What rheumatoid arthritis actually is.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases describes rheumatoid arthritis (RA) as a chronic autoimmune disease that mostly affects joints. The immune system turns on the lining of the joint and damages the tissue covering the ends of the bones, which produces pain, swelling, stiffness, and loss of function.
That mechanism is what separates RA from the wear-and-tear arthritis many people picture. It also explains why RA does not stay in one place: NIAMS notes it can cause medical problems outside the joints, in areas such as the heart, lungs, blood, nerves, eyes, and skin.
Nobody can point to a single cause. NIAMS attributes RA to a combination of genes and environmental exposures, lists age, family history, smoking, and obesity among the risk factors, and notes it affects two to three times as many women as men.
What people tend to notice first.
RA often shows up on both sides at once — if one wrist or hand is involved, its partner frequently is too. Wrists, hands, and feet are the joints most commonly affected. Morning is usually the hardest part of the day: stiffness that lasts more than 30 minutes after waking is a recognized feature, and it can return after long stretches of sitting still.
Tiredness belongs on this list, not as a footnote. NIAMS lists fatigue — feeling unusually tired or having low energy — and occasional low-grade fever among RA's symptoms. None of this diagnoses you; plenty of conditions cause sore, stiff joints, and only an evaluation can sort out which one is yours.
- Note which joints hurt, and whether the same joint on the other side is involved.
- Time your morning stiffness — how long before you loosen up?
- Track fatigue separately from pain; they do not always rise and fall together.
- Write down anything outside the joints: eyes, skin, breathing, chest, numbness.
Pain, fatigue, and the mental fog people rarely get asked about.
Many people with RA say the fog is harder to explain than the pain — losing a word, rereading the same paragraph, planning a task and stalling partway through. A 2023 review in Immunity, Inflammation and Disease reports cognitive impairment measured across RA study groups at widely varying rates, and points to several possible contributors at once: inflammation and autoantibodies, chronic pain, depression, cardiovascular complications, and in some cases medication effects.
Honesty matters more than a tidy story here. That same review states plainly that there is still a lack of knowledge about the underlying processes, risk factors, and ideal treatment approaches. The Mayo Clinic Study of Aging found the risk of incident dementia was similar in participants with RA and matched participants without it, calling the cognitive differences it did observe small and of uncertain clinical significance.
The fog is real and worth raising with your clinician. What it means long-term is not settled, and anyone who tells you otherwise is ahead of the evidence.
How this gets evaluated — and who directs the care.
NIAMS describes diagnosis as a combination of medical history, physical examination, laboratory tests, and imaging. Rheumatologists are the specialists who focus on autoimmune diseases, arthritis, and other conditions of the bones, joints, and muscles.
Treatment is prescriber territory. Disease-modifying antirheumatic drugs (DMARDs) — including biologic response modifiers and JAK inhibitors — can slow or change how the disease progresses, and those decisions belong to the clinician who prescribes them. MedlinePlus states there is no cure for RA, but that early treatment can help you manage symptoms, reduce joint damage, and lead a productive life. Gates Brain Health does not treat rheumatoid arthritis, does not manage DMARDs, and is not a substitute for rheumatology care.
If you develop chest pain or new trouble breathing, treat it as urgent and get emergency help rather than waiting for a scheduled visit — RA-related inflammation can involve the heart and lungs.
Where this practice fits, and what to ask when you call.
Gates Brain Health is a functional neurology practice in Reno, Nevada. Dr. Randall Gates, D.C., DACNB is a board-certified chiropractic neurologist; he is not a medical doctor and does not replace your rheumatologist or primary care provider. People living with RA sometimes call about the neurological side of their experience while their rheumatology care continues. Whether this practice is a sensible fit for you is a question for a conversation, not a webpage.
The practice offers a free consultation before anyone becomes a patient. To ask about one, call (775) 507-2000, Monday through Friday, 8:00 AM to 5:00 PM. Please save your medical details for the phone call rather than sending them through the website.
- Given that I am already under a rheumatologist's care, what would you actually be doing?
- Which of my symptoms do you consider outside your scope?
- How would you communicate with the clinicians managing my medications?
- What would tell you that I am not a good fit here?