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Rheumatoid arthritis


Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist
Next review due April 2021

Rheumatoid arthritis is a condition which causes pain, swelling and stiffness in your joints. 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.

There isn’t a cure for rheumatoid arthritis, but treatments can help relieve pain and lessen the chance of damage to your joints. It’s important to start treatment early, so if you think you may have rheumatoid arthritis, contact your GP.

Holding hands

About rheumatoid arthritis

Rheumatoid arthritis develops when your body’s immune system starts to attack the tissue lining your joints. This causes inflammation. Over time, this inflammation can damage your joints and the surrounding tissues. You may also have inflammation in other parts of your body, including your eyes and your lungs.

Rheumatoid arthritis 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.

When someone says they have arthritis, they often mean they have osteoarthritis. This is a different and more common condition, and has different treatments. See our information on osteoarthritis.

Symptoms of rheumatoid arthritis

The symptoms of rheumatoid arthritis vary from person to person. They often begin quite slowly at first, affecting just a few joints. But for some people, the condition comes on quickly and painfully, affecting lots of joints.

The inflammation may come and go. You might have periods where your condition flares up and your symptoms get worse, followed by periods with little inflammation. Most people have months or even years between flare-ups.

Symptoms that affect your joints

Symptoms of rheumatoid arthritis include:

  • pain in your joints, especially on movement; they may feel painful to touch
  • swelling around your joint(s), which may feel warm
  • stiffness in your joints, especially in the morning or if you’re inactive for a long time

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 other joints, including your shoulders, ankles, neck, knees, hips and elbows.

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 and feeling generally unwell
  • 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.

If you think you may have symptoms of rheumatoid arthritis, contact your GP.

Diagnosis of rheumatoid arthritis

It’s important to be diagnosed as early as possible because the sooner you start treatment, the less damage there will be to your joints.

Your GP will ask about your symptoms and your medical history, and examine you. They may arrange for you to have a blood test. The blood test will look for several different things to help your GP decide whether you have rheumatoid arthritis or another condition. Blood tests for rheumatoid arthritis include tests checking for inflammation and antibodies. These tests are useful, but they can’t say for certain if you have rheumatoid arthritis.

Your GP 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’ll 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 scan or MRI scan to examine your joints further.

If you want to know more about any tests your doctor recommends and how they might help, just ask.

Treatment of rheumatoid arthritis

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

Medicines

Painkillers

Your doctor may recommend that you try over-the-counter painkillers, such as paracetamol (with or without codeine), to help ease your pain. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 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 steroids (corticosteroids), particularly during a flare-up, to reduce inflammation. They can help to reduce pain and inflammation while you're waiting for other treatments to start working. Corticosteroids are usually only used for a short time – this is to reduce the chances of you getting side-effects from them. You may find it helpful to read our information on corticosteroids.

In certain circumstances, your doctor may offer you an injection of corticosteroids into one or more of your affected joints. If this is an option for you, your doctor will explain what’s involved and how the injection might help. To find out more, see our information on steroid joint injections.

Disease-modifying antirheumatic drugs (DMARDs)

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

Examples of DMARDs include:

  • methotrexate
  • sulfasalazine
  • leflunomide
  • hydroxychloroquine

If you’re taking DMARDs, you’ll need to have regular blood tests 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 are newer medicines that work by targeting certain chemicals that cause inflammation. They are given by injection or infusion (a drip into your vein). You can take biological medicines on their own or with a DMARD.

Biological medicines include:

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

Surgery

Surgery can sometimes be helpful if you have significant joint damage from rheumatoid arthritis. It can help to relieve pain, reduce deformities and improve how well your joint works. If your doctor thinks surgery may be a good option for you, they’ll refer you to a surgeon with experience of treating people with rheumatoid arthritis.

There is a range of different types of surgery which might help – from minor procedures to correct deformities to full joint replacements.

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

Physical therapies

Your doctor may refer you to a range of experts in physical therapies who can help you look after your joints and manage everyday living. These may include the following.

  • A physiotherapist – a health professional who specialises in maintaining and improving movement and mobility. They can show 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.
  • A podiatrist, if you have problems with your feet. A podiatrist is a health professional who specialises in conditions that affect the feet. They can give you advice and help you to find the right footwear.
  • A hand specialist, if you have problems with your hands. They’ll show you what to do to help you manage pain and give you advice on how to keep your hands working well.
  • An occupational therapist – a health professional who gives practical assistance to help you manage with everyday tasks and increase your independence. 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 be soothing and make you feel more relaxed. There isn't any evidence that they work as a treatment for rheumatoid arthritis.

