Table of Contents
SUMMARIZE WITHChatGPTPerplexityClaudeGrokGemini
Rheumatoid Arthritis Arm Pain: What Patients Should Know

Living with a chronic autoimmune condition can be tough. About 1.3 million adults in the U.S. deal with this disease. It often affects joints, tendons, and tissues around them. Feeling rheumatoid arthritis arm pain is a sign that you need to see a doctor.

Managing symptoms can feel like a big task. At Liv Hospital, we focus on you. We use the latest medical knowledge to help you feel better and keep your joints healthy.

This guide will help you understand your symptoms and diagnosis. We’ll also talk about treatment options and how to take care of yourself. Taking action now can greatly improve your future health.

Key Takeaways

  • This autoimmune condition affects over one million American adults by causing systemic inflammation.
  • Early medical intervention is critical to preventing long-term damage to your joints and tissues.
  • Symptoms often extend beyond simple discomfort, impacting tendons and overall body systems.
  • Professional evaluation at a specialized facility ensures a personalized and effective care plan.
  • Patients can improve their quality of life through a combination of modern protocols and lifestyle adjustments.

How Rheumatoid Arthritis Can Cause Arm Pain

How Rheumatoid Arthritis Can Cause Arm Pain

Many people are surprised to find that arm pain often comes from their hands and wrists. The pain might seem to be in the forearm or elbow. But, it usually starts with a body-wide immune response that hits smaller joints first.

Inflammation in the joints, tendons, and surrounding tissues

This condition is caused by the immune system attacking the synovium, the lining of your joints. This attack leads to swelling, warmth, and persistent pain. The hand joints rheumatoid arthritis targets first, causing stiffness that makes simple tasks hard.

As inflammation spreads, it affects not just the joint but also the tendons and ligaments. These tissues connect your entire arm. This widespread irritation limits your movement and grip strength.

How pain may travel from the hands and wrists into the arms

Pain from this condition is not always in one place. Tendons in your hands and wrists run through your forearm. So, inflammation in these areas can cause pain that feels like it’s coming from further up.

You might feel tension in your wrist that pulls on your forearm muscles. This can cause a dull ache that moves up your arm.”The complexity of joint inflammation requires a holistic approach that looks beyond the immediate site of pain to understand the full impact on the body.”

This movement of pain is common. It shows why protecting your hands and wrists is key to keeping your upper body comfortable.

Why rheumatoid arthritis pain can affect both sides of the body

This condition often affects both sides of the body. If you see swelling or pain in your left hand, you’ll likely see it in your right hand soon. This symmetry is a key sign of the disease.

Understanding this symmetry helps doctors tell this condition apart from other injuries. By catching these patterns early, we can manage the inflammation better. This helps protect your joints for the long term.

Who Develops Rheumatoid Arthritis and When Symptoms Begin

Who Develops Rheumatoid Arthritis and When Symptoms Begin

Rheumatoid arthritis affects many people, but some patterns stand out. It tends to hit certain ages and genders more. While ra has no single cause, knowing these trends helps us support those with chronic pain better.

How common rheumatoid arthritis is in the United States

This condition is widespread in the U.S. About 1.3 million U.S. adults live with it. This shows how vital early diagnosis and care are for those with joint pain.

Why women are approximately three times more likely than men to develop RA

Studies show a big difference in who gets diagnosed. Women are approximately three times more likely than men to have RA. Scientists are looking into hormones and genes to understand this.

The typical age range for arm pain and joint symptoms

Symptoms usually start between 35 and 60. Many first notice stiffness or pain in their hands and arms during this time. Spotting these signs early is key for joint health.

How genetics, immune activity, smoking, and other factors may contribute

Getting RA involves many factors. Genetics can play a role, and smoking can make it worse. When the body attacks healthy tissue, it can cause fever and joint pain.

Rheumatoid Arthritis Arm Pain and the Joints Most Often Involved

Understanding which joints are affected is key to managing RA. This condition doesn’t just hit one spot. It usually starts in smaller joints and then moves to bigger ones.

Hand joints rheumatoid arthritis commonly affects

The hands are often the first to show symptoms. Look for swelling in the knuckles or where fingers meet the palm. These areas can be tender and warm to the touch.

Wondering what does ra look like in hands? The signs can vary. You might see puffiness, redness, or fingers that seem slightly off. Early detection in these small joints is key to avoiding lasting damage.

