Rheumatoid Arthritis

 Rheumatoid Arthritis is a type of arthritis that is a chronic autoimmune disease.  It causes pain, swelling, decreased flexibility, stiffness and inflammation, primarily in the lining of joints (synovium) (Cleveland Clinic, 2024)(Mayo Clinic, 2025)((Henderson, 2023).  Joints that are typically affected include:

• joints in hands and fingers
• knees
• ankles
• feet 
• toes (Cleveland Clinic, 2024)(Henderson, 2023)

Both sides of the body are usually affected.  Other parts of the body can also be affected, including:

• eyes
• heart
• lungs
• skin (Cleveland Clinic, 2024)(Mayo Clinic, 2025)(Henderson, 2023)(Arthritis Foundation, 2021).

With Rheumatoid Arthritis being an autoimmune condition, the immune system within the body attacks the joints and organs.  This immunological attack causes the joint pain, swelling, changes in flexibility, and stiffness (American College of Rheumatology, 2026).  Currently, there is no cure for Rheumatoid Arthritis, therefore, diagnosing Rheumatoid Arthritis as early as possible can help to alleviate symptoms and prevent joint damage and/or disability.

There are two types of Rheumatoid Arthritis, seropositive and seronegative.

• Seropositive:  Two types of antibodies are present in the blood, anti-cyclic citullinated peptides (anti-CCPs) and rheumatoid factor (RF).  These antibodies cause the symptoms associated with Rheumatoid Arthritis.  One or both can be present in the blood and may be seen in blood tests as soon as five to ten years before the symptoms are present.
• Seronegative:  anti-CCPs and RF are not present.  Diagnosis is made through other means (Henderson, 2023)

There are several symptoms of Rheumatoid Arthritis.  There are periods of time where the symptoms are increased and more active.  This is referred to as a flare.  Periods of time will follow flares with decreased symptoms.  These periods are referred to as remission.  Symptoms include:

• joint pain
• joint swelling
• joint stiffness
• joint tenderness
• body stiffness - particularly in morning or after sitting
• fatigue
• weakness
• fever
• poor appetite
• rheumatoid nodules - firm lumps beneath skin (elbows and hands)
• anemia
• neck pain
• dry eyes
• dry mouth (Cleveland Clinic, 2024)(Mayo Clinic, 2025)(Henderson, 2023)

There are four stages that define the progression of Rheumatoid Arthritis.  

• Stage 1:  The earliest stage with joint inflammation characterized by joint pain and stiffness.
• Stage 2:  Inflammation causes cartilage damage in this stage.  Is characterized by joint stiffness and decreased range of motion.
• Stage 3:  Severe inflammation causing bone damage.  Characterized by more joint pain and stiffness and decreased range of motion.  Physical changes may appear.
• Stage 4:  inflammation does not increase but is characterized by severe pain, swelling, stiffness and loss of mobility (Cleveland Clinic, 2024).

Several risk factors increase the possibility of developing Rheumatoid Arthritis.  They include:

• Gender - women are at increased risk
• Age -  most often begins in middle age.  Referred to as Juvenile Idiopathic Arthritis when diagnosed in children.
• Family History - having a family member with Rheumatoid Arthritis or another autoimmune condition increases risk.
• Smoking - increases risk
• Periodontal disease - damages soft tissue in mouth and raises risk.
• Excess weight - increases risk.
• Genetics - variations in the human leukocyte antigen (HLA) gene increases risk.(Cleveland Clinic, 2024)(Mayo Clinic, 2025)

Several tests/exams can be performed in order to daignose Rheumatoid Arthritis, including:

• Physical exam
• Blood tests:
• Erythrocyte Sedimentation Rate (ESR) - indicates inflammation level
• C-Reactive Protien (CRP) - indicates inflammation level
• RF antibodies level
• anti - CCP antibodies level
• Imaging tests - Shows joint damage and inflammation
• X-rays
• Magnetic Resonance Imaging
  
