Is Rheumatoid Arthritis Genetic? — All Your Questions Answered

Medically Reviewed By Stella Bard, MD
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Rheumatoid arthritis (RA) is an autoimmune disease that causes arthritic joint inflammation. With RA, the immune system mistakenly attacks healthy cells, which may cause swelling, pain, and deformity of joints. The condition can be painful and may get worse over time, but treatment can help alleviate symptoms and slow disease progression. RA is a type of arthritis characterized by an abnormal immune response.

A healthy immune response protects the body’s health by recognizing foreign organisms such as bacteria and viruses and attacking them. With RA, the body mistakenly attacks healthy tissue surrounding the joints.

In RA, the cartilage that surrounds joints, allows the body to absorb shock, and allows the body to move smoothly becomes inflamed, causing swelling and pain. This can later lead to erosion of the joints and a loss of mobility.

RA is a chronic disease and is one of the most common autoimmune diseases. Around 1.3 million people in the United States and around 1% of the global population experiencing the condition.

Read on to learn more about the causes, risk factors, and prevention for RA.

Is rheumatoid arthritis genetic?

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The relationship between RA and inheritance is not clear, as clinicians believe the condition relates to many factors, including both genetic and environmental factors.

Research has suggested that people with particular genetic markers and variations may be more susceptible to developing the condition.

For example, the human leukocyte antigen (HLA) known as HLA-DRB1 may link to the condition. This gene produces proteins that can help the immune system differentiate the body’s own proteins from proteins of foreign invaders, such as bacteria and viruses.

Many other genetic factors may also have a small impact on the risk of developing RA.

Additionally, having a relative with RA may increase a person’s risk of developing the condition. If a first-degree relative, such as a parent or sibling, has RA, you are four times more likely to develop RA than the general population. 

However, as the Rheumatoid Arthritis Support Network states, this risk still does not conclusively confirm that RA is hereditary. Many individuals with the condition have no close family members with the condition, and not all those with the HLA gene will develop RA.

As a result, genetic factors may increase the likelihood of developing RA, but they do not directly cause the condition.

Visit our online information center for RA here for comprehensive information, including symptoms, treatments, clinicians, and more.

Causes of rheumatoid arthritis

RA is an autoimmune disorder, meaning it is the result of abnormal function of the immune system. However, clinicians are not yet sure what causes the immune system to attack the body’s own tissues.

It is probable that RA results from a combination of both genetic and environmental factors. Some of these factors are still unknown.

Other risk factors

Anyone can get RA, including children. However, certain factors, including genetics, may mean you have an increased risk of developing the disease.

For example, females are not only three times more likely than males to get RA but they may also develop symptoms at a younger age. 

Environment

Environmental factors may relate to an increased risk of developing RA.

One 2018 analysis of genetic and environmental factors for RA suggests that environmental factors may include air pollution and occupational exposure to triggers such as dust, smoke, and other air pollutants.

Genetics

People born with the HLA class 2 gene are at greater risk of developing RA, as well as having a more severe case of RA.

The risk of developing RA may be the highest in individuals who both have the HLA class 2 gene and have factors like smoking or obesity that increase risk.

Smoking 

Smoking may increase the risk of getting RA and can also worsen the severity of the disease.

This includes both first-hand smoking and second-hand environmental exposure to smoke. Multiple studies suggest that exposure to smoke accounts for approximately 20–30% of environmental risk for developing RA.

Obesity

People with obesity may have a higher risk of developing RA.

According to the Centers for Disease Control and Prevention (CDC), the more overweight a person is, the higher their risk of developing RA.

Diet and nutrition

Environmental factors that may increase the risk of developing RA include dietary and nutritional factors.

One 2017 analysis of genetic and environmental risk factors suggests that a diet with high sodium, red meat, and iron consumption could increase risk.

Additionally, a low vitamin D intake or low vitamin D levels in the body may be a risk factor for RA.

Hormonal changes and sex

Since females experience RA at a more significant proportion than males, theories suggest that hormones are a trigger for RA.

Individuals can experience major hormone shifts during pregnancy and menopause.

The 2017 analysis suggests that female hormonal factors can contribute to the development of the condition. Researchers found that the onset of RA was related to:

  • the post-menopausal period
  • early age at experiencing menopause
  • the postpartum period
  • the use of anti-estrogen agents

However, more research is necessary to understand the precise role of sex and hormonal factors on RA.

