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Rheumatoid arthritis

Rheumatoid arthritis is a condition that causes inflammation, mainly in your joints and the tissues around them. This causes stiffness, pain and swelling. Most often people get rheumatoid arthritis in their hands and feet but it can affect any joint, as well as other parts of your body.

Rheumatoid arthritis is an inflammatory disease. It develops when your body’s immune system starts to attack and damage your joints and the surrounding tissues.

Rheumatoid arthritis is the second most common type of arthritis in the UK; it affects around one in every 100 people. You’re most likely to develop rheumatoid arthritis between the ages of 40 and 60, although you can get it at any age. More women get it than men.

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An image showing the areas of the hand commonly affected by rheumatoid arthritis

Details

  • Symptoms Symptoms of rheumatoid arthritis

    Symptoms that affect your joints

    Symptoms of rheumatoid arthritis include:

    • pain and swelling around your joint(s), making them feel tender and warm
    • stiffness in the morning, or if you sit for a long time

    If you have any of these symptoms, contact your GP.

    Rheumatoid arthritis usually affects the joints on both sides of your body at roughly the same time. And most people find it affects their hands and feet. But you may also get rheumatoid arthritis in your knees and shoulders, and less commonly in your hips, elbows and other joints.

    Rheumatoid arthritis often develops quite slowly at first. But for some people, it comes on quickly and painfully, and can make it difficult to carry out everyday activities. The inflammation may come and go – you might have periods where your condition flares up and your symptoms get worse. This may last from several days to up to a month. In between flare-ups, the inflammation may go down and you may have barely any symptoms – this may last for months or even years.

    Other symptoms

    As well as symptoms that affect your joints you may also get more general symptoms such as:

    • tiredness, which can make you feel low or depressed
    • flu-like symptoms, such as a fever
    • weight loss

    Sometimes inflammation can develop in other areas of your body, such as your lungs and eyes. If this happens, you might get symptoms such as dry eyes, shortness of breath and a cough and, later, chest pain.

  • Diagnosis Diagnosis of rheumatoid arthritis

    If you think you have rheumatoid arthritis – even if your symptoms are mild – contact your GP. It’s important to be diagnosed as early as possible because the sooner you start treatment, the better it’s likely to work.

    Your GP will ask about your symptoms and examine you. They may also ask you about your medical history. Your GP may arrange for you to have a blood test to check for a number of things, such as rheumatoid factor and anti-CCP antibodies. These are produced by a reaction in your immune system. Your doctor may also arrange for you to have an X-ray to look for changes in your joints.

    If your GP thinks you have rheumatoid arthritis, they will refer you to see a rheumatologist – a doctor who specialises in identifying and treating arthritis. Your rheumatologist may suggest you have other tests such as an ultrasound or MRI scan to examine your joints further.

  • Treatment Treatment of rheumatoid arthritis

    Although there’s no cure for rheumatoid arthritis, there are many treatments that can suppress the disease process in your joints and control your symptoms. Treatments can also slow down the development of the condition and reduce the damage to your joints. The earlier you start treatment, the more effective it will be.

    Medicines

    Painkillers and anti-inflammatory medicines

    Over-the-counter painkillers, such as paracetamol and codeine, may help to ease your pain. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    Non-steroidal anti-inflammatory drugs (NSAIDs) help to control pain and stiffness. Your doctor may prescribe the lowest dose possible for you for short periods of time. This is because using them long-term is linked with heart, kidney and stomach problems. If you take NSAIDs regularly, your doctor may suggest you take a medicine called a proton pump inhibitor as well. This will protect your stomach and reduce the risk of side-effects from NSAIDs.

    Steroids

    Your doctor may prescribe you corticosteroids, particularly during a flare-up, to reduce inflammation. These can help to reduce pain and inflammation while you're waiting for other treatments to start working. Corticosteroids can have side-effects if you use them for long periods of time. Because of this, your doctor will give you the lowest effective dose and monitor you closely. It’s also important not to stop taking corticosteroids suddenly as this can be dangerous.

    Disease-modifying antirheumatic drugs (DMARDs)

    DMARDs work on your immune system and reduce the attack on your joints. If you take DMARDs early enough, it may help to reduce any long-term damage to your joints. They can take several weeks or months to have an effect, so keep taking them even if they don't seem to be working. DMARDs include:

    • methotrexate
    • sulfasalazine
    • leflunomide
    • hydroxychloroquine

    If you’re taking DMARDs, you’ll need to have regular tests of your blood and urine to check for any side-effects.

