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Rheumatoid arthritis


Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist
Next review due September 2023

Rheumatoid arthritis is a chronic (long-term) condition which causes pain, swelling and stiffness in your joints. People usually get rheumatoid arthritis in their hands and feet, but it can affect any joint as well as other parts of your body.

Holding hands

About rheumatoid arthritis

Rheumatoid arthritis is an autoimmune condition, which means it’s caused by your own immune system attacking healthy body tissues. This causes inflammation and damage to your joints. You may also have inflammation in other parts of your body, including your eyes and your lungs.

It’s not clear why some people develop rheumatoid arthritis, although it’s thought there may be a genetic link. It could be that something in the environment – like an infection – can trigger development of the condition in people who are already susceptible.

Rheumatoid arthritis affects around one in every 100 people. You’re most likely to develop rheumatoid arthritis between the ages of 30 and 50, although you can get it at any age. More women get it than men.

Symptoms of rheumatoid arthritis

Rheumatoid arthritis affects your joints and also causes more general symptoms. Symptoms vary from person to person. They often begin quite slowly, affecting just a few joints. But for some people, the condition develops more quickly. Your symptoms may come and go, with periods where your condition flares up, followed by periods where you feel better.

Symptoms that affect your joints

Symptoms affecting your joints can include:

  • pain, which is usually worse when you’ve been resting or inactive
  • swelling around your joint(s); they may feel warm
  • stiffness, especially first thing 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. Most people find it affects their hands and feet first, but it can affect any joint in your body 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:

  • feeling extremely tired (fatigued)
  • flu-like symptoms, such as a fever and feeling generally unwell
  • weight loss

Sometimes, rheumatoid arthritis can start to affect other areas of your body such as your lungs and eyes. For more information on this, see our section on complications below

It’s important to get help for rheumatoid arthritis as early as possible. This is because the sooner you start treatment, the less damage there will be to your joints. So, if you have symptoms affecting your joints and they aren’t getting better after a few weeks, contact your GP.

Diagnosis of rheumatoid arthritis

Your GP will ask about your symptoms and medical history, and examine you. If your GP thinks you could have rheumatoid arthritis, they’ll refer you to see a rheumatologist – a doctor who specialises in identifying and treating arthritis.

While you’re waiting for referral, your GP may arrange for you to have the following tests.

  • Blood tests, to check for certain markers of rheumatoid arthritis, including rheumatoid factor and anti-CCP antibodies. Not everyone with rheumatoid arthritis has these markers, so having a negative test doesn’t always mean that you don’t have rheumatoid arthritis.
  • X-rays of your hands and feet, to look for changes in your joints.
  • Ultrasound or MRI scans, to get more detailed images of your joints.

Your rheumatologist may arrange these tests for you, if you haven’t had them done before your referral.

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Treatment of rheumatoid arthritis

Although there’s no cure for rheumatoid arthritis, there are many treatments that can control the condition. Treatments can reduce the pain and inflammation, and slow down or even completely prevent your joints from being damaged. The earlier you start treatment, the more effective it will be.

Medicines

Painkillers

You can take over-the-counter painkillers, such as paracetamol to help ease your pain.

Your doctor may also prescribe a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen to help control pain and stiffness. If they do, they’ll prescribe the lowest possible effective dose for as short a time as possible. This is to reduce the risk of side-effects. They’ll also suggest taking a medicine called a proton pump inhibitor, which helps to protect your stomach and reduce the risk of side-effects from NSAIDs.

Steroids

Your doctor may prescribe a type of steroid (corticosteroid), called a glucocorticoid. This can reduce the inflammation in your joints, quickly relieving any pain and stiffness you may have. You can have this medicine as tablets by mouth or as an injection into a muscle or joint. Corticosteroids are usually only used for a short time, to reduce the chances of you getting side-effects from them. Your doctor may prescribe them when you’re first diagnosed, while you're waiting for other treatments to start working. Or they may prescribe them if you’re having a flare-up, to help control your symptoms.

Disease-modifying antirheumatic drugs (DMARDs)

Your doctor will usually offer you treatment with a DMARD as soon as you’re diagnosed with rheumatoid arthritis. Ideally, treatment should begin within three months of your symptoms starting. DMARDs work to reduce inflammation in your joints caused by your immune system. Over time, this inflammation can damage your joints; so, controlling the inflammation with DMARDs can help to keep your joints healthy and prevent damage. DMARDs can take a few months to have an effect, so it’s important to keep taking them even if they don't seem to be working.

There are different types of DMARD.

  • Conventional DMARDs include methotrexate, sulfasalazine, leflunomide and hydroxychloroquine. These are the type you’ll be offered first. Your doctor may sometimes offer you a combination of DMARDs, if one on its own is not having enough effect.
  • Biological DMARDs include adalimumab, etanercept and infliximab. Your doctor may suggest these if you have severe rheumatoid arthritis and conventional DMARDs haven’t helped or you’re unable to take them. These medicines are given by injection under your skin or by infusion (a drip into your vein).
  • Targeted DMARDs include tofacitinib and baricitinib. They’re used for people who have more severe rheumatoid arthritis and when other treatments haven’t worked.

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

Supportive therapies

Your doctor should be able to refer you to a range of different health services, which can help you to manage your condition. These may include the following.

