Rheumatoid arthritis
Your health expert: Dr Sundeept Bhalara, Consultant Rheumatologist
Content editor review by Victoria Goldman, January 2023
Next review due January 2025
Rheumatoid arthritis is a chronic (long-term) condition. It 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, including your eyes and your lungs.
It’s not clear why some people have rheumatoid arthritis. This may be linked to their genes. Something in the environment – for example, an infection – may trigger rheumatoid arthritis in people who are already susceptible to this inflammatory arthritis.
Rheumatoid arthritis affects around one in every 100 people. You’re most likely to get it when you’re between 40 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, affecting 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.
Symptoms that affect your joints
Symptoms affecting 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 your:
- ankles
- neck
- knees
- hips
- shoulders
- elbows
Other symptoms
You may also have 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. This is because the sooner you start treatment, the less damage there will be to your joints. 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. But not everyone with rheumatoid arthritis has these markers.
- X-rays of your hands and feet, to look for changes in your joints.
- Ultrasound or MRI scans, to get more detailed pictures of your joints.
Your rheumatologist may arrange these tests for you if you haven’t had them before your referral.
Treatment of rheumatoid arthritis
There’s no cure for rheumatoid arthritis. But many treatments can control the condition. These may:
- reduce the pain and inflammation
- slow down or even prevent joint damage
The earlier you start treatment, the better it should work.
Medicines
Disease-modifying antirheumatic drugs (DMARDs)
Your doctor will usually offer 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 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 be working.
There are different types of DMARD.
- Conventional DMARDs include methotrexate, sulfasalazine, leflunomide and hydroxychloroquine. You’ll be offered these first. Your doctor may sometimes offer you a combination of DMARDs, if one on its own isn’t working 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 haven’t helped. These medicines are given by injection under your skin or by infusion (a drip into your vein).
- Targeted DMARDs include tofacitinib and baricitinib. These are used for people with 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..
Painkillers
You can take over-the-counter painkillers, such as paracetamol, to help ease your pain. But they don’t treat the rheumatoid arthritis itself. 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. They’ll also suggest taking a medicine called a proton pump inhibitor. This helps 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. This can reduce the inflammation in your joints, relieving any pain and stiffness. You can have this medicine as:
- tablets by mouth
- 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, while 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, which can 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. Your doctor may be able to refer you to services such as relaxation and stress management, to 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 are getting worse. A surgeon will assess you and advise whether or not surgery may 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.
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 also start to affect other parts of your body, leading to various complications. These may include:
- 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
- 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.
Taking any medicines prescribed for you will give you the best chance of keeping your arthritis under control and avoiding complications. You’ll have regular reviews with your doctor to check for signs of any complications and talk about how you’re managing more generally. Your doctor can adjust your treatment or refer you to appropriate services, such as a physiotherapist, to get the support you need.
Living with rheumatoid arthritis
Adapting your home
You may find it hard to do certain things at home if your joints are sore and swollen. But there are lots of ways to make everyday tasks easier.
- Use special devices for turning on taps, and gadgets for opening bottles, jars and tins.
- Use aids and gadgets to help with dressing and showering – for example, long-handled shoehorns, rails or handles in your shower or bath, 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 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.
Keeping 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. Doing some exercises while you’re sitting in a chair will help to get you 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.
Looking for physiotherapy?
You can access a range of treatments on a pay as you go basis, including physiotherapy.
To book or to make an enquiry, call us on 0370 218 6528∧
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.
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- Personal communication, Dr Sundeept Bhalara, Consultant Rheumatologist, January 2023