Wrist, elbow, shoulder, and upper-arm involvement

As RA progresses, it often spreads to the wrists. Wrist pain can make everyday tasks hard. Inflammation can also move up the arm.

The elbows and shoulders are common pain spots too. Inflammation around these joints can cause deep pain in the upper arm. This can limit your ability to move and reach overhead.

How RA joint involvement differs from isolated muscle strain

It’s important to tell the difference between RA pain and a muscle strain. A muscle injury usually happens after a specific event and gets better with rest.”Rheumatoid arthritis is characterized by persistent, symmetrical inflammation that does not resolve with the typical rest used for muscle recovery.”

RA pain is symmetrical, affecting both sides of the body. It also causes long-lasting morning stiffness, a sign that sets it apart from a temporary strain.

Why small joints of the hands and feet are affected so often

RA targets the synovium, the lining of the joint. Small joints of the hands and feet have a lot of this lining, making them prime targets.

  • The high surface area of the synovium in small joints attracts more immune activity.
  • Increased blood flow to these areas may carry more inflammatory cells.
  • The complex structure of these joints makes them more susceptible to persistent irritation.

Early Signs of Rheumatoid Arthritis in the Hands, Knees, and Arms

Early signs of rheumatoid arthritis often start with morning stiffness in your hands, knees, and arms. Spotting these signs early is key to getting the right treatment. This is crucial for keeping your joints working well over time. Pay attention to how your body feels after rest and activity.

Morning stiffness lasting 30 minutes or longer

Doctors look for morning stiffness rheumatoid arthritis patients feel when they wake up. While some stiffness is normal after sleep, this kind lasts over 30 minutes. It makes moving your joints hard until you’ve been active for a bit.

Symmetrical swelling, tenderness, warmth, and reduced grip strength

Rheumatoid arthritis often affects both sides of the body at once. You might notice both wrists or hands are tender, warm, or swollen. This swelling can make it hard to grip things, making simple tasks tough.

Early signs rheumatoid arthritis in knees may produce

While hands often show signs first, knees can be affected early too. You might feel a dull ache or instability when walking or climbing stairs. Instead of looking for early signs rheumatoid arthritis in knees pictures of online, see a doctor for a proper check-up.

What rheumatoid arthritis symptoms in hands can look and feel like

In the hands, symptoms include a constant, throbbing pain in small joints. Your knuckles might look puffy or feel sensitive. These changes can make simple tasks like buttoning a shirt or typing hard and uncomfortable.

Symptom TypeCommon PresentationImpact on Daily Life
Morning StiffnessLasts over 30 minutesLimits early morning mobility
Joint SwellingSymmetrical and warmReduces range of motion
Grip StrengthWeakness in handsDifficulty with daily tasks
Knee DiscomfortAching during movementChallenges with walking

How RA Progresses From Pain and Swelling to Joint Damage

The journey from swelling to joint damage is a big worry for our patients. Long-term inflammation doesn’t just cause temporary pain. It changes the joints’ structure.

What cartilage destruction means for movement and function

Cartilage is the cushion between bones, making movement smooth. Chronic inflammation erodes this layer. Bones then rub against each other, causing significant pain and restricted range of motion.

This is clear in rheumatoid arthritis symptoms in hands. Losing this cushion makes simple tasks hard.

How persistent inflammation may contribute to deformities

Loss of cartilage weakens ligaments and tendons. This instability can shift joints out of place. Over time, this may cause visible deformities in hands, wrists, and feet.

Early treatment is essential to preserve joint integrity and keep your quality of life.

Why more than two-thirds of patients experience moderate to severe symptoms

This condition affects people differently, but many face big challenges. Research shows over two-thirds of patients have moderate to severe symptoms. They often deal with persistent swelling and pain that need consistent medical management to avoid disability.

How swollen legs and knees may occur with rheumatoid arthritis

While we often focus on the upper body, the lower limbs are also affected. Patients may see swollen legs rheumatoid arthritis in the knees or ankles. If you have new or ongoing swelling in your lower limbs, get a professional check-up to find the cause and adjust your treatment.

Rheumatoid Arthritis Systemic Symptoms Beyond the Joints

Rheumatoid arthritis (RA) is more than just joint pain. It affects your whole body because it’s an autoimmune disease. This means your body’s immune system attacks healthy tissues, causing inflammation everywhere.

