Rheumatoid arthritis

Expert review by:

Rheumatoid arthritis (RA) is a long-term (chronic) condition that causes pain, swelling and stiffness in your joints. You usually get rheumatoid arthritis in your hands and feet. But it can affect any joint and other parts of your body too.

About rheumatoid arthritis

Rheumatoid arthritis is an autoimmune condition. This means it’s caused by your immune system attacking your healthy body tissues. Rheumatoid arthritis causes inflammation and damage to your joints. But sometimes you may get inflammation in other parts of your body too – for example, your eyes and your lungs.

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

Causes of rheumatoid arthritis

Rheumatoid arthritis is caused by your immune system attacking your joints. It’s not clear exactly why this happens. It may be linked to your genes and the environment you live in.

Certain conditions are more common in people with rheumatoid arthritis and these may potentially trigger the disease in some people. These conditions include if you:

  • had a high birth weight
  • are overweight or obese
  • smoke
  • have diabetes
  • have been exposed to chemicals such as silica

Symptoms of rheumatoid arthritis

Rheumatoid arthritis symptoms vary from person to person. In some people, they begin quite slowly and affect just a few joints. In others, the condition develops more quickly. Your symptoms may come and go – they may flare up at times, followed by periods when you feel better.

Rheumatoid arthritis symptoms that affect your joints

Rheumatoid arthritis symptoms that affect your joints include:

  • pain, which is usually worse when you’ve been resting or inactive
  • swelling and warmth around your joint(s)
  • 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 including:

  • ankles
  • wrists
  • knees
  • neck
  • hips
  • shoulders
  • elbows

Other rheumatoid arthritis symptoms

You may also have other signs of rheumatoid arthritis which include more general symptoms such as:

  • feeling extremely tired (fatigued)
  • flu-like symptoms, such as a fever and feeling generally unwell
  • weight loss for no specific reason

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

It’s important to get help for rheumatoid arthritis as early as possible. The sooner you start treatment, the less damage there will be to your joints. If you have symptoms that affect your joints and they aren’t getting better within a few weeks, contact your GP.

Diagnosis of rheumatoid arthritis

Your GP will ask about your symptoms and medical history, and examine you. They may refer you to see a rheumatologist – a doctor who specialises in identifying and treating arthritis.

There aren’t any specific rheumatoid arthritis tests but you may have some of the tests listed below to help diagnose you.

  • Blood tests to check for markers of rheumatoid arthritis, including rheumatoid factor and anti-CCP antibodies. But not everyone with rheumatoid arthritis has these markers.
  • X-rays of your hands and feet, to look for changes in the bones around your joints.
  • Ultrasound or MRI scans, to get more detailed pictures of the bones and other components of your joints.

Treatment of rheumatoid arthritis

There’s no cure for rheumatoid arthritis, but rheumatoid arthritis treatments can control the condition. These may:

  • reduce pain and inflammation
  • slow down or even prevent joint damage

The earlier you start rheumatoid arthritis treatment, the better it should work.

You’ll meet with your doctor regularly to check how your treatment is working for you.

Rheumatoid arthritis medicines

Disease-modifying antirheumatic drugs (DMARDs)

Your doctor will usually prescribe you a disease-modifying antirheumatic drug (DMARD) as soon as you’re diagnosed with rheumatoid arthritis. Ideally, you should begin taking DMARDs within three months of your symptoms starting.

DMARDs reduce the inflammation in your joints caused by your immune system. Over time, this inflammation can damage your joints. So, taking DMARDs can help to keep your joints healthy and prevent damage. DMARDs can take a few months to work, so it’s important to keep taking them even if they don't seem to work.

There are different types of DMARD.

  • Conventional DMARDs include methotrexate, sulfasalazine, leflunomide and hydroxychloroquine (others are available). Your doctor will usually prescribe these first. Your doctor may sometimes offer you a combination of DMARDs, if one on its own doesn’t work well enough.
  • Biological DMARDs include adalimumab, etanercept and infliximab. Your doctor may suggest these if you have severe rheumatoid arthritis and can’t take conventional DMARDs or they don’t help. These medicines are given by injection under your skin or by infusion (a drip into your vein).
  • Targeted DMARDs include tofacitinib and baricitinib. You may need these if you have more severe rheumatoid arthritis and other treatments haven’t worked.

