Rheumatoid arthritis is a serious autoimmune disease that attacks the joints and other body parts. But RA can be tough to diagnose. Symptoms can mimic other illnesses, or they may flare, then fade, only to flare again somewhere else. Lab tests aren’t perfect—you can test negative for RA factors and still have it. And X-rays don’t show signs until later on. Here are some tricky rheumatoid arthritis symptoms and hints that they’re due to RA and not some other condition.

 

The main symptoms of rheumatoid arthritis are joint pain, swelling and stiffness. It may also cause more general symptoms, and inflammation in other parts of the body.

The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days.

The symptoms vary from person to person. They can come and go, and may change over time. You may occasionally experience flares when your condition deteriorates and your symptoms become more severe.

Symptoms affecting the joints

Rheumatoid arthritis mainly affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.

Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this isn’t always the case.

The main symptoms affecting the joints are outlined below.

Pain

The joint pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.

Stiffness

Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist.

Like joint pain, the stiffness is often more severe in the morning or after a period of inactivity. Morning stiffness associated with another type of arthritis called osteoarthritis usually wears off within 30 minutes of getting up, but rheumatoid arthritis morning stiffness often lasts longer than this.

Swelling, warmth and redness

The lining of joints affected by rheumatoid arthritis become inflamed, which can cause the joints to swell, and become hot and tender to touch.

In some people, firm swellings called rheumatoid nodules can also develop under the skin around affected joints.

Additional symptoms

As well as problems affecting the joints, some people with rheumatoid arthritis experience a range of more general symptoms, such as:

tiredness and a lack of energy

a high temperature (fever)

sweating

a poor appetite

weight loss

The inflammation associated with rheumatoid arthritis can also sometimes cause problems affecting other areas of the body, such as:

dry eyes – if the eyes are affected

chest pain – if the heart or lungs are affected

“Drinking milk or eating beef could cause rheumatoid arthritis, scientists warn,” reports the Mail Online. However, the story is more complicated than the headline suggests.

Researchers investigated genetic mutations in the blood cells of people with rheumatoid arthritis. They believe that mutations to a gene that regulates the immune system may “take off the brakes”, so that the body mounts an over-the-top immune response which causes inflammation and damages joints and tissues.

They also tested people’s blood for DNA from Mycobacterium avium subspecies paratuberculosis bacteria, known as MAP. Researchers have linked MAP to other conditions related to immune function (auto-immune diseases) including Crohn’s disease. MAP is common in cattle in the US and can be found in contaminated dairy or meat products from infected cows.

Researchers found people with rheumatoid arthritis were more likely to have mutations in the gene in question than healthy people, and they were more likely to have traces of MAP DNA. When tested, immune cells showed a “hyperactive” response to MAP infection. This didn’t happen in cells that had no gene mutations.

The researchers theorise that MAP bacteria may trigger rheumatoid arthritis in people who have genetic mutations. However, that doesn’t mean MAP causes the disease. At this stage it’s just a link worthy of further study.

It’s still not clear what causes rheumatoid arthritis, but inherited genes and cigarette smoking are most strongly linked to the disease.

You may have your own personal reasons for not drinking milk or eating beef. But this study does not provide any evidence that avoiding them could prevent rheumatoid arthritis.

Where did the story come from?

The study was carried out by researchers from the University of Central Florida. It was funded by a Crohn’s Disease Grant from the State of Florida. It was published in the peer reviewed journal Frontiers in Cellular and Infective Microbiology.

Despite its misleading headline, the Mail Online did go on to explain the genetic side of the study, and that only people with these genetic mutations could be at risk of rheumatoid arthritis triggered by MAP (though as stated above, this link isn’t established).

What kind of research was this?

This was genetic analysis of blood samples carried out in the laboratory. It builds on the background that two inflammatory diseases – Crohn’s and rheumatoid arthritis – share common features. They’re both autoimmune diseases (where the immune system attacks the body’s own tissue), they both have genetic links, and are treated with similar drugs. Past study has linked MAP with Crohn’s, therefore the researchers were interested in seeing whether they may share common triggers.

