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1. What Is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is an autoimmune, chronic, systemic, inflammatory disease that primarily affects the joints. It is characterized by persistent synovial inflammation that leads to progressive, symmetric polyarthritis and potential joint destruction. Unlike osteoarthritis, which is caused by wear and tear, RA occurs when the immune system mistakenly attacks healthy tissue in the body, especially the synovium—the inner lining of the joints. This results in inflammation, pain, swelling, and can eventually cause joint damage and deformities. RA most commonly affects the small joints of the hands, wrists, and feet.

2. Key Signs and Symptoms

  • Joint Pain and Stiffness: Symmetric joint pain, swelling, and stiffness. Commonly affects the hands, wrists, and feet. Stiffness is often worse in the morning or after periods of inactivity.
  • Small joint involvement (MCPs, PIPs, wrists, MTPs)
  • Morning stiffness >30–60 minutes
  • Swelling and Redness: Joints may appear swollen, tender, and warm to touch.
  • Fatigue: Many patients experience persistent tiredness, even when joints are not actively inflamed.
  • Systemic Effects: RA can affect other organs, leading to symptoms such as fever, weight loss, and anemia.
  • Possible extra-articular involvement (nodules, ILD, scleritis)

3. Risk Factors- RA develops from a combination of genetic susceptibility, environmental triggers, and immune dysregulation.

  • Genetics: Family history of RA increases risk.
  • Gender: Women are more likely to develop RA than men.
  • Age: Most commonly begins between ages 30 and 60 but can occur at any age.
  • Environmental Triggers: Smoking and exposure to certain infections (periodontal disease) may increase risk.

4. Diagnosis

Diagnosis of RA involves a combination of medical history, physical examination, blood tests (such as rheumatoid factor and anti-CCP antibodies), and imaging studies (like X-rays or ultrasounds to assess joint damage). Early diagnosis is crucial to prevent long-term complications and joint damage.

  • Labs: RF, anti-CCP, CRP, ESR
  • Imaging: X-ray(may reveal erosions) and ultrasound (or MRI) of affected joints (may reveal synovitis)

5. Treatment Goals

  • Early diagnosis
  • Inflammation control
  • Joint preservation
  • Improved quality of life
  • Treat to target

6. Medications

  • NSAIDs-symptom relief only-does not prevent joint damage
  • Corticosteroids-short term use for flares or bridge therapy
  • Conventional DMARDs:
    • Methotrexate (first-line)
    • Leflunomide
    • Sulfasalazine
    • Hydroxychloroquine
  • Biologic DMARDs
    • TNF inhibitor
    • IL-6 inhibitor
    • Abatacept
    • Rituximab
    • IL-1 inhibitor
  • Targeted Synthetic DMARDs-
    • JAK inhibitors (tofacitinib, upadacitinib, baricitinib)

7. Management and Nursing Considerations.

  • Physical Activity: Encourage gentle exercises and physical therapy to maintain joint mobility and muscle strength.
  • Patient Education:
    • Self-care strategies
    • Medication adherence
    • Importance of prescribed lab work
    • Recognizing signs of disease flare-ups.
    • Infection prevention/recognition
    • Vaccinations
    • Reinforce importance of early treatment and follow-up
  • Emotional Support: RA can affect mental health; provide resources for counseling or support groups.
  • Monitoring: Watch for side effects from medications, signs of infection, and changes in joint function.
  • Monitor lab values and medication toxicity

8. Definitions and Key Terms

  • Synovitis: Synovitis refers to the inflammation of the synovial membrane, which lines joints and produces synovial fluid for lubrication. This inflammation often leads to joint pain, swelling, and reduced mobility.
  • DMARD- Disease Modifying Antirheumatic Drug.
    • These can be the old, oral medications such as methotrexate, leflunomide, hydroxychloroquine -also known as conventional DMARDs (cDMARD). They can also be biologic DMARDs (bDMARD) which include the biologic medication such as Etanercept, infliximabs etc.
  • Biologic DMARDs- (bDMARD) biologic medication such as Etanercept, infliximabs etc.
  • Symmetrical-symmetry is relevant as some autoimmune, inflammatory diseases affect joints on both sides of the body differently -symmetry (or lack thereof) is important to note.
  • Polyarthritis- inflammation affecting five or more joints simultaneously.
  • Treat to Target- treatment goals are set and the patient’s treatment plan is adjusted at regular intervals to meet those goals

9. Documentation

  • History of presenting symptoms
    • Morning stiffness?  How long does it last? How long have the symptoms been present?
  • History of other comorbidities
  • Family history
  • Lifestyle (particularly smoking)
  • Physical Exam
    • Swollen/tender joints, Range of Motion (ROM)/mobility
    • Lung sounds
    • Eyes
  • Tried/failed medications
  • Moving forward in caring for the patient make sure to note when new treatments were started and when and why they were ended-this becomes important for insurance purposes.
  • Document referrals/ follow up with other providers

10. Your Role as a Nurse

As a nurse, you play a vital role in supporting patients with RA. You will monitor symptoms, administer medications, assist with mobility, provide education, and offer emotional support. Building trust and understanding with patients is essential, as living with RA can be challenging both physically and emotionally.

11. Triage Questions:

  • When did the symptoms start
  • Any fever, pain, redness, recent injury
  • What medications taken?
  • On prednisone?
  • Have any medications helped?
  • Where is the pain?  Which joints are involved?

American College of Rheumatology. (2025, February). Rheumatoid arthritis. Rheumatology.org. https://rheumatology.org/patients/rheumatoid-arthritis

Gravallese, E. M., & Firestein, G. S. (2023). Rheumatoid arthritis — Common origins, divergent mechanisms. The New England Journal of Medicine, 388(6), 529–542. https://doi.org/10.1056/NEJMra2103726

Peterson E, Gallagher MK, Wilbur J. Rheumatoid Arthritis: Diagnosis and Management for the Family Physician. Am Fam Physician. 2024 Nov;110(5):515-526. PMID: 39556634.

National Guideline Centre (UK). Treat-to-target: Rheumatoid arthritis in adults: diagnosis and management: Evidence review C. London: National Institute for Health and Care Excellence (NICE); 2018 Jul. (NICE Guideline, No. 100.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK577119/

Contributor: Karen McKerihan, MSN, NO-C
Last Reviewed: March 2026