Rheumatoid arthritis

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.

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:

• tablets you swallow
• an injection into a muscle or joint

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.