• Ultrasound (Cleveland Clinic, 2024)(Mayo Clinic, 2025)

Treatments are available for Rheumatoid Arthritis.  If treatment is delayed, joint damage occurs.  Treatments include:

• Medications
• NSAIDs - relieves pain and swelling
• steroids - eases inflammation and pain, slows joint damage
• Conventional Disease Modifying Anti-Rheumatic Drug (DMARD) - slows progression of disease
• Biologic response modifiers - slows joint damage.  Works best when used with conventional DMARDs.
• Surgery - knee or hip replacements may restore function and decreases pain.
• Healthy diet
• Activity
• Hot and cold treatments
• Stress Management (Cleveland Clinic, 2024)(Mayo Clinic, 2025)(Arthritis Foundation, 2021)

There are complications that can result from Rheumatoid Arthritis.  These include:

• Osteoarthritis - both Rheumatoid Arthritis and medications used to treat can increase risk.
• Rhematoid nodules 
• Dry eyes and mouth -  Rheumatoid Arthritis can cause Secondary Sjogren's Sundrome which lowers moisture in eyes and mouth.
• Infections - Rheumatoid Arthritis and medications can harm immune system
• Carpal Tunnel Syndrome - Rheumatoid Arthritis affects wrists causing swelling that can press on nerves.
• Heart problems -  Rheumatoid Arthritis can contribute to hardened or blocked arteries.
• Lung disease - Rheumatoid Arthritis can cause inflammation and scarring in lungs leading to shortness of breath.
• Lymphoma (Mayo Clinic, 2025)

American Colloge of Rheumatology. (2026)  Rheumatoid Arthritis.  American College of Rheumatology.  Retrieved from https://rheumatology.org/patients/rheumatoid-arthritis

Arthritis Foundation. (2021)  Rheumatoid Arthritis.  Arthritis Foundation.  Retrieved from https://www.arthritis.org/diseases/rheumatoid-arthritis

Cleveland Clinic. (2024)  Rheumatoid Arthritis.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis#overview

Henderson, J. (2023) Rheumatoid Arthritis: Types, Causes, Symptoms and Treatments.  BlackDoctor.org.  Retrieved from https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis#overview

Mayo Clinic. (2025)  Rheumatoid Arthritis.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648

Grave's Disease

Graves Disease is a condition that affects the thyroid.  The thyroid is a gland that produces hormones responsible for controlling metabolism, Thyroxine (T4) and Triiodothyronine (T3) (Medline Plus, 2024).  It is a small butterfly shaped gland and is located in the neck (Cleveland Clinic, Thyroid, 2026).   Graves Disease is a chronic, autoimmune condition that causes the thyroid to make too much thyroid hormone, Hyperthyroidism (Medline Plus, 2024).  Graves Disease is more common among women, as well as individuals over 30 years old (Mayo Clinic, 2024).

Grave's Disease is caused by the immune system producing antibodies against the thyroid.  These antibodies cause the thyroid cells to work overtime causing them to overproduce and release thyroid hormones (Cleveland Clinic, 2026)(Mayo Clinic, 2024).

Because the overproduction of thyroid hormones affect all other  organ systems, the symptoms of  Graves Disease are widespread.  Symptoms include:

• Nervousness
• Irritability
• Slight tremor in fingers and hands
• Heat sensitivity
• Weight loss despite increased hunger
• Goiter - enlarged thyroid gland
• Menstrual changes
• Erectile dysfunction
• Decreased Libido
• Increased bowel movements
• Graves Opthalmopathy (Thyroid Eye Disease) - includes: bulging of eyes, double vision, gritty eyes, eye pain and pressure, photophobia - light sensitivity
• Grave's Dermopathy - thick discolored skin
• Fatigue
• Heart palpatations
• Insomnia
• Hair loss
• Dyspnea - shortness of breath
• Tachycardia - rapid heartbeat
• Muscle weakness (Medline Plus, 2024)(Mayo Clinic, 2024)(Cleveland Clinic, 2026),

There are several risk factors for Graves Disease.  Risk factors include:

• Family history - often family history of either thyroid conditions or autoimmune conditions raise risk of Graves Disease
• Sex - women are at increased risk
• Age - increased occurence between 30 - 60 years of age
• Other autoimmune conditions
• Smoking - increases risk
• Selenium and Vitamin deficiences (Medline Plus, 2024)(Mayo Clinic, 2024)(Cleveland Clinic, 2026).

