Rheumatoid arthritis

Rheumatoid arthritis is one of a group of conditions called inflammatory arthritis, that also includes psoriatic arthritis, ankylosing spondylitis and lupus. Inflammation is a normal part of your body’s immune response to fight disease and prevent infection. However, in rheumatoid arthritis your immune system is overactive and mistakenly attacks healthy tissues in your joints – this is called an autoimmune disease.

The most commonly affected joints are:

• Hands
• Feet
• Wrists

Rheumatoid arthritis is a chronic condition and, if left untreated, causes damage to healthy bone and cartilage in your joints. However, with the right treatment, you should be able to continue to enjoy life with your symptoms mostly under control.

Rheumatoid arthritis is the second most common type of arthritis in the UK, after osteoarthritis, affecting around 400,000 people in the UK. It occurs more often in women than men and often starts in your 40s.

The most common rheumatoid arthritis symptoms are:

• Joint stiffness, particularly in the mornings
• Swollen and painful joints
• Swollen knee
• Fatigue
• Flu-like symptoms
• Unexplained weight loss
• Fever
• Trigger finger
• Depression
• Tendonitis
• Back pain
• Foot pain
• Hip pain
• Joint pain
• Shoulder pain
• Loss of function, for example you may find buttoning your shirt more difficult if your hands are affected

Symptoms often come and go, with periods where it's much worse; called flares. Cold, damp weather can make your symptoms worse.

Treatment is more effective for rheumatoid arthritis the earlier you start, so you should see your GP as soon as you have symptoms.

If your doctor thinks you have rheumatoid arthritis, they'll recommend a blood test and refer you to a rheumatologist (a doctor who specialises in diagnosing and treating arthritis). The blood test will check for several different proteins that can indicate rheumatoid arthritis. These include rheumatoid factor, which is found in about half of people with rheumatoid arthritis.

To identify the type of arthritis and monitor how the disease progresses over time, your rheumatologist may also take images of your joints, such as:

• X-ray
• MRI scan
• Ultrasound scan

It's not known what causes the autoimmune response in rheumatoid arthritis, but it may be linked to:

• Genetics
• Stressful or emotional events such as a bereavement or childbirth
• Infection
• Injury
• Smoking
• Drinking/eating a lot of coffee or red meat

There's no cure for rheumatoid arthritis. However, it's possible to lessen the impact it has on your everyday quality of life.

Medications reduce inflammation and slow disease progression. These include:

• Anti-rheumatic drugs (DMARDs)
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Painkillers, such as paracetamol or ibuprofen
• Steroids
• Biologics – your doctor may prescribe these complex medicines when other treatments are no longer working

Your rheumatologist or doctor will monitor your condition over time and make any necessary changes to your prescription.

A physiotherapist will advise you about any exercises you can do to ease symptoms and strengthen muscles.

If your joints are badly damaged, you may need surgery to restore mobility. This can include operations to reduce inflammation or pressure on nerves or tendons, a hip replacement, or a joint replacement in severe cases.