RA can be tricky to diagnose because symptoms can mimic other types of arthritis and inflammatory diseases. If you suspect you have symptoms or may be at risk for developing RA, make an appointment with your healthcare provider. 

To get an official diagnosis, your provider will use a combination of tests, which generally include a physical exam, blood tests, and imaging tests. Getting a diagnosis and starting treatment early can slow disease progression and prevent serious joint damage.

Medical History and Physical Exam 

Your primary healthcare provider or a rheumatologist—a doctor who specializes in the joints and bones—can diagnose you with RA. During your appointment, your provider will ask about your medical history and perform a physical exam. Before your visit, try to keep a track of the severity of your symptoms and how long you have been experiencing them. This information can give your provider more information to help them make a diagnosis.

To get a better understanding of your symptoms and overall health, your provider may ask you:

• What symptoms do you have and when did they start?
• Where are you experiencing pain?
• How severe is the pain?
• Is the pain affecting your daily life?
• Have you had any recent injuries or illnesses?
• Does anyone in your family have a history of arthritis?

Factors such as long-term tobacco use, obesity, and stressful life events can also increase your risk of developing RA. It is common for your provider to ask you questions about your lifestyle and daily routine. 

During your physical exam, your provider may:

• Measure your vitals (e.g., temperature, blood pressure, and heart rate)
• Take a look at your joints, such as the wrists, elbows, knees, and ankles
• Ask you to walk around or bend your joints to check how well they are moving 
• Examine your joints for fluid, swelling, pressure, and visual deformities (such as areas that stick out, aren’t aligned properly, or have unusual curves)

While a medical history questionnaire and a physical exam are not enough to diagnose you with RA, these tests can help your healthcare provider figure out if they should order additional tests or refer you to a specialist. In some cases, your provider may think it is unlikely that you have RA and can then work with you to figure out other possible causes of your symptoms. 

Blood Tests

The next step of the diagnosis process is to get your blood tested. Your healthcare provider will typically order one or more blood tests to look for inflammatory markers (signs of inflammation), antibodies, and proteins that can indicate RA.

Generally, blood testing is a simple procedure that can be completed during a single appointment. Multiple blood tests can also be performed using the same sample of blood.

The four most common blood tests for RA examine:

• Erythrocyte sedimentation rate (ESR): This looks at your red blood cells to measure inflammation in your body. 
• C-reactive protein (CRP): This measures inflammation by checking how much CRP is being produced in your liver Your liver lets excess CRP into your blood when your body is experiencing inflammation.
• Rheumatoid factor (RF): This checks the amount of rheumatoid factor or the antibodies that attack healthy joint tissue, in your immune system. 
• Anti-CCP antibody: This estimates the number of cyclic citrullinated peptide (CCP) antibodies in your blood, another type of antibody that attacks healthy cells in the joints.

No one blood test can give you an official diagnosis for RA. Sometimes, your antibody levels can be high for reasons such as viral and bacterial infections. It is also possible to experience a false positive test. 

Typically, your healthcare provider will use a combination of these tests to reach a diagnosis. Positive test results in both the RF and anti-CCP tests can reliably indicate that you have RA. 

Imaging Tests

During your testing process, your healthcare provider may order imaging tests such as X-rays, MRIs, and ultrasounds. Depending on the type of test that is used, images can detect bone erosion (how worn down your bones are), inflammation, and excess fluid around the joints.

If you are in the early stages of RA, there may be little to no joint or bone erosion. In this case, your imaging tests may not have any signs of damage. This is why imaging tests are not used on their own but are combined with blood tests and physical exams to diagnose RA. 

Common imaging tests for RA can include:

• X-ray: Radiographic imaging can identify places where the bone has been eroded between joints, but if your disease stage is early, an X-ray is unlikely to detect any bone changes. However, X-rays can give your provider a good baseline of your condition, which can be used later on to compare how the disease is progressing or if treatment is working.
• Magnetic resonance imaging (MRI): This test uses magnets and radio waves to create a 3D image of your joints. The technology can help your provider identify signs of bone erosion, tissue inflammation, and changes to surrounding joint tissue. Generally, MRIs can show reliable joint changes, even in the early stages of RA. 
• Ultrasound: Ultrasounds can detect similar levels of disease as MRIs, except within deep tissue. Ultrasounds are often a cheaper and more accessible test; they can often be done right in your provider's office.

During an imaging test, you will be required to keep your body still so the technician can take clear and proper photos of your joints. Test results are generally available within 24 hours. 

Diagnostic Criteria

After testing is completed, your healthcare provider will use a set of criteria developed by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). The 2010 ACR-EULAR is the standard diagnostic criteria for RA. A 2020 study in Clinical Medicine deemed that these criteria are still accurate and should be used as a scoring measure to diagnose RA.

There are four categories in the ACR-EULAR criteria. Each category has a scoring guideline. A total score of six or more points indicates an RA diagnosis.

If your provider tallies up a score of 6 or more at the end of this evaluation, they may make a diagnosis of RA, as long as other similar conditions (such as psoriatic arthritis and viral polyarthritis) have been ruled out.

A Quick Review

Getting an early diagnosis of RA can slow or stop disease progression and improve long-term treatment outcomes. But, diagnosing RA can be tricky since RA symptoms can mimic the symptoms of other conditions. Your provider will use a combination of physical exams, blood tests, and imaging to rule out any other conditions and give you an official RA diagnosis.  

If you think you have RA symptoms or might be at risk for developing RA, don’t hesitate to reach out to your healthcare provider for an evaluation. A quick medical history and physical exam can point your provider in the right direction and help them either rule out RA or figure out the next steps for diagnosis. 

