Rheumatoid arthritis is a chronic autoimmune condition that can cause joint pain, swelling, stiffness, fatigue, and inflammation beyond the joints.
Learn how Dr. Siefferman approaches arthritis and joint pain, including common causes, symptoms, and treatment options to help improve mobility and reduce discomfort.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hi, I’m Dr. Jason Siefferman, medical director at Manhattan Pain Medicine. When we think of joint pain and arthritis within joint pain, we really think of it in three frameworks.
The first is post-traumatic. Was there an accident? Was there a sprain? Was there some mechanical injury to the joint? Because if there was, invariably that joint will be loose. There will be some connective tissue around the joint that needs to be repaired to restabilize the joint. And then some structure within the joint, maybe a meniscus or labrum, will also have been torn and that needs to heal. So there’s a lot of regenerative medicine that goes into treating a traumatic injury to a joint.
The next category is osteoarthritic changes and this is what happens with overuse and with age; and having a trauma that’s not healed properly will accelerate the development of osteoarthritic changes. This is where we see things like bone spurs or the edges of the joints become more irregular and there may be some swelling, some irritation, some crankiness in the joint. There may be some joint stiffness. Generally, it gets better with some movement but then with too much movement it will feel sore the next day. You know, this is the kind of typical joint pain that will respond to a steroid injection for a few months. It will respond to NSAIDs temporarily, but ultimately they don’t fix anything. With osteoarthritic joints we will also often veer towards a regenerative medicine approach because that has been shown to be superior to steroid and it actually helps prolong the life of the joint.
The final category of arthritic pain is inflammatory arthritis. And this is where the immune system decides that it wants to attack the joint or the lining of the joint capsule called the synovium. And as a result of this autoimmune process, there’s an inflammatory cascade that’s set off. This is generally a systemic process, so joints that are affected may be symmetrically affected. It may be both wrists, both ankles, both knees. And it will generally happen out of the blue, although any mechanical irritation can also trigger a flare. This is a situation where oral anti-inflammatories are tremendously helpful. The patients often have a lot of morning joint stiffness with this condition and that will often get better with oral anti-inflammatories. This is also a condition where it’s essential to identify which inflammatory process is in play, which is done by a rheumatologist, and come up with a better long-term treatment.
Oral anti-inflammatories are not a sustainable long-term treatment nor do they appropriately treat the underlying inflammatory condition which generally doesn’t just affect the joint. There’s a lot of associated systemic processes that are affected by an autoimmune process. And if it happens to be affecting your joints, that’s just a window into knowing that there’s a process that’s likely affecting the rest of your body. Seeing a rheumatologist, getting an accurate diagnosis, and getting a thorough treatment for that is essential.
Rheumatoid arthritis, or RA, is a chronic autoimmune disease in which the immune system attacks the body’s own tissues, most often the lining of the joints. This can cause joint pain, swelling, stiffness, warmth, fatigue, and reduced function.
RA often affects joints on both sides of the body and may involve the hands, wrists, feet, knees, shoulders, elbows, jaw, or spine. It can also affect other systems, including the eyes, lungs, heart, blood, nerves, and skin.
Early diagnosis and treatment are important because untreated inflammation may lead to joint damage and long-term disability.
At Manhattan Pain Medicine, evaluation begins by identifying whether joint pain is driven by active inflammation, mechanical joint strain, nerve sensitivity, musculoskeletal overload, autoimmune disease, or overlapping pain conditions.
For patients looking for rheumatoid arthritis treatment in Manhattan, MPM helps clarify the pain pattern, coordinate with rheumatology when needed, and support a treatment plan that may include medication management, biologics, infusions, diagnostic ultrasound, targeted joint injections, pain psychology, physical therapy coordination, weight-management support, and long-term monitoring.
The goal is not only to treat pain, but to understand what is driving it.
Secondary textRheumatoid arthritis can begin subtly. Early symptoms may include morning stiffness lasting more than 30 minutes, swelling in small joints of the hands or feet, fatigue, low-grade fever, and pain that feels worse after rest. Because early RA can resemble osteoarthritis, tendinopathy, gout, lupus, Sjogren’s syndrome, undifferentiated connective tissue disease, fibromyalgia, or other autoimmune-related pain conditions, careful evaluation matters.
RA is different from wear-and-tear arthritis. It is an immune-mediated inflammatory disease that may require disease-modifying treatment, not just pain control. Early use of DMARDs, and in some cases biologics or targeted therapies, may improve symptom control and help reduce joint damage.
Rheumatoid arthritis fits across several MPM Zones of Expertise, including Autoimmune and Inflammatory Disorders, Complex Chronic Pain, and Musculoskeletal issues. This matters because RA-related pain may come from active joint inflammation, tendon involvement, nerve irritation, joint damage, compensatory movement patterns, or chronic pain sensitization.