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

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. They’ll prescribe the lowest possible effective dose for as short a time as possible. You’ll also need to take a medicine called a proton pump inhibitor to protect your stomach and reduce the risk of side-effects from NSAIDs.

Steroids

Your doctor may prescribe a type of corticosteroid, called a glucocorticoid to reduce the inflammation in your joints and relieve any pain and stiffness. You can have this medicine as:

Glucocorticoids are usually only used for a short time so you’re less likely to get side-effects from them. Your doctor may prescribe them:

  • when you’re first diagnosed and you're waiting for other treatments to start working
  • if you’re having a flare-up, to help control your symptoms

Supportive therapies

Your GP or rheumatologist may refer you to a range of different health services to help you to manage your condition. These may include the following.

  • Physiotherapy. A physiotherapist can show you exercises to help you stay flexible and build up your muscle strength. They can also help you to improve your general fitness.
  • Podiatry. This can help if you have problems with 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 advice on managing everyday tasks and increasing your independence.
  • Mental health support. Your doctor may be able to refer you to services such as relaxation and stress management. These services can help you learn to live with your condition.

Surgery

Your doctor may refer you to a surgeon if treatments aren’t working and your symptoms get worse. A surgeon will assess you and advise whether surgery can help. The different types of surgery range from minor procedures to correct deformities to full joint replacements.

Talk to your doctor or surgeon 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 (found in fish oils) may help to ease joint pain and stiffness. There’s little or no evidence for other complementary therapies such as acupuncture, aromatherapy and massage. But you may find these therapies help your symptoms for a while.

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

Physiotherapy services

Our evidence-based physiotherapy services are designed to address a wide range of musculoskeletal conditions, promote recovery, and enhance overall quality of life. Our physiotherapists are specialised in treating orthopaedic, rheumatological, musculoskeletal conditions and sports-related injury by using tools including education and advice, pain management strategies, exercise therapy and manual therapy techniques.

To book or to make an enquiry, call us on 0345 850 8399

Complications of rheumatoid arthritis

With the right treatment, most people with rheumatoid arthritis can live a full and active life. But without the right treatment, the disease can have a huge impact on your life. The damage to your joints can get worse over time. This may increase the chances of disability or the need for joint replacement surgery.

Without treatment, rheumatoid arthritis can start to affect other parts of your body, which can lead to various complications, including:

  • lung disease – this 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 gets squeezed, leading to pain and numbness in your hand and fingers
  • infections – especially with severe rheumatoid arthritis
  • osteoporosis (thinning bones) – this is caused by ongoing inflammation and taking corticosteroids regularly

If your rheumatoid arthritis keeps getting worse, you may find it hard to do your normal activities and you may be unable to work. Many people with rheumatoid arthritis have depression. Be sure to talk to your doctor if you’re feeling low.

If you take the medicines your doctor prescribes, it will give you the best chance to keep your rheumatoid arthritis under control and avoid complications. You’ll have regular reviews with your doctor to check for signs of any complications and to talk about how you’re managing more generally. Your doctor can adjust your treatment or refer you to services (for example, a physiotherapist) to get the support you need.

Living with rheumatoid arthritis

Adapt your home

You may find it hard to do certain things at home if your joints are sore and swollen. But there are ways to make everyday tasks easier.

  • Use devices designed to help turn on taps and gadgets to open bottles, jars and tins.
  • Use aids and gadgets to help you dress and shower – for example, long-handled shoehorns, rails or handles in your shower or bath, and shower seats.
  • Rearrange your kitchen and other rooms so you can reach things more easily.
  • Remove loose mats and carpets so you’re less likely to trip over.
  • Use pill-removing devices if you struggle to get medicines out of their packets.
  • Wear clothes that fasten at the front rather than the back or clothes that you can pull over your head.

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

Keep active

If you have rheumatoid arthritis, keeping active may help to:

  • ease stiffness in your joints
  • reduce pain
  • keep your joints moving well
  • strengthen your muscles and bones
  • improve your overall fitness

Keeping active is good for your mental health too.