The same can be said for rheumatoid arthritis (RA), an autoimmune disease that causes your immune system to attack the healthy tissue of your joints. But while RA does include genetics as a risk factor, genetics aren't the only thing that can trigger the disease and, in some cases, genetics have very little to do with whether or not a person develops RA.

Is-Rheumatoid-Arthritis-Genetic-or-Hereditary-GettyImages-1298263178 “>Freepik

"There are there some genes transmitted from one family member to another that might predispose you to RA," says Jonathan Greer, MD, rheumatologist with Arthritis & Rheumatology Associates of Palm Beach and medical advisor to CreakyJoints. "But having the genes only makes it more likely [you'll develop RA], not guaranteed."

So is RA genetic or not? What about hereditary? And what are your chances of developing RA if someone else in your family has it? Here's what you need to know about the genetic component of RA, from what that actually means to how it affects your overall risk.

First Off: Do Genetic and Hereditary Mean the Same Thing?

The words "genetic" and "hereditary" are usually used interchangeably to describe health conditions passed on from one family member to the next (like a parent to their child). But technically, there is a difference between the terms.

• A genetic condition is one that occurs because of a gene mutation. Sometimes these mutations are passed on through family DNA, but other times, they happen totally randomly or because of an external or environmental factor.
• A hereditary condition, on the other hand, is always handed down from parent to child through genetic makeup. Hereditary conditions don't occur "naturally," i.e., as the result of external or environmental factors.

In other words: a hereditary condition is always genetic, but not all genetic conditions are hereditary.

RELATED: 10 Ways Rheumatoid Arthritis Affects the Body

Is Rheumatoid Arthritis Genetic or Hereditary?

OK, so here's where things get a little tricky: the answer is both…and also neither!

RA can be caused by an inherited gene or a random gene mutation, so to say RA is strictly hereditary isn't accurate. While the genes that cause RA can be passed down through family, many cases of RA happen independently of any family history. Likewise, most people with RA have some genetic markers for the disease, but that doesn't mean everyone with the genes will ultimately end up with RA.

According to Robert Koval, MD, an Austin-based rheumatologist at Texas Orthopedics, the risk of RA in the general population is between 1% and 2%; with a family history, your risk may double or even triple, but that still only leaves you with less than a 10% chance at most.

"The odds are in your favor, but you should be aware of symptoms if you have a family history," Dr. Koval tells Health.

He notes that the incidence of RA in identical twins, who share 50% of their genes, is higher than it is in non-identical twins, but still quite low: if one identical twin has RA, there's still less than a 15% chance the other twin will have it as well.

Overall, about 60% of RA cases can be traced back to inheritability versus other factors, according to the UK's National Rheumatoid Arthritis Society. Still, that doesn't mean you, personally, have a 60% chance of developing RA with a family history; the individual risk is much, much lower.

RELATED: 27 Tips for Coping With Rheumatoid Arthritis

What Genes Can Cause RA?

There are over 100 possible genes that could trigger the heightened immune response that causes RA, some of which may be inherited while others may occur naturally, as the result of random gene mutations.

However, researchers have identified four genetic markers they know to be linked to RA:

• HLA-DR4, the most prominent risk factor for RA, which makes you five times more likely to develop RA than someone without it.
• STAT4, a gene responsible for immune system regulation.
• TRAF1 and C5, genes known to cause chronic inflammation.
• PTPN22, which may trigger RA and affect its progression.

Dr. Greer says that because there is such a large number of genes that can cause RA, just having one gene doesn't mean you'll develop the disease; there are lots of changes that can take place in the body, from your gut to your mouth, that can trigger the onset of RA if you are already predisposed genetically.

If RA Isn’t Always Genetic, Then What Causes It?

People who develop RA do seem to have some genes in common, indicating that genetics predisposes you to developing the disease. But since the individual chances of having RA with and without family history are still fairly low, what else causes RA to develop?

The answer is external factors, which play a huge part in turning the genetic possibility of RA into a reality. They include the following:

Gender

RA is far more common in women than it is in men, so simply being female (with the right combination of genes) can increase your chances of developing RA. Per Brigham and Women's Hospital in Boston, about 75% of RA patients are female.

Age

RA can develop at any age, says Dr. Koval, though there are still observable patterns. "For females, in your 50s—around the time of menopause—is common, and so is your 20s [because of hormonal changes]," he explains. "Childbirth, and the major hormone shift it causes in the first six months, is a common time for RA to present." Beyond that, Dr. Greer notes that the reduced efficiency of our immune system as we age leaves people in their 70s and 80s especially vulnerable to developing RA as well.

Lifestyle

This is a broad category, including everything from diet to illness to toxin exposure. The single biggest lifestyle risk factor, however, is smoking, especially if you are a heavy smoker or have smoked for more than 20 years, according to the Mayo Clinic. (Smoking can also increase your RA symptoms, BTW, as the Arthritis Foundation points out.)

RELATED: Here's What Experts Want You to Know About Living With Chronic Pain

The Bottom Line

Genes are undeniably a key piece of the RA puzzle; we know a large number of genes are associated with RA, and any one of them can increase your general risk for the disease. In some cases, those genes may be inherited, and in others, they might occur randomly. But genes remain only a piece of the puzzle, not the whole puzzle.

"It's a complicated issue," says Dr. Greer. "If you have a predisposed patient who comes into contact with an environmental stimulus, it can trigger the disease." 

