Types of Autoimmune Arthritis

Many types of arthritis are autoimmune in nature. That means your immune system mistakenly attacks your healthy cells, thinking they're dangerous invaders like a virus or bacterium.

The most common types of autoimmune arthritis are rheumatoid arthritis (RA) and psoriatic arthritis, but many types exist. And since a lot of other autoimmune diseases affect the joints, autoimmune arthritis can be hard to diagnose.

Rheumatoid Arthritis (RA)

RA is a form of autoimmune arthritis that affects about 1.28 to 1.36 million adults in the United States, and is three times more prevalent in women than in men. It commonly affects the joints in the hands, wrists, and knees.

The joint damage caused by RA can lead to chronic pain, lack of balance, and joint deformity. RA can also affect other organs, including the lungs, heart, and eyes.

RA has two types: seropositive and seronegative RA. People with seropositive RA test positive for rheumatoid factor (an antibody) and/or anti-cyclic citrullinated peptide (anti-CCP), while those with seronegative RA have neither.

Symptoms of rheumatoid arthritis are:

• Pain or aching in more than one joint
• Stiffness in more than one joint
• Tenderness and swelling in more than one joint
• The same symptoms on both sides of the body (such as in both hands or both knees)
• Unintended weight loss
• Fever
• Fatigue or tiredness
• Weakness

RA vs. Osteoarthritis

Rheumatoid arthritis and osteoarthritis have similar symptoms but are very different conditions.

Osteoarthritis (OA), also known as degenerative joint disease, happens when the smooth cartilage on the joint surface wears out over time. It is generally considered a result of the aging process or overuse of a particular joint. It's not classified as an autoimmune arthritis.

RA is an autoimmune disease in which the immune system attacks the synovium (the membrane lining your joints).

Psoriatic Arthritis (PsA)

Psoriatic arthritis affects about 33% of people who have psoriasis, an autoimmune arthritis that affects the skin. Psoriatic arthritis affects the joints and where the ligaments and tendons connect to bone.

This form of autoimmune arthritis can start at any age, but commonly affects those between 30 and 50 years old. For many people, psoriatic arthritis starts about 10 years after psoriasis develops.

In psoriasis, an overactive immune system can cause a rapid increase in skin cell production that leads to raised, scaly patches on the skin. For people with both psoriatic arthritis and psoriasis, joint problems can begin before skin patches appear.

Some people may develop psoriatic arthritis after an injury. Genetics may also play a role.

Psoriatic arthritis can develop slowly or rapidly. Symptoms include:

• Fatigue
• Tenderness, pain, and swelling over tendons
• Swollen fingers and toes that sometimes resemble sausages
• Stiffness, pain, throbbing, swelling, and tenderness in one or more joints
• Reduced range of motion
• Morning stiffness and tiredness
• Nail changes, such as pitting or separation from the nail bed
• Redness and pain of the eye (uveitis)

There is little connection between psoriasis and psoriatic arthritis severity. A person could have few skin lesions but many joints affected by this form of autoimmune arthritis.

Reactive Arthritis

Reactive arthritis isn't related to autoimmune activity. Also known as Reiter’s syndrome, it occurs in reaction to an infection by specific bacteria found either in the gastrointestinal or genitourinary tract. It commonly affects men between 20 and 50 years old. The incidence of this disease is 0.6 to 27 per 100,000 people.

Bacteria involved in reactive arthritis include:

• Chlamydia trachomatis
• Campylobacter
• Salmonella
• Shigella
• Yersinia

These bacteria are really common, but not everyone who becomes infected with them will develop this form of autoimmune arthritis. Researchers have found that people who have a weakened immune system and those with the HLA-B27 gene are more prone to getting the disease, and may have a more sudden and severe onset as well as chronic and long-lasting symptoms.

Reactive arthritis can cause the following symptoms:

• Pain and swelling of certain joints, often the knees and ankles
• Swelling and pain at the heels
• Extensive swelling of the toes or fingers
• Persistent low back pain, which tends to be worse at night or in the morning

Ankylosing Spondylitis

Ankylosing spondylitis is an autoimmune arthritis. It causes inflammation between vertebrae, the bones that make up the spine, and in the joints between the spine and pelvis. In some people, it can affect other joints. Ankylosing spondylitis is the most common type of spondyloarthritis, a family of arthritis-associated diseases.

Severe cases of ankylosing spondylitis can lead to ankylosis, where sections of the spine fuse in a fixed, immobile position. Up to 30 genes associated with this condition have been identified. The major gene associated with this disease is HLA-B27.