Many people with RA feel like they have the flu all the time. This is because their immune system is always on high alert. It leads to a lot of physical tiredness.

Fatigue, fever, and a general feeling of illness

Fatigue is a big problem for those with RA. It’s not just feeling tired. This debilitating fatigue lasts even after a good night’s sleep.

You might also lose your appetite or lose weight without trying. These signs show your body is fighting hard to control the inflammation.

Can rheumatoid arthritis cause fever?

Yes, RA can cause fever, but it’s usually a low-grade one. It’s not as high as what you’d see with a cold or flu.

Remember, fever can be caused by many things, including infections. If you have ra and fever, see your doctor to check for other issues.

Rheumatoid arthritis and high white blood cell count

RA causes inflammation, which can change your blood work. A high white blood cell count is common. This is because your immune system is fighting the inflammation in your joints.

Keeping an eye on these blood levels helps your doctor see how severe your RA is. Always talk to your doctor about any new or ongoing symptoms. This ensures your treatment is working well.

Symptom CategoryCommon ManifestationsImpact on Daily Life
Local SymptomsJoint swelling, stiffness, painReduced mobility and grip
Systemic SymptomsFatigue, low-grade fever, malaiseDecreased energy and stamina
Laboratory FindingsElevated white blood cell countIndicates active inflammation

Complications of RA Affecting the Eyes, Heart, Lungs, and Circulation

Rheumatoid arthritis is more than just joint pain. It’s a disease that can affect many parts of the body. It’s important to watch for signs that go beyond joint pain. This helps keep you healthy in the long run.

Eye inflammation, dryness, redness, and vision changes

The eyes can be affected by rheumatoid arthritis. You might feel dryness, redness, or grittiness. Any sudden vision changes should be told to your doctor right away.

Heart and blood-vessel risks linked to chronic inflammation

Chronic inflammation can harm more than just cartilage. It can also affect your heart and blood vessels. Taking care of your heart is key to managing your RA.

Lung complications, shortness of breath, and persistent cough

RA can also affect your lungs. This might cause scarring or inflammation. If you have a cough or trouble breathing, see a doctor. Early treatment can help a lot.

Circulatory symptoms and other extra-articular effects of RA

RA can also cause changes in your circulation and skin. These symptoms might need a team of doctors to manage. A fever with rheumatoid arthritis means your body is fighting inflammation.

It’s important to talk to all your doctors about your symptoms. This ensures your whole health is taken care of. Reporting new symptoms quickly is key to staying healthy.

Why Early Diagnosis Within Six Weeks Matters

Noticing persistent arm pain early is key. Acting fast in the first six weeks can greatly improve your health. Early detection helps doctors stop joint damage before it’s too late. Getting help quickly helps keep your joints moving and your life quality high.

How a healthcare professional evaluates rheumatoid arthritis arm pain

A specialist starts by listening to your pain story. They look for signs of inflammation, not just muscle tiredness. This first talk helps figure out what’s causing your pain.

Medical history, physical examination, and assessment of RA joints involved

Your doctor will check your joints for warmth, swelling, and tenderness. They look for symmetrical symptoms, a sign of RA. They also review your family health history to see if others have similar issues.

Blood tests for inflammation, antibodies, and abnormal white blood cell counts

Lab tests show how active your immune system is. Doctors look for markers of inflammation and autoantibodies. They also check for high white blood cell counts, common in RA flares. This helps them create a treatment plan for your joint pain and immune health.

How X-rays, ultrasound, and MRI can identify joint inflammation or damage

When exams and blood tests aren’t clear, imaging helps. Ultrasound and MRI spot inflammation early. They show cartilage loss or structural changes, helping doctors tailor your treatment.

Diagnostic ToolPrimary PurposeKey Benefit
Physical ExamAssess swelling and range of motionImmediate clinical insight
Blood PanelsIdentify antibodies and inflammationDetects systemic immune activity
Ultrasound/MRIVisualize soft tissue and cartilageEarly detection of joint damage
X-raysEvaluate bone structureMonitors long-term progression

Treatments That Can Reduce Rheumatoid Arthritis Arm Pain

Relief comes from a plan that tackles pain and disease activity. We create a plan that balances long-term health with symptom relief. This improves your life quality.