As for whether or not RA is hereditary, within families, a history of RA slightly increases your risk of developing the disease but is by no means a guarantee. Much of the time, something else—like age, gender, or certain lifestyle factors—combines with your genetic makeup to create the hyperinflammatory response that leads to RA (family history or not).

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

12-Rheumatoid-Arthritis-Treatment-Options-According-to-Doctors-GettyImages-1217023238 is a destructive chronic disease that gets worse, but treatments stop the disease from [progressing] and can prevent long-term damage," Juan J. Maya, MD, rheumatologist at the Rheumatology Center of Palm Beach and medical advisor to CreakyJoints, tells Health.

In general, rheumatoid arthritis treatments fall into three categories: medication, surgery, and alternative therapies. We asked doctors to explain the most common treatment options for people with RA within these categories. Here are 12 of their picks.

RELATED: 27 Tips for Coping With Rheumatoid Arthritis

OTC medications

These are often a frontline treatment for people who are in the early stages of RA or who have mild, ongoing symptoms. Nonsteroidal anti-inflammatory (NSAID) drugs like ibuprofen (Motrin) and naproxen (Aleve) can reduce inflammation and swelling without the side effects or potential for dependency of stronger drugs like opioids.

There are limitations, though, says Dr. Maya, since NSAIDs are simply pain relievers—they don't stop or treat the disease itself. And not everyone can use NSAIDs on a regular basis: People with kidney disease and stomach ulcers are often advised to avoid them, and even someone without coexisting conditions can suffer GI complications from overuse of NSAIDs.

Steroids

A course of steroid treatment with a drug like prednisone can be helpful for RA patients while they wait for more advanced medications to take effect. Steroids have the ability to reduce inflammation and suppress the body's immune response; they might be used to bring down acute swelling or sudden flares, and can be given orally, intravenously, or via injection.

However, steroids are not a long-lasting treatment because they come with the potential for serious side effects—especially at higher doses. These side effects include GI issues, mood swings, bloating and weight gain, and even osteoporosis. If your doctor prescribes you steroids for your RA symptoms, it will likely be with a plan to taper you off them or transition you to another treatment.

Disease-modifying antirheumatic drugs (DMARDs)

According to Dr. Maya, disease-modifying antirheumatic drugs are one of the most commonly used medications to treat RA. Not only can these drugs stop the progression of the disease, but they can also prevent it from damaging healthy tissue surrounding affected joints. Because they are a moderately strong drug, but not the top tier treatment, many newly diagnosed RA patients end up on DMARDs. Common ones include methotrexate and hydroxychloroquine.

In general, these drugs work by targeting the immune system pathways responsible for triggering the inflammatory response. They can take some time to become fully effective (often requiring the use of NSAIDs or steroids in the meantime to treat symptoms) but tend to work quite well once they reach their full potential. In many cases, your dosage of these types of medications will be small at first, and then slowly increase over time.

However, DMARDs do carry a set of side effects, including increased risk of infection, GI upset, headaches, and fatigue, and in rare cases, liver toxicity.

RELATED: 10 Ways to Ease Rheumatoid Arthritis Pain

Biologics

Biologic response modifiers include drugs like adalimumab (Humira) and tofacitinib (Xeljanz). They work the same way as DMARDs, in the sense that they target your immune system, but the approach is more focused. They block inflammation in specific molecules, says Dr. Maya, stopping arthritis in its tracks.

That said, while biologics can be more effective and tend to work faster, they also carry a risk of infection and are more expensive than other treatment options. They are typically only available as injections or infusions, rather than oral pills.

Physical therapy

Rather than waiting for your RA to become debilitating—or until you're in recovery post-surgery—you might want to consider physical therapy.

According to Dr. John Gallucci Jr., DPT and CEO of JAG-ONE Physical Therapy, the relationship between rheumatologists and physical therapists is growing—and leading to more and more rheumatologists using physical therapy as an early intervention treatment.

"Physical therapy is not just exercise, but can decrease your pain, improve any restriction in range of motion, and help return you to normal function," he explains.

When you see a physical therapist for your RA symptoms, they will likely focus on three things, says Dr. Gallucci: function, flexibility, and strengthening. This might be done through a regime of physical exercises, for sure, but also use of electrical stimulation, heat, ice, and exercise equipment to increase circulation and blood flow to affected joints.

Joint replacement surgery

Joint replacement surgery removes a severely damaged joint—like that of the hip or knee, commonly—and replaces it with an artificial version. Surgery is not a first line of defense, obviously, but occasionally it's a necessity.

This procedure can help an RA sufferer experience less pain and more range of motion, but it's a fairly complicated procedure that also requires a long recovery period and a commitment to post-surgical physical therapy.

Surgery may be needed in a few situations, says Dr. Maya. "If patients can't be on [DMARDs or biologics] or have aggressive disease, like destroyed joints, then we will need a surgeon to repair the damage in those tendons or joints, or replace them completely," he explains.

RELATED: The Most Common Types of Arthritis, and Who's at Risk for Each

Other surgeries

If your joints or tissue are inflamed or damaged but you don't need a full replacement, you may be able to undergo surgery to simply remove what's ailing you.

There are two types of removal surgery: arthrodesis, where a joint is removed and surrounding bones are fused together, and synovectomy, where inflamed tissue around a joint is removed.

These surgeries don't generally work as well as replacement procedures; they have a higher risk of symptom recurrence and often limit your range of motion. But in some cases, it may be a better option for you than a full replacement surgery. It may also be an option to repair a damaged joint, although this, too, isn't always effective.