This type of autoimmune arthritis occurs more often in men than women. About 80% of people with this disease experience some symptoms before 30 years old, and 5% will start having symptoms at over 45 years old.

Symptoms of ankylosing spondylitis include:

• Inflammation
• Pain
• Stiffness in the shoulders, hips, ribs, heels, and small joints of the hands and feet
• Iritis or uveitis
• Problems with the lungs and heart

Axial Spondyloarthritis

Axial spondyloarthritis is another type of autoimmune spondyloarthritis. It typically affects the sacroiliac joints and spine. The joints in the arms and legs are also affected in some cases. People with this condition most often have low back pain. Men in their teens and 20s, and people with a family history of this disease, are most commonly affected.

People with damage of the sacroiliac joints that is visible on X-rays have a subtype of the disease called radiographic axial spondyloarthritis, while those who don’t, have non-radiographic axial spondyloarthritis. Some with non-radiographic axial spondyloarthritis will progress to have structural damage that is visible on X-rays, but some will not. Ankylosing spondylitis is actually a form of radiographic spondyloarthritis.

This form of autoimmune arthritis can progress over the years to cause spinal fusion as well, and can result in a stooped posture if the spine fuses in a forward position.

Symptoms of axial spondyloarthritis include:

• Slow or gradual onset of back pain and stiffness over weeks or months
• Early-morning stiffness and pain, wearing off or reducing during the day with exercise
• Persistence for more than three months (rather than coming on in short attacks)
• Feeling better after exercise and worse after rest
• Weight loss, especially in the early stages
• Fatigue or tiredness
• Feeling feverish and experiencing night sweats

Juvenile Arthritis

Children can have arthritis too. Juvenile arthritis, also known as pediatric rheumatic disease or childhood arthritis, is an umbrella term for inflammatory and rheumatic diseases that affect children under the age of 16.

The most common type of juvenile arthritis is juvenile idiopathic arthritis. Most kinds of juvenile arthritis are autoimmune diseases.

There are three main types of juvenile arthritis, differentiated by the number of joints involved and the presence of certain antibodies in the blood:

• Oligoarticular (just a few joints are affected)
• Polyarticular (more than five joints are affected)
• Systemic (causes swelling, pain, and limited motion in at least one joint and includes systemic symptoms)

Juvenile arthritis affects each child differently and can last for indefinite periods of time. There may be times when symptoms improve or disappear, but sometimes symptoms can worsen. A child with juvenile arthritis may also have one or two flare-ups and never have symptoms again. 

Symptoms of this type of autoimmune arthritis are:

• Painful joints in the morning that improve by afternoon
• Joint swelling and pain
• Joints may become inflamed and warm to the touch
• Muscles and other soft tissues around the joint may weaken
• High fever and light pink rash, which may disappear very quickly
• Growth problems—for example, joints may grow too fast or too slowly, unevenly, or to one side
• Eye problems, such as iridocyclitis

Palindromic Rheumatism

Palindromic rheumatism is a rare type of recurrent autoimmune arthritis characterized by episodes, or attacks, of joint inflammation, sequentially affecting one to several joint areas for hours to days. An attack can occur without any obvious triggers or warning signs. Finger joints, the wrists, and the knees are most commonly affected. This usually occurs in people between 20 and 50 years old.

Some people with PR eventually develop chronic rheumatic disease, the most common being RA. Others may develop lupus or other systemic disorders. People with anti-CCP antibodies detected in a blood test appear more likely to develop RA. There has been some evidence to support that PR can be a presenting feature of RA (or part of the spectrum of RA), rather than a distinct condition.

Symptoms during episodes include:

• Pain
• Swelling
• Stiffness
• Redness
• Fever
• Other systemic symptoms

The time between episodes may last from days to months.

Other Autoimmune Causes of Joint Pain

Several other autoimmune diseases can cause joint pain. They also have myriad other symptoms that can help distinguish them from types of arthritis and each other. Even so, the similarities can be enough to complicate the diagnostic process.

Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE, often just called lupus) is can cause inflammation and pain in any part of the body, with the most commonly affected areas being the skin, joints, and internal organs like the heart and kidneys. People with lupus experience joint pain and swelling at some point, and some may develop autoimmune arthritis. SLE often affects the joints of the fingers, hands, wrists, and knees.

SLE appears most often in women between the ages of 15 and 44. In the United States, the disease is more common in Black people, Asian Americans, African Caribbeans, and Hispanic Americans than in White Americans.

