Dry eye。This is the most common eye complaint for people with RA.

About 10% of people diagnosed with RA (and diligently treated) experience complete remission within one year, and roughly 40%进入缓解within two years. That’s thanks to significant advances in treatment over the past two decades.

这就是为什么它是如此重要的不要忽视的症状，或推迟获得帮助。如果疾病进展和不治疗，当可能出现的最坏的副作用：运动的严重限制范围或者，接头的恶化，逐渐破坏。炎症过程减慢如纤维组织形式或骨头融合，和关节完全停止工作。

预防

While there is no known way to keep from getting rheumatoid arthritis, there are plenty of steps you can take to prevent complications and feel better overall.

• Quit smoking.34101名妇女的瑞典研究报告说，即使光吸烟与女性RA的风险增加和退出（或不启动的话）可以降低风险。
• Maintain a healthy weight to ease pressure on your joints.If you are overweight, you may want to consider a weight-loss plan, as excess pounds can put unnecessary stress on your joints. Consider working with a dietitian to help build a personalized diet or program that targets your specific goals (i.e. less sugar and more omega-3 fatty acids/fish) for managing your RA.
• Eat a healthy diet.While there is no prescribed diet for RA, aim to avoid foods that cause inflammation, like packaged snacks,and include foods that promote bone health and immune function.
• Start or keep up with an exercise routine.研究表明，运动可以帮助缓解RA症状，甚至提高一天的日常运作。它也可以让你更加灵活，可以帮助您更好的睡眠，并提高你的耐力。

什么是生活像人的RA？

一天到一天的类风湿关节炎通常包括疼痛和疲劳，这可以，无可否认，是压倒性的。您可能还需要对付的人谁不真正了解你的病情，并不能完全掌握你正在经历什么。如果RA是比较新的给你，或者你疲惫不堪，在不断的痛苦，我们知道如何不可能能感受到聚集力量来寻找良好的护理和尝试新的治疗方法。所以，从小事做起：首先教育自己RA，然后努力建立在你的生活与RA的人谁信心的工作。

Emotional Health

People who have rheumatoid arthritis often feel that they must掩盖或掩饰他们的问题, which can be a real drain on your brain. The best solutions?

• Speak up.Simply talking with friends and family about what you're going through with RA can remove that burden of solitude—and help your people help you in the way you need it.
• Find ways to relieve stress.Try creating a self-care routine and exploring alternative treatments like meditation.
• Consider talking to a therapist.Being diagnosed with RA often triggers a grieving process as you mourn the healthy you and work toward acceptance of your situation. You may feel depressed, particularly if your disease is super active. By prioritizing your mental health and linking up with a counselor or therapist (your family doc or rheumatologist can refer you to one), you will set yourself up to follow through with all other aspects of RA management.

性生活

百分之五十九那些具有RA的，每发表的一项研究中Rheumatology, felt the disease had a negative effect on their sex life. And no wonder: Depending on its severity, RA itself—along with some of the meds used to treat it—can decrease desire due to fatigue, stiffness, vaginal dryness, erectile dysfunction, and a decreased libido.

So, what’s the fix? Patience, communication, and understanding between you and your partner are obviously key. There are also certain sex positions that may feel more comfortable for you, typically based on your most ouchy joints:

• For wrist and/or elbow pain:根据需要对下你的胳膊肘的背面或侧面，以及地方枕头躺下。
• For neck pain:Don’t put pillows behind your neck or bend it forward when you’re on your back having sex. And be sure to talk to your doctor about how RA may affect your neck and how to protect it.
• For hip pain:If it hurts to move your hips around, have sex in a spoon position, with your partner behind you.
• For knee pain:你要保持你的膝盖伸直，所以尝试是在你的彼此面对的传教士体位或躺在底部。

Pregnancy

It’s complicated enoughwithoutRA-所以当然怀孕with条件带有一个额外的十亿的问题。Will I have to come off my medication?（有些药品是不安全怀孕期间服用，有的则是很好。）Will I pass RA on to my children?（总之，不一定。）了解尽可能多地了解将要考虑的问题，以及关于药物的风险倾诉你的风湿病早期（你开始尝试最好，之前）。