This type of research is helpful in developing early understanding of possible disease pathways and causes of disease. It can sometimes pave the way for future research that may lead to new treatments or prevention.

However, this is a long way off and this stage of research can demonstrate links only – not show whether one factor causes another.

What did the research involve?

Researchers took blood samples from 132 people, 72 of them with rheumatoid arthritis and the remainder without the condition. The blood samples were tested for:

9 mutations to a gene affecting immune system regulation, called PTPN2/22 (previous research has linked mutations in this gene to rheumatoid arthritis)

presence of MAP DNA

behaviour of immune system T-cells when exposed to purified MAP protein

Researchers then analysed the results to look at:

whether people with rheumatoid arthritis were more likely to have mutations to PTPN2/22 than people without rheumatoid arthritis

whether blood from people with genetic mutations was more likely to have traces of MAP DNA

how blood cells from different groups reacted to infection

What were the basic results?

Researchers found that mutations in PTPN2/22 were far more common in people with rheumatoid arthritis than people without:

One type of mutation was present in 78.6% of people with rheumatoid arthritis and 60% of people without (odds ratio (OR)2.28,95% confidence interval (CI) 1.05 to 4.93)

They also found MAP DNA was more common among people with rheumatoid arthritis:

34.3% of people with rheumatoid arthritis had traces of MAP DNA compared to 8.3% of people without rheumatoid arthritis (OR 5.74, 95% CI 1.84 to 17.9)

Blood from people who had genetic mutations was more likely to show a raised T-cell immune response. T-cells are white blood cells (lymphocytes) that recognise abnormal cells or substances and trigger an immune response to destroy them. There was a 7-fold increase in T-cell activity in blood from people with rheumatoid arthritis and with 2 types of mutations, when the cells were exposed to MAP purified protein, compared to a 3.4-fold increase in T-cell activity in blood from people with rheumatoid arthritis but no mutations.

How did the researchers interpret the results?

The lead researcher said in a press release: “We believe that individuals born with this genetic mutation and who are later exposed to MAP through consuming contaminated milk or meat from infected cattle are at a higher risk of developing rheumatoid arthritis.”

He continued: “We need to find out why MAP is more predominant in these patients – whether it’s present because they have RA [rheumatoid arthritis], or whether it caused RA in these patients. If we find that out, then we can target treatment toward the MAP bacteria.”

Conclusion

This is a technical, early-stage study that focused on DNA mutations in genes that regulate the immune system. The study found that people with rheumatoid arthritis were more likely to have these mutations, and to have traces of MAP bacteria DNA. However, that doesn’t mean MAP caused rheumatoid arthritis, or that people should worry about eating meat or dairy products.

Rheumatoid arthritis is a complex and largely unexplained disease in which the over-active immune system damages the body’s joints (and sometimes other organs), causing pain and malformation. There is no cure, and the disease can affect people to varying degrees of severity and disability. Many people need to take a combination of drugs to control symptoms, some of which have side effects, alongside different physical therapies. Better understanding of what causes this disease, and possibly new treatments, would be very welcome.

The research goes some way to improving our understanding of rheumatoid arthritis and suggests new routes for researchers to follow.

At this stage there are some limitations to bear in mind. The study does not show that MAP caused rheumatoid arthritis – not everyone with the condition had MAP DNA, and some people without rheumatoid arthritis had MAP DNA. It also does not tell us whether people got MAP infection before or after they developed rheumatoid arthritis.

We also don’t know whether the MAP DNA indicated that people had active MAP infection, or whether the traces were from a previous infection that had been cured. The research doesn’t tell us the possible source of this infection.

A reported 50% of cows in the US are infected with MAP, but we don’t know if that’s the case in the UK and shouldn’t assume that beef and dairy products are contaminated or carry risk to the public.