RA most often affects the distal joints symmetrically, such as both hands, wrists, and knees. Whether you have just been diagnosed with rheumatic disease — or someone you love has — there is a lot to process. This explanatory guide will help you do that in a proactive and measured way. You’re constantly finding yourself managing symptoms, whether through medication, alternative treatments, or lifestyle changes, often through personal trial and error. You must take time to figure out how to make your home more accessible and discover ways to enhance all manner of activities, like travel. Then there are everyday health habits you’ll no doubt examine, including the types of diet and exercise that are best. Putting in the time to learn how best to do all this is well worth the effort. Thanks to improved treatments, healthier habits, and the array of assistance products available, most people with RA today can find themselves leading spectacular lives.
Managing Morning Stiffness With Rheumatoid Arthritis
Sleeping all night is great for most of your body — but not for your joints. Lack of movement during the night can have you waking up as stiff as steel. Morning stiffness (which, alas, can last beyond the early a.m. hours) is one of the more pervasive problems facing people with RA, affecting even a majority of those experiencing low disease activity, according to research. Fortunately, there are ways to combat this problem. Rheumatologists recommend warming yourself with a heating pad, raising your home thermostat, or doing gentle hand exercises as soon as you wake up, as well as keeping pills by your bed so you can take morning medications immediately. People with arthritis point to things that have worked for them, including taking a hot shower, staying in bed until your feet joints feel steady, and repeatedly performing morning hand stretches as much as necessary before starting your day.
Managing Fatigue With Rheumatoid Arthritis
For people living with RA, fatigue can be so extreme that just getting through the day may feel like an accomplishment. As the patient advocate Laura Genoves puts it, “Some days you feel great, but others you have a tough time,” when daily tasks like walking the dog or even making your morning coffee are exhausting. Another woman living with RA, Cheryl Crow, told Everyday Health she has to take a rest break each afternoon to keep functioning. Fatigue — the bone-tired exhaustion that isn’t always helped by sleeping — is considered a common symptom of RA, and may be due to systemic inflammation, anemia (low hemoglobin, which can be multifactorial), or medications used to treat the disease. Strategies to battle this exhaustion include controlling the disease with medication and not napping, if you can avoid it, so that you consolidate your rest. Incorporating meditation, which unites both body and mind, may also be effective.
Managing Sleep With Rheumatoid Arthritis
Sleep is a common but overlooked problem that creates a vicious cycle of misery: You can’t sleep, so the next day you experience excess pain and feel even more disabled, which makes it hard to fall asleep the following night. Sleep woes may also be related to depression in a complex interplay between the body and the mind. (If you do experience depression, it’s important to speak with your physician.) Fortunately, there are steps you can take to improve your nightly shut-eye, including investing in a heated blanket or mattress pad, getting into the routine of an evening meditation, and shunning snacking a couple of hours before bedtime.
Managing Your Prescriptions for Rheumatoid Arthritis
Here’s the good news: RA treatment options have greatly increased in recent years. With more biologics, biosimilars, combination therapy, and other treatments, it’s even more likely you can quell bothersome symptoms or even put the disease in remission. But how to manage all these prescriptions can be a complex undertaking. It’s important to speak honestly with your physician at every visit about whether your medications are providing the results you are wanting. Before each appointment, keep a symptom journal and bring it with you, write down specific questions you don’t want to forget to ask, and accurately track all herbal and vitamin supplements you’re taking. Be sure to bring a list of all of your medications, both prescription and over-the-counter, to your appointment. Once a medication (or combination) has been prescribed, carefully follow all directions so you don’t make mistakes. Common mistakes include unintentionally doubling (or tripling) up on NSAID drugs and taking methotrexate daily rather than weekly. If you have concerns about your drugs, share with your doctor your reasons for wanting to stop taking them, whether it is fears of side effects or their escalating cost. (Financial assistance may be available to you.) Never stop taking your meds on your own, even if you’re feeling better.
