Rheumatoid Arthritis Explained

Released Sept. 29, 2026 

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Stacy Courtney: Welcome to the Live Yes! With Arthritis podcast. My name is Stacy Courtney, and I am your host for today's episode, which is all things rheumatoid arthritis. In today's episode, we're going to talk about rheumatoid arthritis, or RA, as it is often called. And this is a topic near and dear to my heart, as I have been living with rheumatoid arthritis for about 25 years now. And I do feel like it is a very misunderstood chronic disease, so I'm excited to talk all things rheumatoid arthritis today. Rheumatoid arthritis is a chronic autoimmune disease that often affects more than just the joints. RA is just one of more than 100 different types of arthritis. Today, we're going to explore and explain rheumatoid arthritis, what causes it, how does it affect the joints and other parts of the body, how is it treated and what you can do to help manage it, and much, much more. 

To help us today, I am pleased to be joined by Dr. Susan M. Goodman. She is an attending rheumatologist at the Hospital for Special Surgery and professor of clinical medicine at Weil Cornell Medicine. She is director of rheumatology and Orthopedic Center of Excellence and medical chief and research director of the combined arthritis program called CAP, with a research interest in outcomes and risk mitigation for rheumatic disease patients undergoing orthopedic surgery. She has been instrumental in the development of a transitional research program, building on the relationships developed with orthopedics through CAP research, utilizing tissues routinely excised at the time of arthroplasty to investigate the biology and immunology of rheumatoid arthritis. That was a mouthful, Dr. Goldman. (laughs) So, welcome to the podcast, and quite a résumé you have there, but if you'd like to tell us a little bit more about yourself, and thank you again for joining us today. 

Dr. Susan M. Goodman: Well, thanks for that introduction, Stacy. It's really great to be here with you. And one of the reasons I really like working with the Arthritis Foundation is we frequently work with patient partners, and that keeps things focused on what's really important. 

Stacy Courtney: What is rheumatoid arthritis, or RA, exactly? 

Dr. Susan M. Goodman: RA is the most common autoimmune disease, and it's a form of inflammatory arthritis. The predominant symptom affects the joints, but as you mentioned, it really is a systemic illness. The textbook finding is a symmetric, small and large joint persistent polyarthritis. But many patients present with one joint, a more limited form, and some patients have a much more aggressive form. So, it's a real spectrum of findings. And I think one of the most important things to think about is how it really does affect everything. In fact, if you look at patients before their RA diagnosis, you'll find they've frequently been missing work. They don't have joint complaints per se, but they have fatigue or they lack energy or they feel a little feverish, and that can go on for a year before a formal RA diagnosis. So clearly, the manifestations of systemic inflammation, fever, fatigue, lack of concentration, then become overpowered by the joint pain and swelling, but they're clearly an integral part of the illness. 

Stacy Courtney: And so, I think it's often misunderstood how rheumatoid arthritis is different than osteoarthritis. And everybody calls osteoarthritis the old person type of arthritis. Can you tell me the differences between the two? 

Dr. Susan M. Goodman: You know, the more we study osteoarthritis… It used to be very simple. We knew very little about osteoarthritis, and we didn't know that much about rheumatoid arthritis. So, we very simply would say, "Well, osteoarthritis is the old people's arthritis. It's a wear-and-tear disease. Rheumatoid arthritis is caused by inflammation." Turns out there's probably a fairly significant overlap between them. However, there are major features that differ, and those have to do with the nature of the cells that mediate the inflammation. So, they're very different between rheumatoid arthritis and osteoarthritis, even though there can be a lot of inflammation within an osteoarthritic joint as well. 

Stacy Courtney: Who gets rheumatoid arthritis? How common is it? I think the bigger question, too, is what causes rheumatoid arthritis? 

Dr. Susan M. Goodman: Well, the what causes question we'll leave for, well, probably 20 years from now, but we'll take a stab at it. Who gets it is easier to answer: 1% of the population gets rheumatoid arthritis. That contrasts with close to 30% to 50% of the population over the age of 50 who develop osteoarthritis. Rheumatoid arthritis is a combination of a genetic disease and an environmental disease. So, in the genetically predisposed person, if they're exposed to something else, the things that we know about are things like: Smoking is a great stimulant of RA, autoimmunity; periodontitis. People don't realize how important it is to see their dentist. That's a huge risk factor, both for onset of RA, as well as flares in patients who have established disease. The other things that we know about are things like: Obesity is a risk factor. 