Perinatal and birth history

The CDC suggests that females who have never been pregnant are at greater risk of developing RA. This may relate to hormonal and sex risk factors for RA.

Additionally, breastfeeding may be a protective factor against the risk of developing RA.

However, the 2017 analysis found conflicting results, suggesting that having more than one pregnancy increased the risk of a certain type of RA, particularly if the first pregnancy was before the age of 23.

Researchers also suggested that the postpartum period resulted in an increased risk of RA in the year after birth compared to subsequent years. This may be due to hormonal changes and increased levels of prolactin.

Early life exposures

According to the CDC, certain exposures during early life may increase the risk of developing RA later on.

Children whose parents smoked had double the risk of developing RA in adulthood. Children of lower income parents may also have an increased risk of developing RA as adults.  

How do I prevent RA?

While you may not be able to completely prevent RA, especially if you have risk factors due to genetics and the environment, avoiding or reducing further risk factors may help.

The best methods of care for RA are lifestyle management and maintaining good overall health.

Factors associated with a decreased risk of developing RA include:

  • consumption of fish or omega-3 fatty acids
  • moderate to low alcohol consumption
  • maintaining a healthy, balanced diet
  • maintaining a moderate weight
  • avoiding smoke and smoking

Learn more about diets and arthritis here.

What are the first signs of RA?

Generally, people develop RA between the ages of 30 and 60 years old. However, the average age of developing symptoms is 60.

Initial symptoms of RA include:

  • joint pain and stiffness
  • joint swelling or redness
  • symptoms affecting multiple joints
  • symmetrical symptoms that affect both the left and right sides of the body 
  • body stiffness in the morning that lasts longer than 30 minutes   

Doctors may also investigate additional symptoms that can be the result of inflammation, including:

Diagnosis

There are over 100 types of arthritis. To identify rheumatoid arthritis, doctors will look at multiple criteria.

Diagnosis of RA may require the services of a specialized doctor or rheumatologist.

If possible, it is best to diagnose RA within 6 months of onset to begin treatment promptly and avoid further damage or disease progression.

A doctor or rheumatologist will consult on information regarding symptoms and medical history, including results from:

  • physical examination
  • investigation of present and historical symptoms
  • investigation of personal and family medical history
  • blood tests for rheumatoid factors, anti-CCP antibodies, and inflammation levels
  • imaging tests to detect bone erosion and joint inflammation

Treatment for RA

A permanent cure for RA does not yet exist.

Current treatments focus on medications, lifestyle changes, and treatments, including surgery, to target the symptoms of RA and make daily life more manageable.

Because RA is a progressive disease, ranging from minor to severe, your RA treatment may depend on your particular condition.

All RA treatments aim to reduce swelling, inflammation, and pain, and to prevent further joint damage caused by RA. 

Treatment options

Clinical treatment options for RA can include:

  • surgery, including joint replacement surgery and joint aspiration
  • nonsteroidal anti-inflammatory drugs, such as ibuprofen
  • disease-modifying antirheumatic drugs
  • biological response modifiers
  • steroid injections
  • physical therapy
  • occupational therapy

Management strategies for RA

There are also methods of self-management that can reduce pain and improve quality of life. These can include:

  • protecting your joints — for example, by avoiding sports-related or occupational injuries where possible
  • joining a self-management education class or support group for people with arthritis
  • maintaining a moderate weight
  • performing moderate exercises for at least 150 minutes per week
  • following your treatment plan and contacting your doctor as soon as possible with any symptoms or flare-ups
  • stopping smoking

Summary

RA is an inflammatory disease affecting the joints. If left untreated, it will lead to degeneration of joints.

The exact cause of RA is unknown, but it seems to be related to both genetic and environmental factors. Developing RA can be more likely according to certain genetic factors, such as having a specific HLA class 2 gene or a family history of RA. However, RA is not directly or exclusively caused by genetics.

Treatment and self-management strategies can alleviate symptoms of RA and improve quality of life.

Contact your doctor promptly for any symptoms of RA.

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Medical Reviewer: Stella Bard, MD
Last Review Date: 2022 Apr 12
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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