Heat and ice

Whether heat or ice works better for inflamed joints depends on your preferences and what kind of relief you're looking for. Usually, heat is better for relaxing joints and soothing achy or tight muscles; on the flip side, ice can dull pain and often reduce swelling (though it won't last forever).

Like NSAIDs, this treatment doesn't actually target your RA itself, but can go a long way toward reducing pain without the use of OTC medications.

Exercise

When you're in pain, exercising might feel like the last thing you want to do, but Dr. Gallucci says that physical activity is crucial to keeping inflammation levels low, so you don't end up in pain in the first place.

"What decreases inflammation is blood circulation," he explains, "so [doing activities] like using an exercise bike or walking can increase your heart rate, which increases circulation and relieves the symptom of pain."

RELATED: This X-Ray of a Woman's 'Telescoping Fingers' Shows the Painful Reality of Living With Rheumatoid Arthritis

Relaxation and mindfulness

Tension and stress can contribute to painful symptoms of RA, not only because they leave you vulnerable to illness and injury but because they can disrupt your sleep cycles, influence your diet, and steer you away from healthy activities like exercise.

Learning to move your body in beneficial ways—through yoga and relaxation techniques—can help you prevent the natural worsening of joint pain and stiffness and practicing mindfulness and meditation can help train your brain to process stress in more productive ways.

While taking a yoga class or meditating for ten minutes every day won't make your RA disappear, living a more relaxed, tension-free life might go a long way towards limiting the overall progression of your disease. At the very least, it can't hurt—we all could benefit from a little less stress.

Topical creams

Many people turn to topical treatments to treat arthritis pain on the spot, and this isn't a bad thing—but you should know the limitations of this approach.

For example, it literally is an "on the spot" treatment, says Dr. Gallucci, and one that very rarely gets down deep enough to the source of the problem to provide long-lasting relief.

"These analgesics cause a histamine reaction to the nerve endings and give a feeling of warmth," he explains, "and most people prefer a feeling of warmth as opposed to one of pain."

However, studies have shown that while some of these topical treatments get past the skin barrier, most do not—so you're only masking your symptoms, not treating them, Dr. Gallucci adds.

Still, some people like having a fast relief option in the form of topical creams, like those including capsaicin, which also provides a warming sensation and can be used three or four times per day.

You might also want to consider using diclofenac (Voltaren), a topical NSAID that used to be prescription-only but is now available OTC; a 2020 review published in Rheumatology and Therapy found diclofenac to be similarly effective as other treatments in reducing pain, without the added GI side effects that come with oral NSAIDs.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

It's only natural to wonder and ask these questions, but sometimes there are answers and sometimes there aren't. And sometimes, like in the case of rheumatoid arthritis (RA), there might be a whole bunch of reasons.

What-Causes-Rheumatoid-Arthritis-9-Factors-to-Know-AdobeStock_256413348 is multifactorial," Juan J. Maya, MD, a rheumatologist at the Rheumatology Center of Palm Beach and medical advisor to CreakyJoints, tells Health. "[That means] it's not just one single thing but a few things [put together] that have been shown to increase your chances."

What are the most common risk factors for RA, and do you have any of them? Here's what you need to know.

Genetics

There are a few known risk factors for RA that you can't do anything about—the biggest of which is your genetic profile. In other words, if other members of your family have or have had RA, you also have an increased risk of developing it yourself.

Exact numbers are lacking, but according to the National Rheumatoid Arthritis Society, first-degree relatives of people with RA have three times the risk of developing it themselves; other studies suggest that inheriting RA genes may cause more than half of all cases.

However, an increased risk doesn't mean a guarantee, Robert Koval, MD, rheumatologist at Texas Orthopedics in Austin, Texas, tells Health. "RA has a genetic component, and it does run in families, but while your genes set you up for disease it's not the be all, end all as to whether or not you'll get it," he says.

Many people carrying genes that can cause RA will never develop the condition, and not everyone who develops it was genetically predisposed, either. But genetics remains one of the largest risk factors at play.

Age

Technically anyone can be affected by RA, but according to the Centers for Disease Control and Prevention (CDC), your chances increase with age; the most common age for people to develop RA is during their sixties.

According to the Arthritis Foundation, RA usually begins between the ages of 30 and 60 for women; and men under the age of 45 are only rarely diagnosed with the condition.

Smoking

As if cancer wasn't a big enough reason to avoid smoking, you can add RA to the list, too. Plus, the fact that smoking is a preventable risk factor makes it even more noteworthy here—a 2014 review published in the International Journal of Molecular Sciences concluded that smoking not only increases your chances of developing RA, but it can also make your symptoms and disease progression worse.

"People that smoke develop RA about 10 years before they otherwise would have if they are already genetically predisposed," says Dr. Koval, adding that the chemicals in nicotine can trigger the heightened immune response that can lead to RA.

RELATED: 11 Rheumatoid Arthritis Treatment Options, Explained by Doctors

Poor dental hygiene

What does brushing your teeth have to do with RA? Quite a lot, as it turns out. Dr. Maya notes that people with poor dental hygiene or periodontal disease often have more severe RA symptoms (and vice versa).

The connection seems to be inflammation: RA doesn't just cause inflammation in your joints but can affect your jaw—making it hard to effectively keep your teeth clean—and can increase your risk for oral infections and ulcers, and deplete your salivation, which may lead to more cavities.

We wouldn't go so far as to say that having poor dental hygiene can definitively cause RA, but a few small-scale studies (like this 2018 one and this 2020 one) have linked certain oral microbiome markers to the later development of the disease. At the very least, if you have multiple other risk factors, periodontal disease could contribute to your eventual development of RA.