And interestingly for RA, modest, small amounts of alcohol intake seem to be protective. You can contrast that with osteoarthritis, and the majority of cases are linked to some sort of repetitive trauma, whether it's the impact on the weight-bearing joints with obesity or sports-related injuries. Some sort of traumatic or repetitive stress events is frequently linked to the development of osteoarthritis, but there's a quite strong genetic component to that as well. 

Stacy Courtney: And going back to your comment about seeing your dentist and oral care, I have never heard that that's a risk factor for rheumatoid. 

Dr. Susan M. Goodman: Yeah, it's a very, very strong risk factor. One of the things that is linked to oral hygiene is citrullination of proteins. And that's a process that can take place within dental infections or periodontitis. It's an enzyme that can be activated in that manner. So, it's a very important link. One of the interesting studies that a colleague of mine published had to do with dental infections and flares, the bacteria that get released into the bloodstream with dental infections and flares of rheumatoid arthritis. So, it's a very, very tight link, actually. 

Stacy Courtney: Very interesting. So, rheumatoid arthritis, it does not just affect your joints. It can affect your organs, your skin, your eyes, your heart. Can you elaborate a little bit more on that and how it can affect different organs? 

Dr. Susan M. Goodman: I think the first thing I'd like to say, just because what you've mentioned really can be pretty frightening to our audience. I would say 99% of those complications can be mitigated by therapy. Yes, rheumatoid arthritis can affect really every tissue in the body. When the eyes are affected, it can be both through inflammation of various layers of the eye, the back of the eye, the retina, as well as the front of the eye. There can be associated dry eye syndrome or Sjögren's syndrome with rheumatoid arthritis commonly co-occur. And that can lead to both the irritation and the annoyance of constant dryness of the eyes, but also infections and injuries to the cornea, because your normal repair process can fail to work. That can also affect the mouth: The oral mucus membranes can also become dry with Sjögren's, leading to more dental infections and a vicious cycle. 

Heart disease is significantly increased in patients with poorly controlled inflammatory diseases of all sorts. Rheumatoid arthritis is one of the more common. It's very clear that in the setting of active inflammation, the blood vessels get stiffer, the blood pressure can increase and the development of heart disease is much more common. The good news is some of our traditional disease-modifying drugs can reverse that. Patients are always concerned about drug side effects. I'd like everyone to be more cognizant of the number of things — not just joint pain, which can be pretty bad in and of itself when it limits your daily activities, but all of the other systemic manifestations of RA that can also be decreased or eliminated with normalization through therapy. 

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Stacy Courtney: How is it diagnosed? If somebody is having symptoms, what type of doctor do you go to? What type of tests are run? What type of markers are they looking for to diagnose rheumatoid arthritis? 

Dr. Susan M. Goodman: The most important thing in a diagnosis of rheumatoid arthritis is really the clinical picture. It's a symmetric small and large joint arthritis. Inflammation of the joints has to persist for more than six weeks. In addition, evidence of inflammation through blood tests, like the CRP or ESR, as well as tests for both the rheumatoid factor, as well as the CCP antibody can be used to also contribute to the diagnosis. 

Stacy Courtney: I've often encountered other rheumatoid patients who say that it just takes so long to get diagnosed. How do you expedite the process of being diagnosed? It's a degenerative, progressive chronic disease, so you want to be diagnosed as quick as possible, and sometimes that does not happen. 

Dr. Susan M. Goodman: That's such a good point, because it's clear that the more quickly you gain control of the disease, the more likely you are to be in better shape five years down the road. So, what you do within the first year of disease really does matter. One of the problems we get into is that many of our medical practitioners aren't really trained to do a good joint exam. So, for a rheumatologist to assess the number of tender and swollen joints is what we do, but many people can't. And about 30% of patients with rheumatoid arthritis will have normal lab work. If the patient comes in with complaints, even if they do have swollen and tender joints on exam, that may be missed. If the labs are also normal, that's the patient that slides under the radar and their diagnosis is delayed. The presence or absence of a rheumatoid factor or CCP isn't necessary for the diagnosis. There's a fairly high percentage of our patients who have normal labs. 

Stacy Courtney: I would say I would be one of those patients, too. I mean, there were sometimes where I could barely walk into my rheumatologist's office and I'm so swollen and I can't pick up a cup, but then my labs come back normal. And then you're like…  

Dr. Susan M. Goodman: Exactly. 

Stacy Courtney: It just doesn't make sense. Hopefully, you find a rheumatologist that treats more your symptoms, not just your lab work, because those can be misleading a lot of times. 