Several exams/tests should/can be done in order to diagnose Grave's Disease.  Firstly, a physical exam, medical history and family history should be performed.  Tests that can be conducted in order to diagnose includes:

• Blood tests - Thyroid Stimulating Hormone (TSH), T3 and T4 levels.  TSH levels, produced by the pituitary gland, are lower, while T3 and T4 levels are higher.
• Radioactive iodine uptake - scan of thyroid after ingesting a small amount of radioactive iodine and shows the rate of iodine uptake by the thyroid.
• Thyroid antibody blood test
• Doppler Ultrasound - looks for increased blood flow in thyroid.  Can be used during pregnancy when Radioactive iodine uptake cannot be performed
• Orbit CT Scan (Medline Plus, 2024)(Mayo Clinic, 2024)(Cleveland Clinic, 2026).

Several treatments can be used for Grave's Disease.  Treatment can either stop hormone production in the thyroid or block the effect of the hormones within the body (Mayo Clinic, 2024).  Treatments include:

• Radioactive iodine therapy - destroys thyroid hormone producing cells causing them to shrink.  May increase risk of Thyroid Eye Disease.  Cannont be used with pregnant women.
• Anti-Thyroid medications - blocks iodine from being used by thyroid to produce hormone.
• Beta Blockers - block the effects of hormones within the body.  Cannot be used with individuals with asthma or diabetes. 
• Thyroidectomy - surgery where thyroid is removed.
• Treatments for Thyroid Eye Disease
• Corticosteroids - decreases inflammation behind eyeballs and delivered through vein.
• Teprotumumab (Tepezza) - delivered through IV every three weeks
• Prisms - used in eye glasses to correct for double vision.
• Orbital Decompression Surgery - orbit bone between the eye socket and orbital sinuses are removed increasing space for eyeballs to move into usual placement.  Used if pressure on optic nerve increases possibility of loss of vision.
• Orbital Radiotherapy - X-rays destroys some tissue behind eyes (Medline Plus, 2024)(Mayo Clinic, 2024)(Cleveland Clinic, 2026).

Complications may occur due to Grave's Disease.  If it is untreated or undermanaged, the likelihood of the complications occuring increases.  Complications od untreated Grave's Disease include:

• Pregancy concerns - miscarriage, premature delivery, fetal thyroid issues, poor fetal growth, heart failure in mother, pre-eclampsia
• Heart Conditions - irregular heart rhythms, heart failure
• Thyroid Storm - development of hyperthyroidism is accelerated and the sudden increase in thyroid hormones can cause fever, sweating, confusion, delirium, severe weakness, tremor, irregular heartbeat, severe low blood pressure, and coma.  Is a medical emergency.
• Brittle bones -  increased thyroid hormones makes it difficult for Calcium to move into the bones. (Medline Plus, 2024)(Mayo Clinic, 2024)(Cleveland Clinic, 2026)

For Grave's Disease resources, visit:

https://www.thyroid.org/graves-disease/

https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease

References

Cleveland Clinic (2026)  Grave's Disease.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/15244-graves-disease#diagnosis-and-tests

Cleveland Clinic (2026)  Thyroid.  Cleland Clinc.  Retrieved from https://my.clevelandclinic.org/health/body/23188-thyroid

Mayo Clinic. (2024)  Grave's Disease.  Mayo Clinic.   Retrieved from https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240

Medline Plus (2024) Grave's Disease.  Medline Plus.  Retrieve from https://medlineplus.gov/ency/article/000358.htm