MPM evaluates RA through this broader clinical lens. For some patients, the priority is confirming inflammatory activity and coordinating disease-modifying care. For others, pain persists even when inflammation is controlled, suggesting additional musculoskeletal, neuropathic, or centralized pain drivers. By using the Zones of Expertise framework, MPM helps clarify what is inflammatory, what is structural, what is neurologic, and what may require coordinated long-term support.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Early rheumatoid arthritis symptoms often include joint pain, swelling, warmth, tenderness, and stiffness, especially in the morning or after periods of rest. Morning stiffness that lasts longer than 30 minutes can be an important clue. RA often affects smaller joints first, such as the hands, wrists, and feet, and symptoms may appear on both sides of the body. Some patients also experience fatigue, low-grade fever, loss of appetite, or a general feeling of inflammation. Because early RA can resemble other joint conditions, persistent joint pain or swelling should be evaluated rather than self-diagnosed.
Rheumatoid arthritis is an autoimmune inflammatory disease. The immune system attacks the body’s own tissues, especially the joint lining, which can lead to swelling, stiffness, pain, and joint damage. Osteoarthritis is more commonly related to wear, aging, prior injury, joint mechanics, or cartilage breakdown. RA is more likely to cause prolonged morning stiffness, symmetrical joint involvement, swelling, and systemic symptoms such as fatigue. Osteoarthritis often worsens with activity and may affect specific joints based on use or injury. A clinical evaluation, blood work, imaging, and physical exam can help distinguish between them.
Rheumatoid arthritis does not currently have a cure, but treatment can help manage symptoms, reduce inflammation, slow joint damage, and improve function. Early treatment is important because joint damage can occur when inflammation is not controlled. Many treatment plans include disease-modifying antirheumatic drugs, or DMARDs, and sometimes biologics or targeted synthetic medications. These treatments are designed to affect the disease process, not only reduce pain. Regular follow-up is important to monitor response, adjust medication, and watch for side effects or complications.
DMARDs, or disease-modifying antirheumatic drugs, are medications used to slow the progression of inflammatory arthritis and help protect joints from damage. Traditional DMARDs may include medications such as methotrexate, hydroxychloroquine, leflunomide, or sulfasalazine. Biologics are a type of DMARD that target specific parts of the immune system involved in inflammation. Targeted synthetic DMARDs work through specific immune signaling pathways. These medications can be effective, but they also require medical supervision because side effects, infection risk, and monitoring needs vary by medication.
You should consider medical evaluation if joint pain, swelling, or stiffness lasts more than a few weeks, especially if stiffness is worse in the morning, joints are visibly swollen, symptoms affect both sides of the body, or pain interferes with daily function. Evaluation is also important if you have fatigue, low-grade fever, loss of appetite, unexplained inflammation, or a personal or family history of autoimmune disease. Early diagnosis of rheumatoid arthritis may improve treatment options and help reduce the risk of joint damage. Sudden severe swelling, fever, inability to use a joint, or signs of infection should be addressed urgently.
Lifestyle strategies cannot replace disease-directed medical treatment, but they may support overall function and symptom management. Many patients benefit from appropriate low-impact exercise, physical therapy, joint protection strategies, weight management, stress reduction, sleep support, heat or cold therapy, and smoking cessation. Nutrition may also play a supportive role, especially when focused on overall metabolic and inflammatory health. Pain psychology can help patients manage chronic pain, flare-related fear, stress, and the emotional burden of long-term autoimmune disease. These strategies should be matched to the patient’s symptoms, joint status, and medical treatment plan.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Rheumatoid arthritis, often called RA, is a chronic autoimmune disease that most commonly affects the joints. In RA, the immune system mistakenly attacks the body’s own tissues, particularly the synovium, which is the lining of the joints. This immune activity can cause inflammation, swelling, stiffness, pain, warmth, and reduced function. Over time, uncontrolled inflammation may contribute to joint damage and disability. RA can also affect areas beyond the joints, including the eyes, lungs, heart, blood vessels, nerves, skin, and blood.
RA is not the same as ordinary joint soreness. It is also different from osteoarthritis, which is more often related to cartilage wear, aging, injury, or mechanical stress. Rheumatoid arthritis is immune-driven. This is why the treatment plan often needs to include medications that calm immune activity and reduce inflammation, not just medications that temporarily reduce pain.
RA can present in different ways. Many patients notice pain, swelling, warmth, or tenderness in the hands, wrists, feet, knees, shoulders, elbows, jaw, or other joints. Symptoms may occur on both sides of the body. Morning stiffness lasting more than 30 minutes is common and may be one of the first signs of rheumatoid arthritis. Some patients also experience fatigue, low-grade fever, loss of appetite, brain fog, reduced grip strength, or difficulty walking, typing, opening jars, climbing stairs, or performing daily activities.