Dr. Susan M. Goodman: I always tell patients that we get the labs once we've made our diagnosis, really to look for side effects of the medications, not to confirm what the patient's already told us. I think the patient-reported outcomes just have become such an integral part of our disease management, and they're far more helpful than blood work, other than to monitor medications. 

Stacy Courtney: So, how do we treat rheumatoid arthritis? When I was diagnosed about 25 years ago, biologics were just becoming more popular, but there wasn't a lot of research on long-term effects. I know methotrexate was kind of the gold standard for a long time and still is, I think, for many patients. But was it liquid gold that was used back in the day? We've just made such strides in the medications that we have today. And I feel very fortunate. Had I not had a biologic 20-some years ago, I would probably be in a wheelchair. Do you want to talk maybe a little bit about methotrexate, and then maybe some of the other biologics and how they work to treat the disease? 

Dr. Susan M. Goodman: Methotrexate is our anchor drug in the treatment of rheumatoid arthritis. And the reason that it is, is that it's very effective. About 50% of patients don't need anything in addition to methotrexate. It can be plenty. It can be really an adequate treatment to control the signs and symptoms of RA. It's a drug that works through multiple mechanisms, but it clearly protects cartilage, which is obviously one of the main targets, and it clearly diminishes all of the downstream effects like cardiovascular disease or inflammation. You can see in studies that have been performed with the initiation of methotrexate: Blood pressure comes down, pulse comes down, all of the things that you wouldn't necessarily think to associate with active rheumatoid arthritis clearly melt away as the joint pain and swelling melts away. 

Although it's a good thing that 50% of patients respond to methotrexate, that means 50% of patients don't. And that can be for many reasons. One can be the potential for toxicity. We know that liver toxicity is a problem, and I think one of the reasons the biologics have taken an even larger share of our patient treatment programs is that the toxicity of methotrexate, the risk factors, drinking heavily can increase the risk of toxicity, particularly liver disease, but more importantly, elevated BMI, obesity, fatty liver, those are the things that really increase the potential for liver toxicity. And as the population has become increasingly overweight, methotrexate use — we used to think in terms of alcohol as being the major risk factor for liver toxicity, it clearly isn't — obesity, diabetes, fatty liver, metabolic syndrome, all of those are what contribute more significantly to toxicity. So, 50% of patients won't benefit for many reasons: Either they can't tolerate or their disease is refractory to methotrexate. 

And if the patient has failed to respond to the traditional DMARDs, disease-modifying anti-rheumatic drugs, then we go to biologics or targeted therapies. Those are the drugs that most of our patients have heard about from television. They're game-changers. One, because they work very, very quickly for the most part. The TNF inhibitors can work almost overnight. That's probably more a central effect than a peripheral effect, but that's OK. Patients feel better quickly, which is what everyone wants. But they're also highly specific for the chemicals that stimulate inflammation. 

Stacy Courtney: I feel like biologics were life-changing for me. There's always new biologics coming out — better, safer, more effective biologics. And I just tell people: Don't give up hope, because there's so many options. I hope that everybody finds something that works who's listening and dealing with arthritis. I know there are also side effects to some of these drugs, and that's something that I did struggle with about taking a biologic and the potential for, you know, harmful side effects. But the benefit definitely outweighs the risk in my quality of life. 

Dr. Susan M. Goodman: That's absolutely true. Each individual decides where they're comfortable on the risk-benefit spectrum. But the major problem with the biologics is the risk of infection. We had a lot of problems during the pandemic, of course, when patients were not willing to do anything that would increase their risk of infection. And we saw a lot of people have a lot of problems related to autoimmune disease as they came off their biologics. That's fortunately history now. There are risks with each of the different drug classes, but the major risk is infection. Most of the other things that people worry about are actually less of a risk once the disease is controlled. It's that uncontrolled inflammation that really is what is a problem for patients and what's the problem for the extra articular disease that so many of the patients develop. 

Stacy Courtney: We often hear about disparities in chronic conditions like rheumatoid arthritis and how it affects different populations. Can you speak to that? 

Dr. Susan M. Goodman: We spoke briefly about delays in diagnosis and delays in initiating therapy, and we know that that's tightly linked to socioeconomics. So, there's no question that patients from a poor socioeconomic background have more of a delay in diagnosis and more of a delay in the initiation of targeted therapies. It is a problem with so much else in our society that there are real disparities in care. 

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Stacy Courtney: We talk a lot about mental health with any chronic illness. But specifically to rheumatoid arthritis, how can RA and its related conditions affect one's mental health? 