Speak to your doctor before you try any complementary therapy. Remember that complementary therapies may interfere with conventional medicines and shouldn’t replace the treatment your doctor recommends.

Causes of rheumatoid arthritis

Doctors don’t yet know why some people get rheumatoid arthritis.

There’s probably a genetic cause in some cases – so you’re more likely to get rheumatoid arthritis if a close relative has it. Some experts think rheumatoid arthritis is triggered by an infection of some sort. And your lifestyle may also increase your risk of developing rheumatoid arthritis. For example, you’re more likely to develop it if you smoke.

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 which 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. If you think you may be getting depressed, talk to your GP.

Rheumatoid arthritis can also have an impact on your sleep, which may affect other areas of your life. 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’re struggling to work with rheumatoid arthritis. Speak to your employer about making reasonable changes to your working environment and pattern. There may be an occupational health department that can offer advice. And as mentioned in our section: Treatment of rheumatoid arthritis, an occupational therapist can help you find new ways to manage. Unless you do a particularly physical job, it’s usually possible to keep working with modern treatments. For tips on making life easier at home, see our FAQ: Your home life and rheumatoid arthritis.

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 to help your symptoms improve, for example. You may also find it helpful to contact support groups and talk to other people living with the condition.

For contact details of organisations that can help, see our section: Other helpful websites.

Frequently asked questions

  • It’s hard to predict how your condition will be in the future – the outlook varies from person to person. The typical pattern is to have periods when the inflammation flares up, with quieter periods between. With the right treatment, most people are able to lead full lives with their symptoms under control.

    Some people have a fairly mild disease. In others, the joints become more and more damaged and unstable over time. This can lead to long-term 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 any excess weight and stopping smoking

    .
  • 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 – for example, 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 or choose 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.

    You can get a lot more tips, help and support from the organisations listed in our section: Other helpful websites.

  • Being active is important for everyone, including those with arthritis. Careful exercise can ease stiffness and reduce stress on your joints, as well as keep you mobile. The key is getting the balance right between rest and exercise. 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. They will also be able to show you how to exercise safely during a flare-up. You may be able to exercise other parts of your body while resting the inflamed joints for a while.

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

    • If you’re not used to getting much exercise, build up slowly.
    • Exercise when you’re in the least amount of pain. If you have pain during exercise, stop and rest.
    • It’s best to avoid vigorous or contact sports, such as squash, to protect your joints. If you injure a joint it can spark a flare up of inflammation that can be hard to get back under control.
    • Find an exercise you enjoy. Swimming and other exercises in water are particularly good if you have arthritis because your joints are supported by the water.

    You may find it helpful to read our blog on exercise and arthritis. And you can find lots of advice about how to keep active with arthritis from the organisations listed in our section: Other helpful websites.


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Related information

    • Rheumatoid arthritis in adults: management. National Institute for Health and Care Excellence (NICE), February 2009, updated December 2015. www.nice.org.uk
    • Rheumatoid arthritis. BMJ Best practice. bestpractice.bmj.com, last updated January 2018
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    • Rheumatoid arthritis. PatientPlus. patient.info/patientplus, last checked 20 January 2015
    • Rheumatoid arthritis and the lung. PatientPlus. patient.info/patientplus, last checked 23 September 2016
    • Disease-modifying antirheumatic drugs. PatientPlus. patient.info/patientplus, last checked 23 April 2014
    • Rheumatoid arthritis (RA). The MSD Manuals. www.msdmanuals.com, last full review/revision February 2017
    • Non-steroidal anti-inflammatory drugs. NICE British National Formulary. bnf.nice.org.uk, reviewed 11 April 2018
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    • Musculoskeletal medicine: rheumatoid arthritis. GP Update Handbook (online). GP Update Ltd, gpcpd.com, accessed 11 April 2018
    • Rheumatoid arthritis. Arthritis Research UK, 2014. www.arthritisresearchuk.org
    • Complementary medicines for rheumatoid arthritis. Arthritis Research UK. www.arthritisresearchuk.org, accessed 12 April 2018
    • Complementary and alternative therapies. Arthritis Research UK, 2013. www.arthritisresearchuk.org
    • Daily life. Arthritis Research UK. www.arthritisresearchuk.org, accessed 12 April 2018
    • Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2017; 76:960–77. doi:10.1136/annrheumdis-2016-210715
    • The importance of exercise. National Rheumatoid Arthritis Society. www.nras.org.uk, last reviewed 18 August 2014
    • Personal communication, Dr Sundeept Bhalara, Consultant Rheumatologist, April 2018
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, April 2018
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist
    Next review due April 2021



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