Stress

Yes, stress is a part of life for most of us, but if you're already predisposed to RA, high stress can lead to the onset of the disease, says Dr. Koval.

In other words, chronic stress or even one single extremely stressful event (like a death in the family or traumatic accident) can cause RA genes to be expressed in a person who has them thanks to their family history.

Illness or infection

Sickness happens even to the best of us, but most of the time we recover and move on.

However, sometimes your body triggers a heightened immune response during infection, sending a message to begin attacking the healthy tissue of the joints (this is more likely in people with the genetic disposition toward RA, but unfortunately it can happen to anyone).

Before you panic that the cold you just caught will give you RA, know that this is not a common cause. Bacteria is a typical culprit—think Lyme Disease—and some more serious viruses, like Epstein-Barr virus, parvovirus, hepatitis, and HIV are often associated with the onset of RA.

RELATED: 27 Tips for Coping With Rheumatoid Arthritis

Environmental toxins

Dr. Maya warns that some environmental exposures, such as to silica, can increase your chances of developing RA. This is most commonly seen in people who work in industrial settings, like mines, quarries, and steel mills, where inorganic silica (a soil-based mineral) is often found in high amounts.

A 2020 review published in Safety and Health at Work suggests a clear link between occupational exposure to RA and a higher incidence of the disease, especially if the workers were also smokers.

Female hormones

Per Dr. Koval, the female to male ratio for developing RA is 10 to 1, making the disease much more common in women than in men. Why? Female hormones.

The frequent hormonal changes during a woman's reproductive years, including menstruation, pregnancy, and breastfeeding, and perimenopause, can often trigger the inflammatory response that leads to RA. In fact, one large Danish study from 2011 found that women were significantly more at risk for developing an autoimmune disorder in the first year after pregnancy, proposing that something about the state of being pregnant for nine months can trigger a systemic immune response.

Poor nutrition

There's no magic diet that will ensure you avoid RA, but we do know that obesity increases your likelihood of developing it. The Mayo Clinic points to both age and gender as contributing factors here, noting that RA is especially common in obese women under the age of 55.

The relationship between body fat and RA is linked, again, to inflammation. Body fat can cause your cells to produce more cytokines, a protein associated with the inflammatory response. This can speed up the onset of RA, leading to inflammation in your joints much sooner. It's also typical for RA patients who are obese to lose range of motion more quickly, per the Arthritis Foundation.

RELATED: 5 Things You Need to Know About Rheumatoid Arthritis

Can you prevent rheumatoid arthritis?

You can't "prevent" RA in the typical sense; genetically-speaking, there's nothing you can do to change whatever genes you've inherited, and even mitigating some of your other risk factors may not allow you to avoid the disease. Sometimes, RA just happens—when there are so many possible causes contributing to your overall risk, it's nearly impossible to say which one was to blame (or if you could have done something to prevent it).

That said, there are ways to adopt a healthy lifestyle that reduce your chances of developing RA, whether you carry the genes that cause it or not.

"Eat as healthy as you can—eat less pro-inflammatory foods, and limit sweeteners and red meats," says Dr. Koval. "And even reducing the amount of smoking you do can cause a delay in the presentation of RA symptoms."

In addition to your diet, Dr. Maya adds that it's important to maintain good dental hygiene and stress levels, since those are two other factors at least somewhat in your control.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

“After Wimbledon, I just feel like I had the flu and wasn’t feeling well. I took some time off from tennis and training in the gym and was just going to relax, but I wasn’t feeling better. So I decided to go back to training and see what happens,” Wozniacki, now 30, tells Health.

But after flying to Washington DC for another tournament, Wozniacki only felt worse. “Before the tournament, I started having some pain in my joints, and I told my dad that maybe we should skip this week, so I withdrew from the tournament to be ready for Montreal, which was a bigger tournament,” Wozniacki says. “Something was off when I practiced. Day to day, I felt exhausted and was dizzy on the court. I also had pain in some joints.”

Unfortunately, her mysterious symptoms continued to lead to more setbacks. Soon after withdrawing from the Washington Open, Wozniacki played at the Rogers Cup in Montreal and lost her first-round match in just under three hours. While Wozniacki was devastated from her loss, she was anxious to recover and get ready for her next match in Cincinnati. The next morning, however, she couldn’t move her arms and hands.

RELATED: 27 Tips for Coping With Rheumatoid Arthritis

“I looked over at my husband and told him I couldn’t move. I was in so much pain and felt exhausted. I said something is serious here. When I arrived in Cincinnati, I went to see a doctor—an exercise physiologist—because I felt extreme pain in my shoulders, elbows and hands. I had to hold my elbows in my hands so they wouldn’t move. It felt like my shoulders were out of socket,” Wozniacki says.

Wozniacki’s joints were swollen, but her doctor didn’t see any damage to her ligaments at the time—and because of that, Wozniacki chalked it up to her demanding travel schedule, intense training, and challenging matches. She received some treatment for her achy joints, but her condition wasn’t improving. “I was feeling some symptoms like a lot of women that have an autoimmune disease but don’t really know they have it. You start by feeling a little better or a little worse, but it comes down to feeling very tired or overworked,” she says. “I never really paid attention to it because of the grueling schedule of being a professional tennis player. You just think you’ve overworked yourself.”

Wozniacki didn't know it yet, but she was suffering from rheumatoid arthritis (RA), a chronic autoimmune disorder that causes pain, swelling, and inflammation in the joints—and it would take multiple doctors, blood tests, and worsening symptoms to get a correct diagnosis.