  • Physiotherapy. A physiotherapist 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.
  • Podiatry. This can help if you have problems affecting your feet. A podiatrist can give you advice and help you to find the right footwear.
  • A hand specialist. Your doctor may refer you for a specific hand exercise programme, if you have problems with your hands.
  • Occupational therapy. An occupational therapist can give you practical assistance to help you manage with everyday tasks and increase your independence.
  • Mental health. Your doctor may be able to refer you to services offering techniques such as relaxation and stress management, to help you adjust to living with your condition.

Surgery

If you’ve tried other treatments and you have ongoing pain or problems using your joint, your doctor may refer you to a surgeon. They will assess you and advise whether or not surgery may be helpful for you. 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 which options may be suitable for you.

Complementary therapies

Many people with rheumatoid arthritis try complementary medicines to ease their symptoms. There’s some evidence that omega-3 oils (for example, fish oils) may help to ease joint pain and stiffness. However, there’s little or no evidence for other complementary therapies, such as acupuncture, aromatherapy and massage. You may find that these therapies help to improve your symptoms over the short-term though.

If you decide to try a complementary therapy, let your doctor know. Remember, a complementary therapy shouldn’t replace any treatment your doctor recommends.

Complications of rheumatoid arthritis

The outlook for rheumatoid arthritis is improving all the time. With the right treatment, most people with rheumatoid arthritis are able to live a full and active life.

But without the appropriate treatment, the disease can have a huge impact on your life. The damage to your joints can worsen over time, increasing the likelihood of disability or the need for joint replacement surgery. Without treatment, the condition can also start to affect other parts of your body, leading to various complications. These can include the following.

  • Lung disease, which can cause symptoms such as cough, shortness of breath and wheezing.
  • Dry eye syndrome.
  • Carpal tunnel syndrome – this is when a nerve in your wrist is compressed, leading to pain and numbness in your hand and fingers
  • Problems affecting your heart and blood vessels – people with rheumatoid arthritis are at greater risk of cardiovascular disease.
  • Infections, particularly with severe rheumatoid arthritis.

  • If your rheumatoid arthritis progresses to this stage, you might find it difficult to go about your normal activities or feel unable to work. It’s also common to develop depression. Be sure to talk to your doctor if you’re feeling this way.

    Taking any medicines you’re prescribed will give you the best chance of keeping your arthritis under control and avoiding complications. You’ll also have regular reviews with your doctor, when they’ll check for signs of any complications, as well as asking how you’re managing more generally. They can adjust your treatment or refer you to appropriate services to get the support you need. For more details on this, see our information on supportive therapies in the treatment section above.


Frequently asked questions

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

    Some people have a fairly mild disease whereas for 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.

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  • You might start to find certain tasks difficult if your joints are swollen or painful. There are many things you can do at home to make everyday tasks easier. 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 gadgets for opening bottles, jars and tins.
    • You can also get aids and gadgets to help with dressing and showering – for example, long-handled sponges, dressing sticks and buttonhooks.
    • Rearrange your kitchen and other rooms to make sure the things you use most are easy to reach. You might find it helps to fit larger handles or sliding doors on cupboards, if you’re finding it hard to grip.
    • 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 spinner knob may all help. If you’re buying a new car, consider a car with automatic gears and power steering.

    Contact your local council for a free needs assessment to see if you’re eligible for help with paying for equipment or adapting your home. An occupational therapist will also be able to assess you and suggest measures that may help.

  • Doing some gentle exercise is really beneficial if you have rheumatoid arthritis. If you overdo it, you might ache and feel a bit sore but you should be fine to continue after a day’s rest. Careful exercise can ease stiffness in your joints, reduce pain, keep your joints moving well and strengthen your muscles and bones. Keeping active is good for your mental health too.

    The key is to make sure you’re doing the right type and amount of exercise. Here are some tips that may help.

    • If you’re not used to getting much exercise, start with a small amount of gentle exercise and build up slowly.
    • If you develop any pain during exercise, stop and rest. You can start again slowly if it feels better after you’ve rested.
    • Make sure you warm up by starting your exercise slowly, and do some stretching exercises to cool down afterwards. This will help to prevent stiff muscles and joints.
    • To protect your joints, it’s best to avoid vigorous or contact sports such as squash, football or running. Go for low-impact activities where you’ll have minimal stress on your joints – for example, swimming and cycling.
    • It can be really helpful to incorporate some strengthening and stretching exercises. Pilates and tai chi can be helpful for people with rheumatoid arthritis.

    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.



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Related information

    • Rheumatoid arthritis in adults: management. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published 11 July 2018
    • Rheumatoid arthritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2020
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    • Musculoskeletal problems. Oxford handbook of general practice. Oxford Medicine Online. oxfordmedicine.com, published online June 2020
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    • Rheumatoid arthritis. NICE British National Formulary. bnf.nice.org.uk, last updated 30 July 2020
    • Disease-modifying antirheumatic drugs. Patient. patient.info, last edited 18 April 2019
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    • Complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia. Arthritis Research UK (now Versus Arthritis). www.versusarthritis.org, published October 2012
    • Rheumatoid arthritis. Versus Arthritis. www.versusarthritis.org, accessed 28 August 2020
    • Rheumatoid arthritis and the lung. Patient. patient.info, last edited 23 September 2016
    • Your home – tips for every room. Versus Arthritis. www.versusarthritis.org, accessed 28 August 2020
    • Personal communication, Dr Sundeept Bhalara, Consultant Rheumatologist, 14 September 2020
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  • Reviewed by Pippa Coulter, Freelance Health Editor, September 2020 
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist
    Next review due September 2023

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