Rheumatoid arthritis is one of a group of conditions called inflammatory arthritis, which also includes psoriatic arthritis and ankylosing spondylitis and related conditions, such as lupus. They cause pain, stiffness and swelling in your joints.
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 severity of rheumatoid arthritis varies from mild to severe. Over time, if left untreated, chronic inflammation can damage healthy bones and cartilage in your affected joints.
Although all joints can be affected, the most commonly affected joints are:
Elbows, hips and shoulders are less commonly affected.
With the right treatment, you should be able to continue to enjoy life with your symptoms mostly under control.
Rheumatoid arthritis doesn’t usually run in families and can affect anyone. It 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 in men.
The main differences between rheumatoid arthritis and osteoarthritis are the:
The most common rheumatoid arthritis symptoms are:
You may also experience general symptoms outside your joints, including:
In most cases, symptoms first develop in the hands, feet and wrists, most notably in the morning, easing off by midday. Symptoms may come and go until they become regular.
Cold, damp weather can make your symptoms worse and at times your symptoms can be significantly worse — these are called flare-ups.
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There is no definitive test for rheumatoid arthritis and other conditions can cause similar symptoms. Your GP will ask about your symptoms, check the movement of your joints and perform a physical examination.
If they think 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).
A blood test will check for several different proteins that can indicate rheumatoid arthritis. Your blood test may measure:
To identify the type of arthritis you have and monitor how the disease progresses over time, your rheumatologist may also take images of your joints, such as:
If you receive a diagnosis of rheumatoid arthritis, your rheumatologist may assess how you cope with everyday tasks.
Rheumatoid arthritis occurs when your immune system makes antibodies that mistakenly attack the healthy linings of your joints. Your joint linings, therefore, become inflamed. This inflammation causes chemicals to be released that damage nearby bones, cartilage, ligaments and tendons. Over time, this causes the joints to become deformed and misaligned, and eventually, the joints are destroyed.
Some people have a greater tendency to develop autoimmune diseases. However, what triggers the autoimmune response in rheumatoid arthritis is unknown. It may be linked to:
Women are more likely to develop rheumatoid arthritis, which may be due to the female sex hormone oestrogen, although this hasn’t been proven.
There is no cure for rheumatoid arthritis. However, early treatment can lengthen the gaps between flare-ups to months or even years, and reduce any long-term joint damage. Medications include:
Disease-modifying anti-rheumatic drugs (DMARDs)
Eg hydroxychloroquine, leflunomide, methotrexate and sulfasalazine. DMARDs block the effects of chemicals that are released when your immune system attacks your joints.
DMARDs take several months to start having an effect and although most people tolerate them well they do have side effects, including:
Eg etanercept and infliximab. Biologics are usually only prescribed when other treatments are no longer working. They are injected and usually taken alongside a DMARD. They work by stopping certain chemicals in your blood from attacking your joints.
Side effects include:
In some people, dormant infections eg tuberculosis (TB) and shingles can recur.
Eg baricitinib and tofacitinib. This is a new treatment for severe rheumatoid arthritis. It is usually only prescribed if you can't take DMARDs or biologics, or if these treatments were not effective. They are taken as tablets one to two times a day, usually alongside a DMARD.
Non-steroidal anti-inflammatory drugs (NSAIDs)
These can be taken with painkillers or instead of painkillers. Your doctor may recommend a traditional NSAID eg ibuprofen, diclofenac or naproxen, or a type of NSAID called a COX-2 inhibitor eg celecoxib or etoricoxib.
NSAIDs can reduce joint inflammation and pain. However, they will not stop the disease from getting worse over time and can increase your risk of serious stomach problems eg internal bleeding.
Eg over-the-counter painkillers, ibuprofen or paracetamol.
These are powerful medicines that can reduce inflammation, pain and stiffness. They can be given as a tablet, an injection into a painful joint or an injection into a muscle to relieve pain in many joints.
Steroids only provide short-term pain relief eg when waiting for your DMARD medication to start working or during a flare-up. If steroids are taken for long periods of time, they can cause major side effects, including:
Whichever medication you take, your GP or rheumatologist 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, which may ease your symptoms by improving your fitness, joint flexibility and muscle strength.
It is important to try to stay active as inactivity will weaken the muscles around your joints.
An occupational therapist can provide you with advice and training to help you protect your joints at home and work.
If your joints are badly damaged, you may need surgery to restore their mobility. Surgeries include:
Rheumatoid arthritis can be life-threatening as it increases your risk of developing other serious conditions and symptoms, including:
Rheumatoid arthritis increases your risk of developing these conditions because it can reduce the amount you exercise due to joint pain and stiffness. Rheumatoid arthritis may also be treated with medications that increase your blood pressure or suppress your immune system, which puts you at greater risk of certain conditions.
Two in 10 people with rheumatoid arthritis have a mild form and can lead a normal life for many years. One in 10 with the disease become severely disabled. Seven in 10 have an intermediate form of the disease and can lead full lives but will need to adapt their lifestyle.