Finally, after meeting with a fifth doctor in New York City, Wozniacki got some answers about her strange symptoms. “Because I was so persistent, he just did a bunch of tests,” Wozniacki says. The initial results of her tests showed that she has an autoimmune disease, but whether it was RA, lupus or another illness wasn’t clear. After several other tests, Wozniacki was diagnosed with RA in September 2018.

RELATED: 10 Autoimmune Diseases Every Woman Needs to Know About

At first, she was confused about what it meant to have the disease and how she could have developed it. To her, the word arthritis conjured up the condition associated with aging, and no one in her family has a history of an autoimmune disease. “I was 27 years old and the number two tennis player in the world. I’m in great shape and eat well. I do all the right things,” Wozniacki says.

But just like the 1.5 million American adults affected by RA, according to the Arthritis Foundation, Wozniacki couldn’t have prevented the disease, no matter how healthy or fit she is. Autoimmune diseases, like RA, can happen to anyone, regardless of gender or age. Health experts aren’t sure what the exact causes of RA are, but women are three times more likely than men to develop RA, and it most commonly develops in women between the ages of 30 and 60.

Moreover, women from certain ethnic groups are more vulnerable to developing autoimmune diseases than others. For example, Black, Hispanic, Asian and Native American women are two to three times more likely to develop an autoimmune disease than Caucasian women, according to the American Autoimmune Related Diseases Association.

“It’s really hard to say why [I developed RA] because I don’t really know. There’s no one in my family that we know of that has RA or an autoimmune disease, unless someone is undiagnosed. It could be triggered by various things, like I was exhausted and my immune system was compromised at the time,” Wozniacki says. “Honestly, I was experiencing symptoms for quite some time, but it really took me being bedridden to really be like something isn’t right here.”

Even after her diagnosis, Wozniacki was determined to continue playing tennis and living a normal, healthy life

“After the US Open, I played in Beijing at the China Open and won one of my biggest tournaments. It was so emotional for me. The fact that I proved to myself that I could do it. With the right care and people around you, you can really do so much, and that’s why I want to be an inspiration for other women going through the same thing,” Wozniacki says.

Since her diagnosis, Wozniacki says she has been able to keep her RA under control through a combination of treatment and a healthy diet and exercise routine. “It’s important to have an open dialogue with your doctor about your treatment. For my treatment, I keep it to myself because what works for me might not work for the next person. It could be different,” she says.

Today, there are countless treatments for RA, including disease-modifying anti rheumatic drugs (DMARDs), non steroidal anti-inflammatory drugs (NSAIDs) and low-dose corticosteroids, per the American College of Rheumatology. Patients with more serious cases of the disease may also need biologics, which block immune system chemical signals that lead to inflammation and joint damage.

Wozniacki says she has made adjustments to her lifestyle that help prevent RA flare-ups, like getting enough quality sleep at night, staying active and eating an anti-inflammatory diet. “I get up and walk. Moving around for 30 minutes a day has really helped. Sometimes I take a nice, warm relaxing bath. It helps me avoid stress,” Wozniacki says.

RELATED: What It’s Like to Have Your Immune System Attack Your Hair

In addition to running, swimming, and strength training, Wozniacki says she has also taken up yoga and Pilates. As for playing tennis? After almost 15 years of playing professional tennis, Wozniacki retired from the sport in January 2020. She still picks up her racquet, but she has learned how to listen to her body and knows when she needs to take it down a notch.

When flare-ups do happen, Wozniacki says the first signs are usually swelling and pain in her hands and feet. “I can feel it through my rings. My rings don’t fit on my fingers on some days. They kind of slide off,” she says. In addition, RA has affected her voice, causing it to sound raspy. “The joint next to your vocal cords can get inflamed and start to swell. When I have a flare-up, my voice gets more raspy,” she says.

According to the Arthritis Foundation, hoarseness in patients with RA can happen because of the inflammation in the cricoarytenoid joints, which are next to the vocal cords and are responsible for helping open and close them when you speak or breathe. This inflammation can also lead to swallowing issues. In addition, a June 2013 review in Autoimmune Diseases shows that RA can affect the larynx, aka the voice box, which aids in breathing, producing sound and swallowing food.

Now, Wozniacki’s working to inspire and empower all women living with chronic inflammatory diseases

As part of the Advantage Hers campaign, and in partnership with UCB, a global biopharmaceutical company, Wozniacki aims to encourage women living with chronic inflammatory diseases—like RA, psoriatic arthritis, and axial spondyloarthritis—to share their stories and connect with each other.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

In a new Instagram post shared Wednesday, O'Neal, 56, shared a photo of her back, covered with surgery scars and bruises, to demonstrate what it's like to live with rheumatoid arthritis (RA). "A fall scratch scar on my right hip," she began, describing the history of each of her scars. "And the back surgery scar from eight years ago. My last back surgery scar is on the front from February."

O'Neal also revealed a bit about her current treatment plan, pointing to the red marks on her back: "All those red marks are from heating pad. I should probably turn those down a little bit," she said.

Luckily, it wasn't all bad news for O'Neal. "Believe it or not this is me actually getting better," she said. "Cheers to everyone and rheumatoid arthritis can go f–k itself."