Complementary and Alternative Medicine for Rheumatoid Arthritis
Once your disease is under control, many people begin to experiment with nondrug complementary techniques, everything from supplements to spices. This is an area fraught with misinformation, so it’s prudent to use a buyer-beware approach. Even popular methods like acupuncture, magnet therapy, cryotherapy, or sauna therapy actually have little to no research supporting them for use with rheumatoid arthritis. It’s important to check with your doctor before exploring any alternative technique, especially if it’s something you plan to ingest. Home remedies worth pursuing include warm baths and other heat treatments. You might also benefit from mindful breathing or other mind-body techniques, because the relaxation response they bring reduces inflammatory stress. Essential oils dripped into a bath or placed on a diffuser can also help keep you calmer. Omega-3 fatty acids are a type of polyunsaturated fat known to be anti-inflammatory. Although stores sell supplements, you can find omega-3s in cold-water seafood, so it may be worth increasing your consumption of these foods instead. Try adding a little fish oil to your morning smoothie, or snack on canned herring on crackers in the afternoon. Several herbs and spices are also thought to have anti-inflammatory properties, including ginger, thyme, cinnamon, and turmeric.
Diet for Rheumatoid Arthritis
Food is so important for all our cells, so it makes sense that people with RA often look to experiment with whether changing their diet might help their disease. Unfortunately, good-quality studies showing that any specific eating plan can benefit RA are hard to come by. Still, since RA is a disease of inflammation, trying an anti-inflammatory diet makes sense — and indeed, preliminary studies show it can help improve RA symptoms in just a few weeks. This diet is similar to the heart-healthy Mediterranean diet experts have long recommended. Some eating plans, such as the keto diet, which is chock-full of high-fat foods, may actually be detrimental for people with joint inflammation. The best eating plans are those that draw from a variety of healthy options, so don’t get stuck munching on one food item repeatedly. That said, your RA symptoms might benefit from incorporating certain foods into your diet that are known to be beneficial, including certain culinary herbs, healthful teas, antioxidant fruits like blueberries, and even yummy inflammation-fighting desserts like cherry cobbler and dark chocolate.
Exercising With Rheumatoid Arthritis
Contrary to popular belief, exercise does not make rheumatoid arthritis worse. In fact, experts now know that “motion is lotion,” with regular physical activity a key part of retaining function and quality of life. Of course, you’ll want to check with your physician before you start any new workout plan. Once you’ve done that, work to strengthen your muscles (which protect delicate joints) by lifting light weights, and gain endurance through aerobic activities. Both are essential for helping to manage your RA. People with the disease tend to do best with low-impact activities like walking or swimming. Other great exercises include water aerobics, the Chinese meditative movement of tai chi, and gentle forms of yoga.
Home Accessibility and Rheumatoid Arthritis
Everyone wants to be comfortable in their own home, but when you have RA, having that cozy space may mean making some changes to aid your independence, safety, and mobility. Some of these swaps require buying a few things, like a raised toilet seat and grab bars for the bathroom, or getting flat knobs or handles for your kitchen cabinets rather than round ones. Some changes that have a big effect can be had for less than $20. Bottle openers and vegetable peelers with larger grips make cooking easier for painful joints, and aids are available to assist with everyday activities such as putting on shoes and buttoning clothes.
Mobility Aids for Rheumatoid Arthritis
You don’t want to be stuck sitting at home just because you have RA. If your joint damage makes it hard to walk, embrace a mobility aid and get back into the world. The smallest assist is a simple cane, which can stabilize you and minimize the risk of a fall. Get a cane that is the proper height for you: Let your arms hang comfortably; the top of the cane should reach your wrist. You’ll want to hold the cane on the side of your stronger leg, and move your weaker leg and the cane together.
Traveling When You Have Rheumatoid Arthritis
Traveling by plane requires some advanced preparation. Ideally, you’ll want to book a nonstop flight to minimize the time and energy involved. Consider using curbside baggage check-in and asking for a wheelchair to get to the gate or on and off the plane. Traveling by other transit methods, be it a car, train, bus, or cruise line, each have their own considerations. In every instance, though, you’ll want to think about what you need and plan for it. Incorporate some travel-friendly gadgets to ensure your vacation will be a success. Add a zipper pull to your suitcase, bring hand warmers and compression gloves onboard, and think about splurging on a four-wheel 360-degree bag that can be pushed and pulled in any direction. The specialist with the most expertise regarding rheumatoid arthritis and its most cutting-edge treatments is a rheumatologist. Because of the disease’s potential effects on movement and on everyday activities, you could also benefit from seeing a physical therapist (PT) and an occupational therapist (OT).