Be as active as you feel you can. Even if you can’t manage to exercise regularly, sitting down less often is good for your body. You can even do some exercises while you’re sitting in a chair to help get moving again.

It’s important to choose the right activity for you. If you overdo it, you may feel achy and sore but you should be fine to carry on again after a day’s rest.

  • Build up slowly and listen to your body.
  • If you get any pain during exercise, stop and rest.
  • Make sure you warm up first and do some stretching exercises to cool down afterwards.
  • Include some strengthening and stretching exercises such as Pilates and tai chi.

Your physiotherapist can help to create an exercise programme specifically for you.

Rheumatoid arthritis affects everyone differently, so this is hard to predict. But with the right treatment, most people can lead full lives. The earlier you start the treatment, the less damage there’ll be to your joints. For more information, see our section on treatment of rheumatoid arthritis.

Rheumatoid arthritis is an autoimmune condition. This means your immune system attacks your joints. This may be linked to your family history or to a specific trigger such as an infection. For more information, see our section: About rheumatoid arthritis.

Rheumatoid arthritis symptoms vary from person to person. Your joints may be red, sore and stiff. You may have other symptoms too, such as fatigue or weight loss. For more information, see our section on symptoms of rheumatoid arthritis.

Your doctor will usually offer a disease-modifying antirheumatic drug (DMARD) as soon as you’re diagnosed with rheumatoid arthritis. You may also be prescribed a corticosteroid medicine while you’re waiting for the DMARD to start working. For more information, see our section on treatment of rheumatoid arthritis.

More on this topic

Did our Rheumatoid arthritis information help you?

We’d love to hear what you think. Our short survey takes just a few minutes to complete and helps us to keep improving our health information.

The health information on this page is intended for informational purposes only. We do not endorse any commercial products, or include Bupa's fees for treatments and/or services. For more information about prices visit: www.bupa.co.uk/health/payg

This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.

Any information about a treatment or procedure is generic, and does not necessarily describe that treatment or procedure as delivered by Bupa or its associated providers.

The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.

  • Rheumatoid arthritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2020
  • Rheumatoid arthritis (RA). Medscape. emedicine.medscape.com, updated January 2022
  • Rheumatoid arthritis. Patient. patient.info, last edited November 2020
  • Rheumatoid arthritis in adults: management. National Institute for Health and Care Excellence (NICE). nice.org.uk, updated October 2020
  • Rheumatoid arthritis. British National Formulary. bnf.nice.org.uk, last updated November 2022
  • Disease-modifying antirheumatic drugs. Patient. patient.info, last edited November 2020
  • Adalimumab. British National Formulary. bnf.nice.org.uk, last updated November 2022
  • Infliximab. British National Formulary. bnf.nice.org.uk, last updated November 2022
  • Hand and wrist surgery in rheumatoid arthritis. Medscape. emedicine.medscape.com, updated June 2021
  • Sigaux J, Bellicha A, Buscail C, et al. Serum fatty acid profiles are associated with disease activity in early rheumatoid arthritis: results from the ESPOIR cohort. Nutrients. 2022 Jul 19; 14(14):2947. doi: 10.3390/nu14142947. PMID: 35889904; PMCID: PMC9322967
  • How will rheumatoid arthritis affect me? Versus Arthritis. www.versusarthritis.org, accessed January 2023
  • Gadgets and equipment for your home. Versus Arthritis. www.versusarthritis.org, accessed January 2023
  • Keep moving. Versus Arthritis. www.versusarthritis.org, accessed January 2023
  • Carpal tunnel syndrome. MSD Manuals. msdmanuals.com, last modified September 2022
  • Ashai S, Harvey NC. Rheumatoid arthritis and bone health. Clin Med (Lond). 2020 Nov; 20(6):565–67. doi: 10.7861/clinmed.20.6.rabh. PMID: 33199321; PMCID: PMC7687316
  • Personal communication, Dr Sundeept Bhalara, Consultant Rheumatologist, January 2023
Content review by:
The Patient Information Forum tick


Our information has been awarded the PIF tick for trustworthy health information.

Content is loading