    Biological medicines

    If DMARDs don’t work well for you, or you have side-effects from them, your doctor may suggest you take a biological medicine. These work by targeting certain chemicals that cause inflammation and mimic substances produced by your own body, such as antibodies. Unlike most medicines, which are made by chemical processes, biological medicines are made from living organisms, such as cloned human white blood cells. You can take biological medicines on their own, or with a DMARD. Biological medicines include:

    • abatacept
    • infliximab
    • etanercept
    • adalimumab
    • certolizumab
    • rituximab
    • tocilizumab
    • golimumab

    Surgery

    If other treatments haven’t worked, you may be offered surgery. Operations vary from minor procedures (sometimes keyhole surgery) to remove the inflamed lining of a joint, to more major surgery to completely replace a joint.

    Talk to your doctor for more information and to find out what your options are.

    Physical therapies

    Your doctor may refer you to a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility). They can give you exercises that will help you to stay flexible and build up your muscle strength. They can also help you to improve your general level of fitness.

    If you have problems with your feet, a podiatrist (a health professional who specialises in conditions that affect the feet) may be able to help. They can give you advice and help you to find the right footwear. If you have problems with your hands, your doctor may refer you to see a hand specialist. They will help you with strategies to manage pain and give you advice on how to keep your hands functioning. They can advise you on the aids available to help with everyday living) as well as on splints to protect your joints.

    Complementary therapies

    Many people with rheumatoid arthritis use complementary medicines to ease their symptoms. There’s some evidence that omega-3 oils (for example, fish oils) can help to ease joint pain and stiffness. Complementary therapies such as acupuncture, aromatherapy and massage may relieve pain and stiffness and make you feel more relaxed. Yet there isn't any evidence that they have any effect on how rheumatoid arthritis develops.

    Speak to your doctor before you try any complementary therapy.

  • Muscle, bone and joint treatment

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including muscle, bone and joint treatment.

  • Causes Causes of rheumatoid arthritis

    The exact reasons why you may develop rheumatoid arthritis aren’t fully understood. But if other members of your family have it, you’re more likely to get it.

    Your lifestyle may also increase your risk of developing rheumatoid arthritis. For example, if you smoke you may be more likely to develop it. Other things that have been proposed as triggers for rheumatoid arthritis include stress, infection, and hormone changes.

  • Living with rheumatoid arthritis Living with rheumatoid arthritis

    Living with rheumatoid arthritis can be difficult. The more severe your condition is, the bigger the impact it’s likely to have on your life. As with many long-term conditions that cause pain and discomfort, having rheumatoid arthritis can affect your emotions and your relationships with those around you. Our tips and advice on mental health may help you find ways to manage.

    Rheumatoid arthritis can also have an impact on your sleep, which may affect other areas of your life, or lead to depression. If you’re having trouble sleeping, our information about sleep, including tips on how to get a better night’s sleep, may be useful.

    It’s important to get help if you are struggling to live with rheumatoid arthritis. If you’re finding it difficult to work because of the pain, help is out there. An occupational therapist can help you find new ways to manage. An occupational therapist is health professional who can give practical assistance to help you with everyday tasks and increase your independence. For tips on making life easier at home, see our question What can I do at home to make life easier?

    Talk to your doctor about the impact rheumatoid arthritis has on your day-to-day life and what can be done to help you. They may be able to change your medicines for a while until your symptoms improve, for example. You may also find it helpful to contact support groups and talk to other people living with the condition.

  • How will rheumatoid arthritis affect me in the future? How will rheumatoid arthritis affect me in the future?

    Answer

    It's difficult to say because rheumatoid arthritis affects people differently. You may have few flare-ups and be able to lead a relatively normal life, or if it’s more severe, you might have some disability.

    More information

    It’s hard to predict how your condition will be in the future. Some people are able to lead their life almost as usual but if your joints are severely damaged, over time they can become unstable. This can lead to long-term pain and disability. By starting treatment for rheumatoid arthritis early, you can help to minimise the damage to your joints.

    It's also important to follow your treatment plan and lead a healthy lifestyle. This may mean making some changes, such as losing weight and stopping smoking. Your doctor can give you more advice and information.

  • What can I do at home to make life easier? What can I do at home to make life easier?

    Answer

    If you make some changes to your home and car, it can help to protect your joints and reduce pain and stiffness. Finding new ways to move or lift things and pacing yourself can help to reduce the stress on your joints.