Rheumatologist
A rheumatologist is a doctor whose practice revolves around inflammatory diseases. These physicians commonly treat rheumatoid arthritis along with osteoarthritis, lupus, Sjogren’s syndrome, and other similar conditions. You’ll want to choose your rheumatologist carefully, because this is the doctor you will most closely work with to get your disease under control. It is important that you can openly communicate with this physician and that their concern for your well-being comes through. It may take a while to develop a close relationship with a rheumatologist, but after a while if you determine that the doctor is not a good fit — maybe he or she is not listening well or doesn’t return your calls — you may want to seek out a different rheumatologist. Depending on where you live, though, a rheumatologist may be hard to find, because there is a critical shortage of these specialists in the United States. Although demand for these doctors is up, the number of physicians specializing in rheumatology is actually declining. In the worst-case scenario where no rheumatologists are within even hundreds of miles, you may need to use a physician assistant or nurse practitioner trained in rheumatology, or to work with a far-away rheumatologist by telemedicine.
Physical Therapist/Occupational Therapist
Good range of motion in your joints and strength in the surrounding muscles are crucial for daily functioning. An important way to maintain this is by regularly performing stretching and strengthening moves. A study concluded that RA hand function, pain, and range of motion all improve following resistance exercises. RELATED: Don’t Lose Your Grip: Rheumatoid Arthritis and Grip Strength A physical therapist (PT) is the ideal person to guide you through targeted exercises, some of which you do in their office and others you can do at home. You’ll want to find a PT who has experience working with RA so they will be sure to select exercises that are most beneficial and to avoid any that can cause you harm. On some occasions, the best way to get through a flare is by immobilizing your joints rather than moving them. Your therapist can help you rest your joints by fitting you with braces or splints. An occupational therapist (OT) is someone who focuses more on the small joint and muscle movements needed to perform everyday tasks like dressing, cooking, and functioning at work. An OT can also recommend certain supportive devices to make many of these activities easier. PTs and OTs are both licensed professionals who must pass a national exam to be certified to practice. Some are affiliated with a hospital, while others practice on their own. RELATED: 6 Hand Exercises for Rheumatoid Arthritis But clinical depression or anxiety that persists is actually considered to be a complication of having RA. Like RA itself, mental health conditions may need to be assessed and treated by a professional. Mental-health issues are common in people with RA. In some cases, this can be life-threatening: Research from 2019 found that fully 1 in 10 of those with RA or other musculoskeletal diseases have thought about suicide. Experts have identified a range of strategies to help people with RA develop resilience to help guard against mental illness, such as incorporating more humor and seeking out a positive support system. Taking charge of your mental health, whether by yourself or with a health professional, is as important as tackling the physical disease.
Managing Depression and RA
Does RA bring on depression, or do some of the same forces, including inflammation, make RA sufferers prone to mental health woes? Experts who have examined the link between the two conditions have not yet provided an answer. People with RA experience higher rates of depression than the general public. The link between diseases seems especially pronounced in older people. A study from 2018 found that older Americans diagnosed with depression are more likely to also have arthritis, and the more severe the depression, the higher the rate of arthritis. Even though depression and RA are linked, your rheumatologist may not ask you about your mental state. It is important to bring up depression with a medical provider, but you might be better off sharing symptoms with your primary care physician instead of a rheumatologist. Many rheumatologists admitted in a survey that they are unsure what to do about their patients’ depression. When it comes to managing low mood, you can take a number of helpful steps on your own. These include getting sufficient rest, exercising, meditating, and finding a community that uplifts you. Still, you may need to seek out a mental-health professional. Some techniques they use include cognitive behavioral therapy (CBT), which helps you alter your thinking and has been shown to improve depression. Acceptance and commitment therapy (ACT) is an approach that teaches you to step back and observe (rather than try to change) thoughts that are not beneficial. If you and your doctor decide medication is needed, there are plenty of options; some not only treat depression but can also help reduce pain.
