Rheumatoid arthritis (RA) affects more women than men, and female hormones may play a role in the onset of the disease. The symptoms of RA are mostly the same for men and women, but there are key differences in when and why they first appear.

RA causes the joints to become inflamed, which can lead to a range of symptoms, such as pain and stiffness. These symptoms can affect many areas of the body.

RA affects every person differently, but it is common for the symptoms to come and go. People with this condition tend to experience flare-ups, when their symptoms are worse, and remissions, when the disease is more manageable.

It is not clear what causes RA, but there are environmental and genetic risk factors, which include being overweight and smoking. Hormonal factors are likely to contribute too as around 75% of people who have RA are women.

In this article, we look more closely at the symptoms of RA in women and explain how these may vary at different stages of life.

RA symptoms

Women tend to develop RA at a younger age than men, with symptoms typically appearing between the ages of 30 and 50.

The symptoms of RA can affect many different parts of the body. The most commonly affected areas include those below.

Joints

The main symptoms of RA include pain, aching, and stiffness in the joints. These typically begin in the smaller, peripheral joints in the body, such as those in the fingers and toes. RA is a symmetrical disease that affects both sides of the body.

It is common for many people's finger, toe, knee, ankle, or elbow joints to feel stiff, particularly at the start of the day. However, if the stiffness lasts for longer than 30 minutes, it may be an early symptom of RA.

Later-stage symptoms of RA include swelling and redness around the affected joints. The joints may feel tender to touch, and moving them may be challenging and painful.

Skin

Around 20% of women who have RA may develop rheumatoid nodules. These are firm, raised lumps underneath the skin.

Nodules often appear on areas of the body where there is pressure on the skin, such as the elbows.

Eyes and mouth

RA can cause the eyes and mouth to become dry and irritated. This irritation can also affect the gums, which may be more at risk of infection.

The disease can also lead to light sensitivity and vision changes.

Lungs and heart

The lungs can become inflamed or scarred in people with RA, which can lead to breathing difficulties. Inflammation can also affect the heart and blood vessels.

Inflammation around the heart can cause pain in the chest or fever, while inflamed blood vessels can damage the skin or organs.

Whole body

RA can cause other physical symptoms, such as weight loss, limited joint motion, and muscle weakness.

The disease can also have an impact on mental health and well-being. People with RA have a higher risk of fatigue and depression.

RA risk and hormone levels

In women, there is a link between hormones and the onset of RA. The authors of a 2017 review suggested that estrogen, progesterone, and androgens influence the development of RA.

However, hormones are complex, and their role in RA remains unclear. It seems that they may increase the risk of RA in some cases and decrease it in others.

The levels of different hormones in the body change throughout a woman's lifetime. Below, we consider how RA can affect various life events and vice versa.

Pregnancy

Women who have been pregnant are less likely to develop RA than those who have not. If a woman who has RA becomes pregnant, she may experience fewer symptoms of the disease during pregnancy.

Postpartum

Women have a higher risk of developing RA in the first year after giving birth. Experts believe that this may be due to the rapid change in hormone levels in the body at this time.

Breast-feeding

Breast-feeding for up to 1 year may decrease the risk of developing RA. However, experts remain divided on whether or not breast-feeding for more than 1 year increases the woman's risk of RA.

Menopause

Estrogen levels tend to decline after the age of 40. Women have a higher risk of developing RA after 40, and those who experience early menopause are also more at risk. RA that occurs after the menopause may progress more quickly.

Endometriosis

Endometriosis is a condition in which endometrial tissue is present in areas of the body other than the uterine cavity. Although female hormones stimulate the growth of this lining, the condition may also relate to the immune system.

Endometriosis can cause a range of symptoms, including pain and fertility problems. Women who have endometriosis may be more at risk of developing RA.

Polycystic ovary syndrome (PCOS)

PCOS affects hormone levels in the body and can cause irregular periods and fertility problems. PCOS may increase the risk of developing RA, but this possible causal link is complicated and requires additional research.

Anti-estrogen medication

Anti-estrogen medication can help treat infertility, breast cancer, and osteoporosis after menopause. Depending on the dosage, this medication may increase a woman's risk of developing RA.

When to see a doctor

Anyone who is experiencing symptoms of RA should see a doctor.

The doctor will usually complete an initial physical examination before making a referral to a rheumatologist. Rheumatologists specialize in diseases that affect the joints and connective tissue.

The rheumatologist will ask questions about the individual's medical history and symptoms.

They will usually examine the joints and may also order tests if necessary.

A blood test can measure inflammation and confirm the presence of specific antibodies. Imaging tests, such as an x-ray, can reveal any damage to the joints or inflammation in surrounding tissues.

Treatment

The primary aim of treatment for RA will usually be to prevent or reduce inflammation.

Controlling the inflammation in RA can lessen the chance of damage to joints or organs. If there are few or no signs of inflammation, doctors will describe RA as being in remission.

A reduction in swelling should allow a greater range of movement, as long as previous disease flare-ups have not damaged the joints.

Doctors will often prescribe medication to ease symptoms and reduce inflammation. They may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) in the form of a tablet to take orally or a cream to apply to the joints.

In some cases, a person may need surgery to repair or replace their joints. Surgery can help decrease pain and improve range of movement.

Takeaway

RA is a severe disease that can affect the whole body, often causing pain and disability.

The Centers for Disease Control and Prevention (CDC) recommend that people with RA maintain a healthy weight and quit smoking. Being overweight and smoking with RA can worsen its symptoms and increase the likelihood of developing risk factors, such as high blood pressure, for other diseases.

There is a link between female hormones and the onset of RA, which tends to occur earlier in women than in men. The hormonal changes that can occur throughout a woman's life, such as those that take place during pregnancy or menopause, can affect the symptoms of the disease.

Women can limit the impact of RA on their lives by seeking early treatment and following the advice of a doctor when managing their symptoms.