Medications for rheumatoid arthritis have improved over the years. Taking medications alongside making lifestyle changes can significantly improve your outlook for rheumatoid arthritis.
Rheumatoid arthritis can have a huge impact on your life and make daily tasks difficult. It often needs long-term treatment alongside changes to your lifestyle.
Try to prioritise self-care, eating healthily and getting regular exercise. Your doctor may recommend that you get the annual flu vaccination and pneumococcal vaccination. Also, make sure you take your medication and attend regular reviews with your GP and/or specialist doctor.
You may want to look into the self-management course provided by the National Rheumatoid Arthritis Society, where you can learn about techniques to manage your pain and goal-setting exercises for everyday life.
Coping with rheumatoid arthritis can affect your mood and mental health. Talk to your healthcare team if you are struggling. You can also try joining support groups where you can talk to others who have rheumatoid arthritis.
If you are trying for a baby, speak to your GP. Certain medications for rheumatoid arthritis should not be taken when you are trying for a baby. If you are managing a young family, you may be able to get extra support from your health visitor or an occupational therapist.
Treatments for rheumatoid arthritis often suppress your immune system, which can increase your risk of getting coronavirus. Treatments that suppress your immune system include:
However, it is important that you do not stop taking your medication for rheumatoid arthritis during the coronavirus pandemic. If you do, your risk of complications and flare-ups will significantly increase.
If your doctor has identified you as "clinically extremely vulnerable", strictly follow all coronavirus guidelines, including:
You should be extra careful if you:
What are the 4 stages of rheumatoid arthritis?
The four stages of rheumatoid arthritis are:
What is the main cause of rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease, which means your immune system mistakenly attacks your healthy tissues. It isn't clear what causes this autoimmune response but it may be linked to several lifestyle factors, including:
Infection and injury have also been linked to triggering rheumatoid arthritis. There is some evidence of genes playing a role but their effect is so small that the condition doesn't usually run in families. Women are more likely to develop rheumatoid arthritis.
How serious is rheumatoid arthritis?
Rheumatoid arthritis is a life-changing condition that can affect your ability to carry out everyday activities. The sooner you start treatment and adapt your lifestyle, the lower your risk of developing permanent joint damage and disability.
Can rheumatoid arthritis be cured?
There is currently no cure for rheumatoid arthritis although there are several effective treatments to reduce your risk of joint damage, relieve your pain and slow the progression of the disease. Lifestyle changes can also help manage your symptoms. Speak to your GP for advice and treatment.
What foods are bad for rheumatoid arthritis?
Foods (and drinks) to avoid or limit if you have rheumatoid arthritis include:
What organs are affected by rheumatoid arthritis?
Rheumatoid arthritis targets your joints, however, it can also cause inflammation elsewhere in your body. This includes your blood vessels, eyes, heart and lungs.
What is the difference between arthritis and rheumatoid arthritis?
Arthritis refers to a group of conditions that cause inflammation of the joints, which includes rheumatoid arthritis. Rheumatoid arthritis is also an autoimmune disease, which means your immune system mistakenly attacks your healthy tissues. However, not all types of arthritis are autoimmune, such as gout, osteoarthritis and septic arthritis.
What is the best vitamin for arthritis?
Vitamin D is especially important for people with rheumatoid arthritis to take. Vitamin D is important to keep your bones strong and to maintain a healthy immune system. Treatments for rheumatoid arthritis can often suppress your immune system and steroid treatments increase your risk of vitamin D deficiency.
Can you live a normal life with rheumatoid arthritis?
Most people have mild or moderate rheumatoid arthritis and can live a full life with appropriate treatment and lifestyle adaptations eg eating a healthy diet, taking regular exercise and using self-help devices.
What does RA fatigue feel like?
It is more severe than tiredness. You may feel as if all your energy has been drained eg you may get dressed but then have no energy left to leave the house or you may feel hungry but not have the energy to make something to eat. Some people describe it as similar to the fatigue you feel when you have the flu.
What's the best painkiller for rheumatoid arthritis?
Over-the-counter painkillers, such as paracetamol and ibuprofen, are both effective in providing pain relief for rheumatoid arthritis. If you are still in pain, your GP may prescribe a specific type of non-steroidal anti-inflammatory (NSAID) called a COX-2 inhibitor eg celecoxib or etoricoxib. Steroids are also an option, however, long-term use can cause serious side effects. See your GP to find out which painkiller is most appropriate for you.
Do you lose weight with rheumatoid arthritis?
Weight loss and muscle wasting can occur with rheumatoid arthritis, usually in severe cases. Getting appropriate treatment for rheumatoid arthritis can often help, as well as eating a healthy diet and getting regular exercise. See your GP if you are worried that you are unintentionally losing weight.
Does rheumatoid arthritis affect the brain?
It is common for people with rheumatoid arthritis to experience brain fog. This refers to difficulties with memory, attention, and focus eg difficulty making and keeping to plans, forgetting appointments and struggling to think of a word when speaking.