Managing Anxiety and RA
Sure, everyone gets anxious sometimes. We wouldn’t be human if we didn’t stress about an important project or disease progression. But experts differentiate between ordinary stress and clinical anxiety. When feelings of nervousness, unease, or worry become excessive, hard to control, or get in the way of our regular life, the stress-response flips into an anxiety disorder. People with RA are more likely to experience anxiety than those without the disease. When Canadian researchers studied more than 60,000 area residents, they found those with RA were 25 percent more likely to have anxiety than physically healthy individuals, according to one study. It’s unclear whether an underlying link, such as systemic inflammation or environmental factors or even health habits, is the cause of both anxiety and RA. But it’s certainly true that living with a chronic pain condition is stress-inducing. People with RA have numerous, logical fears in their lives, such as pain, financial woes, and the disease’s effects on your relationships. Uncontrolled or undertreated disease can add another layer of anxiety. If your anxiety is getting the best of you, learning about RA is one way to help minimize free-floating worry. So too is eating healthy foods, exercising as much as you can, and taking up meditation to calm your mind. If you decide to work with a psychotherapist, one popular anti-anxiety technique is short-term CBT. And if medication is needed, which might mean an antidepressant, benzodiazepine, beta-blocker, or others, be sure your practitioner is aware of all the drugs you take to manage your RA. If you’ve heard a friend say, “But you don’t look sick,” you’re hardly alone. Tensions with friends sometimes develop because rheumatoid arthritis can be an invisible illness, with internal symptoms that are not seen. Friends may not understand the differences between RA and other forms of arthritis, or the fact that RA symptoms may wax and wane. It can be difficult for other people to understand why you can’t get out of bed in the morning or why you need to take an afternoon break at work. Fortunately, open communication and a little bit of education can help.
Your Friendships and RA
If you had a group of besties before being diagnosed, you may be sad that you can’t always socialize with them like you used to. Part of adjusting to the realities of having a chronic disease includes resetting the expectations you have of your friends, and they have of you. That doesn’t mean you can’t continue to hang with them, just that you may need to find new group activities that are easier for you to manage. Well-meaning friends are also likely to bombard you with the latest home remedy they’ve read about or that helped with their (different!) medical condition — DMSO (dimethyl sulfoxide) or milk thistle, anyone? Try to tell yourself they have your best interests at heart, even if their advice is unhelpful. You’ll want to educate your friends about the realities of your condition, and about the best ways they can assist you. One effective way is to ask them to inquire how they can support you rather than simply taking over a given task. If you find you’re pulling back from your pals and isolating yourself, there are steps you can take to help, like working with a cognitive behavioral therapist to alter the thoughts that keep you from being social. You might also join a patient support group or chronic disease self-management program to add new friends who are facing similar challenges.
Your Romantic Relationships and RA
Communication is critical for every romantic relationship, but it’s especially vital when you have RA. Without open and honest dialogue, it’s easy for one or both of you to start resenting the disease, or to fall into seeing one another as patient or caregiver rather than equal partners. RA flares can show up at the worst times for a relationship — including, most distressing of all, the day of your wedding! When one young woman and her husband bought a new house, she needed to learn that it was okay to ask for help during the stressful move and to lean on her husband more than usual. Even in everyday life, you may find yourself needing to periodically educate and explain your reality to your partner. They may not understand, for example, why you can do certain things that may seem difficult but can’t do others they judge as easier. To be in the healthiest relationship, work on your own self-esteem, because how you feel about yourself and your life influences everything — even your sex life! If your thoughts start flagging, engage in elevating self-talk, practice self-compassion, or begin a physical exercise program so you feel good about the parts of your body that are working wonderfully.