Dr. Susan M. Goodman: The really obvious relationship is in what happens when a young, healthy person — and I'm sure this rings a bell — is suddenly not capable of doing the things that they just assumed they would do during the course of a normal day. I think the thought of being dependent on other people and not capable of carrying out your own activities of daily living, you see grown adults who just start crying when they talk about having to get someone to button their shirt. It's just so hard for them to deal with. And you have responsibilities. You're a young adult, you're trying to take care of your family or start a family, you're trying to advance your career and you can barely get to work and focus. I think the good news now is that our treatments are better and they're also faster. 

What I've seen is that depression is very common. The patients who get RA, get diagnosed, get on a treatment that's effective, kind of go on with their life and don't look back. Maybe 30% to 40% of patients aren't that, and they do need adjustments to their medications. They do have flares. The flares can be somewhat unpredictable. And I think that's a really wearing way to live. That makes people understandably anxious, depressed. The fatigue that goes along with it is a big part of it. And then, of course, the effect of chronic pain. The primary manifestation of RA is pain. So, you've now taken someone who was living a dynamic life, they now have chronic pain. They're too tired to do what they set out to do, and they don't feel like they can fulfill their own obligations. So yeah, it's a tough disease to live with. However, there's so many ways now we can both get the disease under better control but also treat the downstream manifestations. In my professional lifetime of treating RA, the difference has been dramatic. And hopefully will continue to be dramatic. 

Stacy Courtney: Everything you said rings so true to me as well. I mean, 25 years ago, you know, fresh out of college, had got my first job, got married, and then I just felt like my body failed me, and then you question, "What did I do to get this?" And then, people say, they talk about what supplements and diets you can do, because it must be something that you're not doing that's caused it. Making me feel like I had done something wrong to cause this. That affected my mental health negatively, because I thought it was something that I was doing wrong. 

Dr. Susan M. Goodman: It's a huge unnecessary burden. I completely agree. And it takes a bad situation and makes that patient feel much worse. It's a disease. Yes, there are things you could do to take care of your health, obviously, but it's not something that you bring on yourself. There's a huge genetic component. 

Stacy Courtney: Let's talk about self-care, and obviously it's important with any chronic illness, but especially with rheumatoid arthritis. So, what can somebody do to help manage their condition? Obviously keep your weight in check. Eating healthy. What are some other things that people can do to help manage their symptoms? 

Dr. Susan M. Goodman: The best healthy eating regimen that consistently shows significant benefits is the Mediterranean diet. And that's not a terribly rigorous, restrictive diet. It's a common-sense diet. And that has been shown to improve inflammatory conditions. The other thing that's as important is maintaining a healthy life through weight control and exercise. And the exercise is very important. If your joints are the weak link and you also let your muscles and bones get weak, you're in much worse shape. You really can compensate for bad knees, for instance, by having really strong thighs (laughs), and you keep the impact down. If you exercise on a stationary bike instead of going for a run, the impact and the blows to the knees obviously decreases and obviously weight also contributes to that. 

A simple diet is a Mediterranean-type diet, nothing extreme. The really restrictive diets haven't been shown to be that effective. So, there's no reason to feel guilty because you haven't created this ridiculously restricted diet. Exercise. Also, the obviously important things for so many reasons: Go to the dentist and stop smoking. (laughter) That will really go a long ways. 

Stacy Courtney: Do you recommend any type of supplements for your patients to help manage symptoms? 

Dr. Susan M. Goodman: 

No, I don't. Most people get a good diet. Some people do need calcium or vitamin D, and obviously folic acid if you're taking methotrexate. But other than that, no, I don't routinely recommend supplements. 

PROMO: The Arthritis Foundation’s website offers access to expert resources and strategies for managing arthritis-related pain. Get guidance you can trust and comprehensive information about various pain management techniques and therapies. By using our resources, you’ll expand your understanding of pain relief options and be empowered to improve your quality of life. Visit arthritis.org/pain. 

Stacy Courtney: Before each episode, we post a question on social media, and for this episode we asked: "What's one thing you really wish you knew about rheumatoid arthritis when you were first diagnosed?" So, I'm going to read a few social media responses. We have Denise Evans, and she says, "I didn't know how bad the fatigue would be. Everyone knows how it affects your joints, but I didn't realize the main issue for me would be the fatigue and how chronic it is." And I can completely relate to that comment. I have to have a daily nap. And I joked that it was a 47-minute nap (laughs) every afternoon to keep me going because the fatigue was so bad. And a lot of people don't realize that, going into it, because one, if you're in chronic pain, you're obviously going to be tired, but just the everyday fatigue and brain fog that goes along with it. And that also would affect my mental health, too. So, Dr. Goodman, why do you have so much fatigue with rheumatoid arthritis? 