Besides joint pain and swelling, people with this autoimmune disease can also have the following symptoms:

• Chest pain when taking a deep breath
• Fatigue
• Fever with no other cause
• General discomfort, uneasiness, or ill feeling (malaise)
• Hair loss
• Weight loss
• Mouth sores
• Sensitivity to sunlight
• A butterfly-shaped rash across the face, which develops in about half the people with SLE
• Swollen lymph nodes

Systemic Sclerosis

Also called systemic scleroderma, this autoimmune disease occurs when scar tissue (fibrosis) builds up in the skin and other internal organs, including muscles and joints. The skin thickening that accompanies systemic scleroderma can cause tightening, resulting in a loss of flexibility and ease of movement, especially in the fingers.

The word “scleroderma” means hard skin in Greek. Fibrosis is due to the excess production of collagen, which normally strengthens and supports connective tissues throughout the body.

The three types of systemic scleroderma, defined by the type of tissues affected, are:

• Limited cutaneous systemic scleroderma also includes the CREST syndrome and affects the hands, arms, and face.
• Diffuse cutaneous systemic scleroderma affects large areas of the skin, including the torso and the upper arms and legs. It also often involves internal organs.
• Systemic sclerosis sine scleroderma affects one or more internal organs but not the skin.

Symptoms of systemic sclerosis include:

• Joint pain and swelling
• Raynaud’s phenomenon, where the body’s normal response to cold or emotional stress is exaggerated, resulting in painful color changes in the fingers and toes due to abnormal spasms (vasospasms) in small blood vessels called arterioles
• Skin sores or ulcers
• Reduced facial movements
• Internal organ fibrosis and/or vascular damage (involving the lungs, heart, gastrointestinal tract, or kidneys)

Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) causes widespread aching and stiffness. This autoimmune condition usually affects the shoulders, upper back, and hips. It can start at 50 years old, although the average age for symptoms to start is 70. Approximately 15% of people with PMR develop a potentially dangerous condition called giant cell arteritis (GCA), which is inflammation of the lining of the arteries.

Symptoms of PMR are a result of inflammation of the joints and surrounding tissues, and they include:

• Aching
• Stiffness
• Fatigue
• Fever
• Poor appetite
• Weight loss
• Persistent headaches
• Scalp tenderness (GCA)
• Vision changes (GCA)
• Jaw pain (GCA)

Diagnostic Challenges

Since many of the symptoms of all of these autoimmune arthritis conditions can be very similar and nonspecific, it is important to consult with a rheumatologist to get a proper diagnosis.

Here are some things the healthcare provider will do to help determine your diagnosis:

• Gather your medical history, including asking about a family history of autoimmune diseases
• Perform a physical exam to check your symptoms
• Order laboratory tests to check for inflammatory markers
• Order X-rays, CTs, and MRIs to look for signs of joint damage

Treatment

There is currently no real cure for autoimmune arthritis, but some medications can help control disease progression and alleviate symptoms. Some lifestyle changes can also help people manage their autoimmune arthritis. Treatment is most effective when started early.

Medications

Medical treatment varies by the type of autoimmune arthritis a person has. Medications for autoimmune arthritis include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) control pain and inflammation.
• Corticosteroids reduce inflammation and the functions of an overactive immune system. Side effects can be serious, relating to bone strength, diabetes, hypertension, and how prone you are to infection, so healthcare providers usually only prescribe these for the shortest duration possible.
• Disease-modifying anti-rheumatic drugs (DMARDs) have been shown to slow, or modify, the progress of joint damage for people who have rheumatoid arthritis, psoriatic arthritis, and juvenile arthritis. These medications can take weeks or months to take effect, however. One of the most commonly used drugs in this class is methotrexate.

Lifestyle Changes

Besides medications, lifestyle changes can help with the pain and movement issues associated with autoimmune arthritis. Consider the following:

• Regular physical activity as your condition allows and with the approval of your healthcare provider. Choose activities that put less stress on your joints, such as walking, bicycling, and swimming.
• When you exercise, wear protective equipment to reduce the chance of injury.
• Manage your weight to reduce the stress you place on your joints.
• Maintain a healthy diet including fruits, vegetables, fish, nuts, beans, low processed foods, and low saturated fats.
• Stop smoking. Research has linked smoking to some autoimmune diseases such as rheumatoid arthritis.

A Word From Verywell

With so many different types of autoimmune arthritis and other autoimmune diseases that can cause joint pain and swelling, it is important to give your healthcare provider all the information needed to correctly identify and target the one causing your symptoms. While much of why autoimmune arthritis occurs is still a mystery, research is ongoing to learn more about these conditions, which can potentially lead to better treatments and quality of life for those affected.

Stay positive even if you are diagnosed with one of these conditions. There are many ways to manage your disease and relieve painful and annoying symptoms through medications and lifestyle changes.