Family Planning With RA
Women with RA often worry that they won’t be able to have children. They might fret over whether needed medications will harm their pregnancy or that their baby might inherit RA genes. But with enough time and proper planning to get the disease under control, experts say most women with RA are able to conceive and have a successful pregnancy. Still, until that time, it’s imperative to use effective contraception. Women with RA do sometimes take longer to get pregnant, but you must always assume it is possible. Effective forms of birth control include an implant (Nexplanon) under the skin of your upper arm or an intrauterine device (IUD) inserted into your uterus. When used properly, oral contraceptives are another reliable method. Women sometimes mistakenly worry that being on the pill will exacerbate their RA or that the pill is not compatible with RA medications, but these long-lingering myths are not true. Doctors now understand that it is vital to begin disease-modifying drugs within the first two years of an RA diagnosis to prevent this joint damage and its attendant disability. Rather than stick with one drug for life, though, the “treat-to-target” treatment paradigm recommends continually monitoring disease activity over the months and years, and switching therapies as needed to achieve the results you and your doctor desire. Three main categories of medications are used for rheumatoid arthritis. The first category is the disease-modifying anti-rheumatic drugs (known as DMARDs). These drugs suppress the body’s overactive immune system or inflammatory processes. methotrexate (Trexall) is one of the oldest in this class. Newer in this categrory are biologics including etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira). So too are Janus kinase (JAK) inhibitors like tofacitinib (Xeljanz, Jakvinus) and upadacitinib (Rinvoq). Another category of RA medicines are corticosteroids such as prednisone and prednisolone. These strong anti-inflammatory drugs can swiftly reduce pain, stiffness, and swelling. Taken long-term, though, they can have significant side effects, which is why they are primarily used for a short time by patients waiting for DMARDs to take effect, or to enhance results. Finally, patients with RA frequently take nonsteroidal anti-inflammatory drugs (known as NSAIDs). NSAIDs offer temporary pain relief but do nothing to stop damage in the joints. You can buy common NSAIDs over the counter, including naproxen (Aleve), ibuprofen (Advil), or aspirin. If these aren’t sufficient and you need stronger NSAIDs, your doctor can prescribe medicines like etodolac (Lodine), meloxicam (Mobic), and celecoxib (Celebrex). Remember that medications are only one part of RA treatment, though. Physical and occupational therapy and home remedies also have a role. And if joint damage gets really severe, surgery may be required to repair or replace them. But there are also many, sometimes hidden, expenses required to help you live your best life — everything from accommodations to make your home comfortable to things that will help you while traveling to what service people you might hire to help you do things you could formerly do yourself. RA may also take a toll on your career. Symptoms may require that you modify your job, work only part-time, or even change careers. Research found that people with RA are 53 percent less likely than healthier peers to be employed, although some think that number may not be so high now, since better meds are available. Unknown future health is something that young adults with RA may face. It’s no wonder you may find yourself worrying about all the ways the disease will impact your finances. The best advice: Plan as much as you can, and try not to stress about things you can’t control.
Medication Prices for RA
People with RA often find themselves taking several medications, the cost of which can add up. There are DMARDs, steroids, NSAIDs, analgesics, and more. Keeping track of it all may be difficult enough; paying for it can feel overwhelming. Depending on the meds you take, the list price can run hundreds or thousands of dollars a month. Fortunately, financial aid and assistance programs have been created to help. These include assistance from nonprofit charities, government programs, and drug companies themselves. You can learn about these options from your physician, other patients, and online research. To find state programs, for example, the National Conference of State Legislatures (NCSL) has an online report on the states that offer assistance.
Managing Your Work Life With RA
With more effective medications and disease-management tools, chances are good you can have a long and productive career. Still, this may require that both you and your employer make certain changes. The Americans With Disabilities Act mandates that a workplace make reasonable accommodations. Ideally, you should consult with your doctor or occupational therapist to figure out what you most need at work before you approach your boss. Some careers are easier to manage than others when you have RA. Some of the best types of work for people with RA include desk jobs, consulting or freelance work, or careers where you are your own boss. But you can thrive in other types of employment too. Mornings are often the hardest times. Work around morning stiffness by asking if you can arrive later when necessary, and by modifying your posture periodically while at work. Try standing occasionally and lifting your feet onto a stool to take strain off your lower back.
Can You Apply for Disability if You Have RA?