Symptoms may fluctuate. Patients can have periods of increased inflammation, often called flares, followed by periods when symptoms feel more controlled. A flare may include increased joint swelling, stiffness, pain, fatigue, and reduced function. Because RA can also overlap with other pain conditions, it is important to determine whether symptoms are caused by active inflammation, joint damage, tendon involvement, nerve irritation, musculoskeletal compensation, or chronic pain sensitization.
The exact cause of RA is not fully understood. It is believed to involve a combination of immune system activity, genetics, environmental exposures, and risk factors such as smoking. RA can occur at many ages, but risk increases with age, and it is more common in women than men. A family history of autoimmune disease may also increase risk for some patients.
The important point for patients is that RA is not caused by overuse alone. A person with RA may feel joint pain during movement, but the underlying problem is immune-mediated inflammation. This distinction matters because treating only the pain without addressing inflammatory activity may allow disease progression.
Rheumatoid arthritis diagnosis usually involves a combination of history, physical examination, blood tests, and imaging. A clinician may look for joint swelling, tenderness, warmth, range-of-motion changes, symmetry of symptoms, and morning stiffness. Blood tests may include inflammatory markers and autoimmune markers such as rheumatoid factor or anti-CCP antibodies, although not every patient with RA has positive antibodies. Imaging may include X-rays, ultrasound, or MRI depending on the clinical question.
At MPM, evaluation also considers overlapping conditions. Joint pain may be related to lupus, Sjogren’s syndrome, vasculitis, undifferentiated connective tissue disease, gout, enthesitis, Ehlers-Danlos syndrome, hypermobility spectrum disorder, tendinopathy, peripheral neuropathy, spine pain, sacroiliac joint dysfunction, TMJ disorders, frozen shoulder, fibromyalgia, or other complex chronic pain conditions. Diagnostic ultrasound may help evaluate certain joints or soft tissue structures and may also help guide injections when appropriate.
The foundation of RA care is disease control. Medications may include NSAIDs for pain and inflammation, corticosteroids for short-term flare control, conventional DMARDs, biologic DMARDs, or targeted synthetic DMARDs. DMARDs are designed to slow disease progression and help protect joints. Biologics and targeted therapies affect specific parts of the immune system and may be used when clinically appropriate. Because these medications can increase infection risk or cause other side effects, they should only be used under medical supervision with appropriate monitoring.
Pain management may also be part of care, especially when symptoms persist despite disease-directed treatment. Depending on the presentation, MPM may consider medication management, peripheral joint injections, sacroiliac joint injection, steroid injections, diagnostic ultrasound, infusions, biologics for appropriate inflammatory conditions, B12 replacement when deficiency is relevant, weight-loss support, pain psychology, and coordination with physical therapy. Suboxone or other pain medication strategies may be considered only in specific clinical contexts and under appropriate supervision.
Some patients continue to experience pain even when inflammatory markers improve or RA appears medically controlled. This does not mean the pain is not real. It may mean that more than one pain generator is present. Joint damage, tendon irritation, myofascial pain, nerve pain, spine pain, autonomic symptoms, pelvic floor dysfunction, TMJ disorders, fibromyalgia, medical PTSD, post-COVID pain, or deconditioning may all affect how pain is experienced and managed.
This is where MPM’s multidisciplinary model can be helpful. Rather than assuming every symptom is caused by active RA, MPM evaluates the full pain system. The goal is to identify which symptoms reflect inflammation, which reflect structural or mechanical stress, which may be neuropathic, and which may benefit from behavioral, rehabilitative, or interventional support.
Patients should seek evaluation for persistent joint pain, swelling, stiffness, fatigue, or reduced function, especially when symptoms last more than a few weeks or are worse in the morning. Early diagnosis and treatment may improve outcomes and reduce the risk of long-term joint damage. Patients with known RA should also seek care when symptoms change, flares become more frequent, medications cause side effects, or pain persists despite treatment.
Urgent care may be needed for sudden severe joint swelling, fever, signs of infection, chest pain, shortness of breath, neurologic symptoms, or severe medication reactions. Patients should not stop DMARDs, biologics, steroids, or other RA medications without speaking with their healthcare provider.
MPM approaches rheumatoid arthritis pain through a diagnosis-first, coordinated model. The evaluation looks at inflammatory disease activity, joint structure, musculoskeletal mechanics, nerve pain, functional limitations, prior medication response, and overlapping autoimmune or chronic pain conditions. Care may involve coordination with rheumatology, physical therapy, psychology, and other specialists when needed.
For patients looking for rheumatoid arthritis treatment in Manhattan, MPM offers a careful, patient-centered approach to understanding joint pain, inflammatory activity, and overlapping pain conditions. The goal is to support long-term function and help build a treatment plan that reflects the complexity of RA and related conditions.