RELATED: This X-Ray of a Woman’s 'Telescoping Fingers' Shows the Painful Reality of Living With Rheumatoid Arthritis

According to the Arthritis Association, rheumatoid arthritis (RA) is an autoimmune disease—or when the body’s immune system attacks its own healthy cells—most commonly impacting the joints of the hands, feet, wrists, elbows, knees and ankles. Additionally, it can affect organs and body systems, such as the lungs, heart, and eyes. The American College of Rheumatology claims that 1.3 million adults suffer from the often debilitating health condition. 

Symptoms of the disease—which include joint pain, stiffness, swelling and loss of joint function as well as weakness, weight loss, fever, and fatigue, per the Centers for Disease Control and Prevention—oftentimes come and go, as the disease exists in periods of flaring and remission.

While there is no cure for RA, ongoing monitoring and an effective treatment plan, including medications like disease-modifying antirheumatic drugs (DMARDs) and biological response modifiers (BRMs, aka immunotherapy) paired with pain reducing self-management practices, can result in periods of remission for sufferers with low to no disease activity. 

While specific causes of RA are unknown, there are a variety of risk factors, including age, sex, genetics, smoking, and obesity.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

The image, which is actually an X-ray of a 69-year-old woman's hands, was published Wednesday in a case report in the New England Journal of Medicine. The woman, who had been diagnosed with rheumatoid arthritis (RA) 18 years earlier, presented to a rheutmatology clinic for the treatment of severe joint deformities, per the case report. Her elbows, wrists, knees, and left ankle were all swollen, and she'd lost her ability to make a fist with her hands due to her condition.

The woman also presented with a phenomenon called "telescoping fingers," which is a consequence of "bone resorption," or the breakdown of bone in the body on a cellular level. This ultimately causes bones in the hand to become shorter and instable, which can also lead to the collapse of the soft tissue of the fingers. The case report says this patient did, in fact, present with shortened fingers.

While doctors were able to reduce the amount of pain the patient’s RA caused her (by way of a combination of four different medications), the patient did not regain hand functionality.

telescoping-fingers-rheumatoid-arthritis

What is rheutmatoid arthritis?

About 1.5 million people in the United States have RA, according to the Arthritis Foundation. The autoimmune condition causes swelling, stiffness, pain, and loss of joint function, according to the U.S. National Library of Medicine (USNLM). More women than men live with rheumatoid arthritis, and it commonly strikes during middle age. Some people who have rheumatoid arthritis experience symptoms for only a short time, but severe cases can last for the duration of one’s life.

RELATED: How Rheumatoid Arthritis Differs From Osteoarthritis

Because RA is an autoimmune condition—which means its the result of the body's immune system attacking its own tissues—it doesn’t strictly affect the joints; it can affect the eyes, lungs, and mouth too.

According to the USNLM, it's still unknown what causes RA, but experts believe number of factors might contribute, including environment, hormones, and genes. Rheumatoid arthritis is treated via surgery, medicine, and lifestyle changes; these can reduce swelling and pain and halt joint damage, but there's currently no known cure for the condition.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

Don’t have time to watch? Read the full transcript:

RA is an autoimmune disease: The immune system attacks the joints and can cause heart, lung, and eye damage.

Young people, even children, can get RA: The average age of diagnosis is 30 to 50.

RA is not the same as osteoarthritis: Osteoarthritis happens as we age, due to wear and tear on the joints over time.

To prevent joint destruction, strong RA medications are needed: Some suppress the immune system and others relieve pain. They can have side effects…but also prevent joint damage.

RA is 3 times as common in women as men.

Proponents say that whole-body cryotherapy (WBC) not only supercharges metabolism, it's also an effective treatment for rheumatoid arthritis, asthma, depression, anxiety, migraines, fibromyalgia—the list goes on and on. The FDA’s response to those claims: Don't believe everything you read.

“Based on purported health benefits seen in many promotions for cryotherapy spas, consumers may incorrectly believe that the FDA has cleared or approved WBC devices as safe and effective to treat medical conditions,” said Aron Yustein, MD, a medical officer in the agency's Center for Devices and Radiological Health. "That is not the case."

The trouble is, there's no good research on what exactly happens inside the body in extreme temperatures. "We simply don't know," FDA scientific reviewer Anna Ghambaryan, MD, PhD, said in the statement. The risks of WBC, however, are clear. Aside from the obvious hazards (like frostbite, burns, and eye injuries), asphyxiation can occur when nitrogen vapors reduce the amount of oxygen in an enclosed room.

The agency's warning may not come as a surprise if you read the news last October about a woman who died of asphyxia in a cryotherapy chamber in Nevada. Her death raised questions about the growing and largely unregulated trend.

RELATED: 10 Bogus Health Trends That Waste Your Time

But the frigid cold isn't the only danger. The FDA noted that “patients who opt for WBC treatment—especially in place of treatment options with established safety and effectiveness—may experience a lack of improvement or a worsening of their medical conditions.” The agency urges anyone considering WBC to have a chat with their MD first.

Yes, it's possible to have the tiny joints in your fingers replaced with prostheses to ease the pain and suffering associated with arthritis. And although this type of surgery (known as arthroplasty) is still being perfected and is far less common for knuckles than for knees or hips, it can provide rapid relief to people whose hands are ailing.

"Patients are happy right off the bat," says Arnold-Peter Weiss, MD, a hand surgeon, professor of orthopedics, and associate dean of medicine at Brown University Medical School, in Providence, R.I. "It even surprises me."