在哪里可以找到类风湿关节炎社区？

RA affects such a small percentage of the population that, without actively searching, running into another RA-er IRL is as likely as spotting a Charleston Chew at a movie-theater concession stand. Yet, finding your people—those who knowexactly你经历什么，是同样重要的是你的精神健康为找到一个治疗计划工程。形式的连接，探索资源，共享双方的痛苦和灵感，并结交新朋友，从这里开始。

Top RA Instagrammers

• Britt Johnson,@hurtblogger

Follow because:She’s been through the mud—and pretty much stuck there—and does not sugarcoat the realities. Shedoes, however, find light and love in the tiniest places, constantly reminding you that if she can find the strength, so can you.

• 西瑞利，@thebarbellbeautie

Follow because:She may be afraid of needles (hello, Humira shots), but she is not afraid of a barbell. Serving up your daily dose of workout inspiration—and actual workout routines—without ignoring the exercise issues that come with a chronic condition.

• 蕾妮·安德森，@the_rheumatoid_arthritis_mama

Follow because:She’s relatable on every level: She covers all aspects of how RA affects her life—and shares that emotional rollercoaster in her captions—including how she maintains a robust marriage in a hurting bod, keeps mommin’ through exhaustion, and fuels her health with arthritis-approved recipes.

• Eileen Davidson,@chroniceileen,chroniceileen.com

Follow because:她是一个大型主张谁背水战上使她发来提高认识什么是真的很喜欢有RA，和她做这件事没有（疼痛）的骨头。她是一个天生的讲故事的人，与上海社会科学院的一个侧面。

• Aimée Matsumoto,@fitaimee_ra

Follow because:Just when you think you can’t rock mom life (or even have it at all), splurge on In-N-Out Burger, or muster the energy to exercise, Aimee is here to prove you wrong on所有of it—period.

Top RA-Related Podcasts

• 慢性简报。By versatile and hilarious writer Daniel Malito (who has had juvenile arthritis for more than 25 years, since he was 11 years old), the archives of this RA-related podcast are poignant and sometimes LOL-funny.
• Chronic Sex。Sex educator and activist Kirsten Schultz hosts this explicit—as in, NSFW unless you’re wearing headphones!—podcast, uncovering truths about how chronic illness and disability (including RA) affect relationships, sex, and sexuality.
• Sickness + Health。Artist and health advocate Cara Gael O’Regan has lived with Ehlers-Danlos Syndrome, another joint-related condition, for more than two decades; here, she does in-depth interviews on some of the toughest topics—insurance coverage, disability, mortality—as they intersect with chronic conditions and pain.
• Arthritis and Work by the Arthritis Society。While it’s not an ongoing series, this is a gold mine of solid work-related resources specific to balancing a career when you have RA.

Top RA Support Groups and Non-Profits

• Arthritis Foundation。This org and its award-winning magazine,Arthritis Today, help you create a personalized plan for a full life. From quizzes (“What’s Your Arthritis Diet?”) and expert Q&A’s to customizable programs and tools (“Track and React,” a symptom-tracking app), the Arthritis Foundation encourages you to look at your RA diagnosis holistically.
• 关节炎国立研究基金会。For more than four decades, this group has provided grants and organized fundraising for arthritis research into the causes and prevention of, and new treatments for, chronic joint conditions. Whether you're heavy into science or not, this is where you'll want to look for researchers’ latest and greatest RA findings.
• 类风湿关节炎Support Network。Its goal? Provide up-to-date information so that people with RA know their options for prescription drugs and alternative therapies, and fully understand their diagnosis. The site also has a treasure trove of resources, including a rheumatologist directory.
• My RA Team。This massive social network virtually connects you with others who have rheumatoid arthritis. It’s great for emotional support, practical advice, and real-world insights on managing the condition.