Disease-modifying antirheumatic drugs and long-term disease control

DMARDs are key in managing rheumatoid arthritis. They slow disease progress, not just hide symptoms. They calm the immune system, protecting joints and tissues.

It’s important to check your blood often when on these drugs. Some might see low wbc rheumatoid arthritis in blood tests. Your doctor will adjust your treatment to keep you safe.

Biologic and targeted synthetic medications for persistent disease activity

For those not helped by usual treatments, we try biologic or targeted synthetic drugs. These treatments block immune system pathways that cause inflammation. They’re great for those with ongoing disease activity.

These drugs are a big step forward in treating rheumatoid arthritis. They help target the cause of pain while keeping you healthy.

Short-term anti-inflammatory and pain-relief options

While waiting for long-term treatments, we use short-term options. NSAIDs and corticosteroids quickly reduce swelling and stiffness. Patients often wonder how long does rheumatoid arthritis fever last. These symptoms usually go away as the inflammation is controlled.

Physical and occupational therapy for strength, mobility, and joint protection

Medicine isn’t the only answer. Physical and occupational therapy are key. They help keep joints moving and build strength. Occupational therapists teach ways to protect your joints during daily activities.

Treatment CategoryPrimary GoalTypical Usage
DMARDsDisease ModificationLong-term maintenance
BiologicsTargeted SuppressionPersistent inflammation
NSAIDs/SteroidsSymptom ReliefShort-term flare management
TherapyFunctional SupportOngoing rehabilitation

Managing Arm Symptoms Safely at Home

Managing arm symptoms at home is key to your health. Medical treatments are important, but your daily habits matter too. By making your home supportive, you can handle chronic inflammation better.

Balancing rest with gentle movement during flares

When you’re in a flare, your body might want to rest. But too much rest can make your joints stiff and muscles weak. It’s best to find a balanced approach. Rest when needed, but also do gentle exercises to keep your joints flexible.

  • Listen to your body’s signals to avoid overexertion.
  • Perform slow, controlled stretches to maintain flexibility.
  • Avoid heavy lifting or repetitive motions that trigger pain.

Using heat for stiffness and cold for swelling when appropriate

Temperature therapy is a simple but effective way to feel better. Heat is good for soothing morning stiffness. It relaxes tight muscles and improves blood flow. On the other hand, cold packs are great for reducing swelling and numbing pain during a flare.”Consistency in applying thermal therapy can significantly improve daily function and reduce the reliance on oral pain medications.” Medical Advisory Board

Protecting the hands, wrists, elbows, and shoulders during daily activities

Making small changes to your daily routine can help protect your joints. Use ergonomic tools like wider-grip utensils or jar openers to ease pressure on your hands and wrists. Try to spread the weight of tasks across larger joints instead of just your fingers or wrists.

Tracking morning stiffness, swelling, fever, and changes in arm function

Keeping a health journal is important for your doctor’s visits. It helps your healthcare team understand how your disease is progressing. When wondering, “which of the following is symptomatic of rheumatoid arthritis,” remember to track these key signs:

  • Duration of morning stiffness: Note if it lasts longer than 30 minutes.
  • Swelling and warmth: Document the frequency and location of visible inflammation.
  • Systemic signs: Record any unexplained fevers or persistent fatigue.
  • Functional changes: Note any new difficulty with tasks like buttoning shirts or gripping objects.

Conclusion

Managing your health is key when you feel persistent discomfort in your limbs. Spotting the signs of rheumatoid arthritis arm pain is a big step. It helps protect your long-term mobility and quality of life.

If you notice recurring stiffness or swelling, don’t wait. Seek a professional evaluation right away. Early diagnosis is key to avoiding permanent joint damage and keeping your independence.

Today, there are many ways to manage rheumatoid arthritis. A treatment plan tailored to you can reduce inflammation and ease symptoms like fatigue or fever. You don’t have to face this alone.

Our team is here to support and guide you. Contact a qualified healthcare provider today to talk about your symptoms. Start your journey to better health now and keep your future comfortable and strong.

How Rheumatoid Arthritis Can Cause Arm Pain

Inflammation in the joints, tendons, and surrounding tissues

Rheumatoid arthritis often causes arm pain due to the immune system attacking the joints. This leads to swelling and discomfort in the joints, tendons, and surrounding tissues. It results in a radiating ache throughout the arm.