Dr. Susan M. Goodman: Fatigue is a really complicated symptom for patients with RA, and it's probably caused differently for early onset disease and late onset disease. With early disease, it does seem very closely linked to inflammation, and there's a clear response in someone within the first year of onset with the initiation of effective therapy. You see both a decrease in inflammatory markers and a decrease in fatigue. In late disease, that's not true. Fatigue seems multifactorial. And although there still is a component that relates directly to inflammation, there are also other aspects to fatigue, like depression and chronic pain, plus some other things that we probably don't know about. But fatigue in late disease is very different than fatigue in early disease. What that also means, unfortunately, is there's no simple answer as to how to deal with it from a medical standpoint. 

Stacy Courtney: Right. Kira Colleen says, “Stress increases your pain level.” If you can control your stress, then definitely your pain is going to be decreased. Kim Crane says that, “You should see a rheumatologist straight away. General practitioners don’t know enough regarding RA to treat it properly. Handing out strong painkillers does not help the situation. It is simply covering it up, not solving it.” 

Dr. Susan M. Goodman: It's a huge problem, and I'm not sure what the solution is. I think patient outreach and education within the community, such as programs like this, can help make people more aware. 

Stacy Courtney: The next user, Anna Droge, says, "Community is just as important as medication. Medication will eventually need to be switched up or fail but having community support on the good and bad days makes it all much more bearable." And that is exactly what you just said as well. Education, community, the Arthritis Foundation — you are with people who are in your same situation. You can lean on each other on your bad days and then celebrate your good days. The Arthritis Foundation has been such a huge blessing in my life. And so, I encourage anybody who's listening to our podcast today to definitely get involved with us, because we're all here for you, to support you, because it's a life-changing diagnosis. 

Dr. Susan M. Goodman: As you're saying, Stacy, it's so important that people know they're not the only one who feels this way. And a young person who's developed — or an older person who develops — rheumatoid arthritis, it's a pretty overwhelming event. It's just so important that someone who's recently gotten a diagnosis of RA knows that people have gotten through it, have gone on to successful lives. Maybe it's a 47-minute nap. Everybody finds a way to cope and continue to be a productive participant in their own life. It's good to know that other people have found other ways that help them deal with this. 

Stacy Courtney: Yes. Fiona Robertson says, "Although RA did completely change my life, it wasn't all for the worst. I've experienced some wonderful things, and wonderful people have come into my life because of my diagnosis. I've allowed myself time to grieve for things that I've lost, but I keep looking forward to a great life that is still out there, and I'm going to choose to go and find it." So, thank you for everybody who responded on social media. So, Dr. Goodman, if you want to offer our listeners the top three things that you would want them to know about rheumatoid arthritis. 

Dr. Susan M. Goodman: Number one, rheumatoid arthritis is now a treatable disease. Number two, for those patients who are diagnosed early, the likelihood of achieving remission is pretty good these days. We have really effective medications. And number three, there's a great community out there you can tap into through the Arthritis Foundation. And you can get help and get guidance in finding the support you need. 

Stacy Courtney: Excellent. I would say my top three takeaways are, one, I learned about the dentist and how important that is. I do go to the dentist every six months, but I did not know that it was a risk factor for rheumatoid arthritis. Secondly, I just want people to know that it's not something that you have done. Like you said, there is a genetic and environmental component to this disease, and it's not something that you've done or not done to have this illness. And number three, get involved with the Arthritis Foundation because it is a huge community of support. It was life-changing for me to get involved, and now I feel lucky to be able to help others and hopefully inspire people, because there's so many treatments out there. And I just want everybody to be as fortunate as I have been with finally finding the biologic that's worked for me. 

I always say that, with the Foundation, we're raising money to pour into research, so we can find better, safer, more effective treatments. So, Dr. Goodman, thank you so much for joining us. You have been wonderful to chat with. I want to thank our listeners. And for more arthritis resources, including information about rheumatoid arthritis, you can visit the Arthritis Foundation website at arthritis.org. And you can send your questions, comments and thoughts to [email protected]. We'll see you all next time. 

Dr. Susan M. Goodman: Thanks for having me. It's been great being here with you, Stacy. 

Stacy Courtney: Thank you. 

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