    More information

    There are many things you can do at home to make everyday tasks easier and reduce the stress on your joints. If you make a few small changes, it may help to protect your joints and prevent problems from becoming worse in the future. Here are just a few tips.

    • Use labour-saving gadgets and aids specially designed for people with arthritis. These include devices for turning on taps, kitchen utensils with padded handles and automatic can openers.
    • Rearrange your kitchen and other rooms to make sure the things you use most are easy to reach.
    • When you lift things, try to reduce the weight of the item and spread the load across more than one joint. For example, lift things with two hands instead of one. Or slide heavy things rather than pick them up – such as heavy pans across the worktop.
    • Plan ahead and pace your day. Don’t do strenuous jobs all at once. Instead, split them into smaller jobs and do a little at a time. You may find it easier to leave larger jobs for the afternoons when you’re less stiff and sore.
    • Adapt your car to make driving easier. A padded steering wheel, extra side mirrors or a steering wheel knob may all help. If your rheumatoid arthritis is more severe, consider a car with an automatic gearbox rather than a manual one.

    An occupational therapist can assess you in your home to see whether you may be eligible for financial help to make changes to your home. Your local social services department may also be able to help with equipment, or with adapting your home. Some equipment may be available through the NHS, but you may have to pay some costs yourself.

  • Will exercise make my rheumatoid arthritis worse? Will exercise make my rheumatoid arthritis worse?

    Answer

    Not if you exercise carefully. Exercise can help you manage your pain and reduce stress on your joints, as well as keep you mobile. The key is getting the balance right between rest and exercise.

    More information

    If your joints are inflamed, getting some rest will help you feel better. But don’t rest for too long because if you don't keep them moving, your joints will stiffen and your muscles will get weak. Exercise won’t make your arthritis worse, as long as it’s the right kind of exercise.

    Your physiotherapist can help to design an exercise programme specifically for you. This will include different types of exercise, such as strengthening exercises, flexibility exercises and aerobic exercise to keep you fit.

    Here are some tips that may help you when you’re exercising.

    • Exercise when you’re in the least amount of pain. If you have pain during exercise, stop and rest.
    • Don’t do vigorous or contact sports, such as squash, because these can jar your joints.
    • During a flare-up, just do range of movement and gentle strengthening exercises.
    • Find an exercise you enjoy. Swimming and other exercises in water are particularly good if you have arthritis as your joints are supported by the water.
  • Other helpful websites Other helpful websites

    Further information


    Sources

    • Rheumatoid arthritis in over 16s. National Institute for Health and Care Excellence (NICE), 28 June 2013. www.nice.org.uk
    • Rheumatoid arthritis. BMJ Best Practice. www.bestpractice.bmj.com, published 6 October 2014
    • Rheumatoid arthritis. PatientPlus. www.patient.info/patientplus, reviewed 20 January 2015
    • Rheumatoid arthritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2013
    • Bykerk VP, Massarotti EM. The new ACR/EULAR remission criteria: rationale for developing new criteria for remission. Rheumatology (Oxford) 2012; 51(Suppl 6):vi16–20. www.rheumatology.oxfordjournals.org
    • Rheumatoid arthritis. Arthritis Research UK. www.arthritisresearchuk.org, published June 2014
    • Rheumatoid arthritis and the lung. PatientPlus. www.patient.info/patientplus, reviewed 16 October 2012
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 9 November 2015
    • Map of Medicine. Rheumatoid Arthritis. International View. London: Map of Medicine; 2012 (Issue 4).
    • Rheumatoid arthritis (RA). The Merck Manuals. www.merckmanuals.com, published August 2015
    • DMARDS. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2015
    • Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2014; 73:492–509. www.ard.bmj.com
    • Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs. National Institute for Health and Care Excellence (NICE), 24 April 2013. www.nice.org.uk
    • Adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis. National Institute for Health and Care Excellence (NICE), 22 October 2007. www.nice.org.uk
    • The role of the podiatrist in the management of rheumatoid arthritis. National Rheumatoid Arthritis Society. www.nras.org.uk, reviewed 24 January 2013
    • Management of rheumatoid arthritis. PatientPlus. www.patient.info/patientplus, reviewed 27 January 2015
    • Useful tips. National Rheumatoid Arthritis Society. www.nras.org.uk, reviewed 28 February 2013
    • Everyday living and arthritis. Arthritis Research UK. www.arthritisresearchuk.org, published April 2013
    • Benefits and rheumatoid arthritis. National Rheumatoid Arthritis Society. www.nras.org.uk, reviewed May 2015
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