How pain may travel from the hands and wrists into the arms

The musculoskeletal system is connected, so inflammation in the hands can spread to the arms. We see patients where wrist involvement causes pain to move up to the forearm and upper arm.

Why rheumatoid arthritis pain can affect both sides of the body

Rheumatoid arthritis often affects both sides of the body symmetrically. If one elbow or wrist is affected, the other will likely be too. This symmetry helps us diagnose RA.

Who Develops Rheumatoid Arthritis and When Symptoms Begin

How common rheumatoid arthritis is in the United States

Rheumatoid arthritis affects about 1.3 million adults in the United States. It is a significant health concern and a common form of arthritis we treat.

Why women are approximately three times more likely than men to develop RA

Women are three times more likely to develop RA than men. Hormonal influences may play a role in this disparity.

The typical age range for arm pain and joint symptoms

RA often starts in adults between 35 and 60. Early treatment during this age range is key to preserving joints.

How genetics, immune activity, smoking, and other factors may contribute

RA is a complex condition influenced by genetics and environmental factors. Smoking can worsen the disease, so we advise against it.

Rheumatoid Arthritis Arm Pain and the Joints Most Often Involved

Hand joints rheumatoid arthritis commonly affects

The small joints of the hands, like knuckles and finger joints, are often the first to show symptoms. We monitor these areas for swelling that interferes with daily tasks.

Wrist, elbow, shoulder, and upper-arm involvement

As RA progresses, it can affect the wrists, elbows, and shoulders. This can limit movement and make everyday tasks difficult.

How RA joint involvement differs from isolated muscle strain

RA is different from a simple muscle strain because it involves inflammation. Unlike a strain, RA symptoms include joint warmth and stiffness that require medical treatment.

Why small joints of the hands and feet are affected so often

The immune system often targets the smaller joints first. We look for signs of RA in the hands and feet, as they are early indicators of systemic inflammation.

Early Signs of Rheumatoid Arthritis in the Hands, Knees, and Arms

Morning stiffness lasting 30 minutes or longer

Morning stiffness lasting over 30 minutes is a key indicator of RA. It is different from the brief stiffness seen in aging or wear-and-tear.

Symmetrical swelling, tenderness, warmth, and reduced grip strength

We look for symmetrical swelling and warmth in the joints. Patients often report a decline in grip strength, making everyday tasks challenging.

Early signs rheumatoid arthritis in knees may produce

RA can also affect the knees, causing difficulty climbing stairs or a “spongy” feeling in the joint. We recommend seeking professional evaluation over self-diagnosis.

What rheumatoid arthritis symptoms in hands can look and feel like

Rheumatoid arthritis in the hands presents as visible puffiness and tenderness. These symptoms are a physical manifestation of the autoimmune attack.

How RA Progresses From Pain and Swelling to Joint Damage

What cartilage destruction means for movement and function

Chronic inflammation can lead to cartilage destruction. Once cartilage is lost, bones may rub together, limiting movement and causing permanent damage.

How persistent inflammation may contribute to deformities

Long-term inflammation can weaken ligaments and tendons, leading to joint deformities. Early intervention is key to preventing these deformities.

Why more than two-thirds of patients experience moderate to severe symptoms

Without proper treatment, over two-thirds of patients may experience severe symptoms. Our goal is to move patients toward remission or low disease activity.

How swollen legs and knees may occur with rheumatoid arthritis

Swollen legs and knees are common in RA patients. We take new or severe swelling seriously, requiring a thorough medical evaluation.

Rheumatoid Arthritis Systemic Symptoms Beyond the Joints

Fatigue, fever, and a general feeling of illness

RA is not just a joint disease; it affects the whole body. Patients often experience profound fatigue and a general feeling of being unwell.

Can rheumatoid arthritis cause fever?

Yes, RA can cause a low-grade fever. This is a sign of systemic inflammation.

Rheumatoid arthritis and high white blood cell count

A high white blood cell count is often linked to RA during flares. The body produces more immune cells to fuel the inflammatory response.

Complications of RA Affecting the Eyes, Heart, Lungs, and Circulation

Eye inflammation, dryness, redness, and vision changes

RA can cause eye inflammation and severe dryness. Any sudden vision changes or persistent redness should be reported immediately.