The procedure is quick and relatively straightforward, but it's not appropriate for everybody and does carry a risk of complications and failure. Moreover, some experts argue that knuckle replacements have not been studied thoroughly enough to justify their widespread use in arthritis patients. Still, it's a viable option for people in severe pain.
More about arthritis

• Living With Rheumatoid Arthritis
• Medications That Treat Rheumatoid Arthritis
• Side Effects of Treatment for Rheumatoid Arthritis

Is knuckle replacement right for you?
Knuckle replacements have been around since the 1950s. In general, the surgery is used only in people with severe pain or lack of mobility. That typically means arthritis patients whose pain interferes with daily activities and people whose pain isn't alleviated by nonsurgical treatments like finger braces, splints, or anti-inflammatory medications such as Advil or Aleve.

Historically, knuckle replacement was most common in patients with rheumatoid arthritis (which can cause hand deformities), although the procedure is pretty evenly split now between RA and osteoarthritis patients, says Jay Bridgeman, MD, assistant professor of hand and microvascular surgery at the Penn State College of Medicine. Improvements in rheumatoid arthritis medications over the years have reduced the number of surgeries that are necessary, he explains.

The purpose of the surgery is to remove the damaged cartilage, tissue, and bone, and insert an artificial replacement joint in the remaining healthy bone. Although the new joint doesn't entirely restore mobility, it can almost completely eliminate pain and return the hands to their normal shape.

Dr. Weiss, who practices at Rhode Island Hospital, says he performs anywhere from one to three knuckle-replacement surgeries each month, usually on the knuckles at the base of the fingers (known as the metacarpophalangeal joints). Osteoarthritis patients typically get one or two of these joints done at once, while rheumatoid arthritis patients often have all four of them "go bad" at the same time, he says.

Next Page: Effectiveness is debated

[ pagebreak ]Nortin Hadler, MD, a rheumatologist and professor of medicine at the University of North Carolina at Chapel Hill, says he doesn't recommend the procedure to as many patients as he once did. "Now rheumatologists are more aggressive at treating the diseases—because we can be," he says. "The medications are better and the disease is milder—partly because of earlier diagnosis—and we are less enthusiastic about the surgery."

The effectiveness of knuckle replacement is a matter of ongoing debate among hand surgeons and rheumatologists. Surgeons, not surprisingly, are more likely to believe it's a worthwhile procedure. In a 2003 survey, 83% of hand surgeons said that knuckle replacement "always" or "usually" improves hand function, compared with just 34% of rheumatologists. Likewise, 92% of surgeons and 60% of rheumatologists replied that the surgery always or usually relieves pain.

What are the options?
Depending on the joint that needs to be repaired and the finger in which it is located, there are various options for treatment. These include a total knuckle replacement, fusing the existing joint together (known as arthrodesis), or cleaning away damaged cartilage and bone.

The small knuckles at the tip of the finger aren't usually replaced, as studies have shown that failure and poor longevity can be a problem with this joint. Fusion is typically effective at relieving pain in these knuckles, though it does not restore mobility, Dr. Bridgeman says.

By contrast, the middle knuckles are usually replaced, particularly those on the ring and middle finger, which need to retain flexibility for gripping. (The exception is the middle knuckle on the index finger. Fusion is generally preferred because this joint gets heavy use and prosthetics tend to wear out too quickly.)

The bottom knuckles, where the fingers meet the hand, are the largest and are almost always replaced, especially in rheumatoid arthritis patients.

Several types of replacement knuckles exist. The most widely used versions—including a model patented by Dr. Weiss—are made from flexible silicone rubber and act like spacers between the remaining healthy bones. Although these implants allow flexibility, they tend to break and slip.

To avoid these complications, researchers are trying to make better metal-and-plastic replacement joints that work like a ball-and-socket—like most prosthetic knees and hips—so they fit in the joint more tightly.

Regardless of which knuckle is being replaced or what device is used, the surgery is a quick outpatient procedure. Each knuckle takes about 30 minutes, Dr. Weiss estimates. The procedure is covered by Medicare, which reimburses doctors about $600 per joint, although the full cost of the procedure may vary widely.
Next Page: Recovery time

[ pagebreak ]Recovery time
The procedure carries a small possibility of complications. As with any surgery, there is a slight risk of infection, and cases of enlarged lymph nodes (lymphadenopathy) have been reported.

In most cases, patients typically feel about 90% better almost immediately, Dr. Weiss says. But Dr. Hadler says that the recovery is neither simple nor brief.

After surgery, patients are required to undergo physical therapy, which can last anywhere from six to 12 weeks. Rheumatoid arthritis patients tend to need more rehab than those with osteoarthritis, because they usually also have to work on problems in their shoulders and elbows, Dr. Weiss says.

During that time they gradually regain their strength and mobility. Patients are in a splint for the first few weeks, and after that they wear the splint only at night and use the hand normally during the day.

The surgery is very effective at reducing pain, Dr. Bridgeman says, but most patients lose range of motion in the joint over time.

There is also a small risk of damage to the implant. Up to 30% of replacement knuckles break, although some studies have found higher rates of fracture.

If that doesn't happen, knuckle implants—like artificial knees—tend to break down after about 10 to 15 years, at which point the finger begins to feel unstable and wobbly, Dr. Weiss says. Five to 10 years after surgery, some patients experience stiffness, joint breakage or dislocation, and recurrent pain.

The number of people potentially needing knuckle replacement surgery could rise in the coming years as more Baby Boomers are afflicted with osteoarthritis—a disease that occurs as we age. But Dr. Hadler says he and other doctors would be wise to help patients improve their joints and work around problems in lieu of having surgery.

"The goal is make it so our patients don't need the surgery in the first place," he says. "I would rather we have them use large pens and get different doorknobs [that are easier to grip] than have surgery."