If your limitations make it impossible to continue working, you can apply for disability. This can mean either short- or long-term disability from your employer, or the federal Social Security Disability Income program. The application process for disability income can be daunting. But if you patiently gather all your materials and get your doctor on board, your chances of success improve, although you may need to appeal an initial denial. A social worker can offer valuable assistance with this process. (Find one at the website of the National Association of Social Workers.) An important aspect of coping with RA is to get inspired by others in the same situation. It’s crucial to have people in your daily life who act as a beacon for you. But it’s also key to boost your confidence and get practical advice by reading accounts about the lives of others who also have your disease and are finding their way. The following stories are especially helpful.
Brandy Gomez-Duplessis, Makeup-Artist to the Stars
Pain and stiffness in your hands is no joke for anyone, but it can end the career of someone who makes her living making up celebrities like Kerry Washington, Jennifer Aniston, and Queen Latifah. Rather than quit the field she loves, Brandy Gomez-Duplessis discovered adaptations that allow her to successfully continue her work, such as putting grips on her tools, becoming proficient in her nondominant hand, and asking for help sometimes.
Kelly Rouba-Boyd, Wheelchair-Using Fashion Model
She was diagnosed with juvenile rheumatoid arthritis as a toddler and has used a wheelchair for years, but Kelly Rouba-Boyd never gave up her dream of sashaying down a fashion runway. The fantasy became a reality when the author and advocate was invited by the fashion designer Michael Kuluva, who himself has RA, to participate in runway show in 2016. Read more about Kelly’s story.
Stacy Courtnay, Patient Advocate to Physicians and Scientists
As a mom with severe RA symptoms that haven’t responded to many top medications or to a litany of natural approaches, Stacy Courtnay is intimately familiar with the harsh realities of living with the disease. Rather than suffer in silence, she is using her experience to help others by participating in several Arthritis Foundation pilot programs — one that helps doctors and researchers better understand the disease and a second that is creating an information dashboard for patients to use in developing their treatment plan. Read more about Stacy’s story. Participating in a clinical trial for rheumatoid arthritis is a way you may help yourself, especially if existing medications have not been helpful enough. And it is a way to make life better in the future for others with the condition.
How to Find a Clinical Trial for RA
Clinical trials are conducted across the United States by hospitals, universities, doctors’ offices, community clinics, and other organizations. Some are funded by the federal government, others by corporations, industry groups, or nonprofit organizations such as patient advocacy groups. The U.S. National Library of Medicine maintains a massive database of ongoing clinical trials, called ClinicalTrials.gov. Hundreds of trials for RA patients can be found on that website. The nonprofit organization CISCRP is another source for identifying clinical trials. Your doctor or healthcare center may also be able to direct you to a clinical trial that is appropriate for you.
What to Consider Before Joining a Clinical Trial
Clinical trials may not be appropriate for everyone. You’ll want to have a discussion with your physician before signing up for a trial. If your current treatment plan is working well, you might not want to participate in a trial at this time, because you may be taken off the effective medication. And because trials typically compare a treatment group with a placebo group, it is possible you will have no active treatment at all during the course of the trial. Before deciding, consider a number of questions, such as whether all costs, including travel, will be covered; what the potential side effects or risks might be (a process known as informed consent); and how long your commitment will be, including follow-up that could continue for months or years.
News and Research on Rheumatoid Arthritis
Stay up-to-date with the latest news and research on rheumatoid arthritis by subscribing to Everyday Health’s newsletter, Living With RA. Once you subscribe, we’ll deliver it to your inbox two times a week. Prefer to browse? Check out and monitor sites such as CreakyJoints, RheumNow, the Arthritis Foundation, the American College of Rheumatology, and other reputable arthritis sites featured in EH’s Rheumatoid Arthritis Resource Center
Arthritis Awareness: By the Month, Day, and Week
Arthritis Awareness Month, which takes place in May, is far from the only opportunity you’ll have to learn about arthritis awareness and advocacy and to engage with the arthritis patient community. There is also World Autoimmune and Autoinflammatory Arthritis Day on May 20, World Arthritis Day on October 12, Rheumatoid Awareness Day on February 2, the UK’s RA Awareness Week in June, and Rheumatic Disease Awareness Month in September. Read more about 8 Arthritis Blogs We Can’t Stop Reading.