Heart and blood-vessel risks linked to chronic inflammation

Chronic inflammation can affect the cardiovascular system. We work with patients to manage heart and blood-vessel risks.

Lung complications, shortness of breath, and persistent cough

RA can also affect the lungs, causing coughs or shortness of breath. We monitor for these symptoms, which may indicate lung inflammation.

Circulatory symptoms and other extra-articular effects of RA

RA can impact nerves and blood vessels, causing numbness or tingling in the arms. These effects highlight the need for a multi-specialty approach to treatment.

Why Early Diagnosis Within Six Weeks Matters

How a healthcare professional evaluates rheumatoid arthritis arm pain

We perform a detailed evaluation of arm pain to diagnose RA. We look for specific patterns of swelling and functional limitations.

Medical history, physical examination, and assessment of RA joints involved

We combine your medical history with a physical exam to map out RA joint involvement. Knowing which joints are affected helps us build an accurate diagnosis.

Blood tests for inflammation, antibodies, and abnormal white blood cell counts

Diagnostic tests are essential. We look for specific antibodies and check for a high white blood cell count. In some cases, we may see a low WBC count, which requires careful monitoring.

How X-rays, ultrasound, and MRI can identify joint inflammation or damage

We use advanced imaging like ultrasound and MRI to detect inflammation and early structural changes. These tools help us identify issues before they appear on a standard X-ray.

Treatments That Can Reduce Rheumatoid Arthritis Arm Pain

Disease-modifying antirheumatic drugs and long-term disease control

Our primary strategy involves DMARDs. These medications slow the progression of the disease and are the cornerstone of treatment.

Biologic and targeted synthetic medications for persistent disease activity

For patients not responding to traditional therapies, we may introduce biologics or JAK inhibitors. These targeted treatments block specific parts of the immune system to halt inflammation.

Short-term anti-inflammatory and pain-relief options

To manage immediate pain, we may use NSAIDs or short-term steroids. We use these carefully to bridge the gap until long-term medications take effect.

Physical and occupational therapy for strength, mobility, and joint protection

We believe in the power of movement. Physical and occupational therapy are vital for maintaining strength and learning how to protect your joints during daily activities.

Managing Arm Symptoms Safely at Home

Balancing rest with gentle movement during flares

During a flare, finding a balance between rest and gentle movement is important. Gentle movement helps prevent further stiffness.

Using heat for stiffness and cold for swelling when appropriate

Safe home care includes using heat to soothe morning stiffness and cold packs to reduce swelling. We guide you on the best timing for each method.

Protecting the hands, wrists, elbows, and shoulders during daily activities

We teach joint protection techniques, such as using larger joints to carry bags or using ergonomic tools. Protecting these areas today helps preserve function for the future.

Tracking morning stiffness, swelling, fever, and changes in arm function

We encourage you to keep a log of your symptoms. Tracking fever and the duration of your stiffness helps us fine-tune your treatment plan.

FAQ

How long does rheumatoid arthritis fever last?

A low-grade fever from an RA flare usually lasts while inflammation remains active and improves as the underlying disease is controlled.

What does RA look like in hands during the early stages?

Early RA in the hands may cause symmetrical swelling, warmth, redness, and a soft or boggy feeling in the knuckles and finger joints.

Which of the following is symptomatic of rheumatoid arthritis beyond joint pain?

Beyond joint pain, RA may cause fatigue, low-grade fever, unexplained weight loss, and prolonged morning stiffness.

Can RA cause a low white blood cell count?

Yes, a low white blood cell count can occur with RA, including in Felty’s syndrome or as a medication side effect, and requires medical monitoring.

Is it common to have swollen legs with rheumatoid arthritis?

Swollen legs can occur with RA, particularly when the knees or ankles are involved, although other causes of leg swelling should also be evaluated.

How many joints are typically involved in an RA diagnosis?

RA commonly affects multiple joints, especially the small joints of the hands and feet, often in a symmetrical pattern.

Does RA cause fever frequently?

RA can cause a low-grade fever, particularly during periods of increased systemic inflammation.

What are the primary signs of RA in hands to watch for at home?

Watch for persistent symmetrical swelling, warmth, tenderness, prolonged morning stiffness, and difficulty moving or gripping with the hands.

References

Nature. https://www.nature.com/articles/s41571-019-0193-0