Rheumatoid arthritis

Rheumatoid arthritis is a chronic (long-term) inflammatory disease that causes pain, stiffness and swelling in your joints.

By Wallace Health I Medically reviewed by Adrian Roberts.
Page last reviewed: October 2018 I Next review due: October 2021

What is rheumatoid arthritis?

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:

  • Hands
  • Feet
  • Knees
  • Wrists

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:

  • Onset — rheumatoid arthritis can occur at any age, though usually in your 40s, and progresses quickly; osteoarthritis starts later, usually after age 60, and develops gradually
  • Underlying cause — rheumatoid arthritis is an autoimmune disease while osteoarthritis is caused by wear and tear with age

How to tell if you have rheumatoid arthritis

The most common rheumatoid arthritis symptoms are:

  • Joint stiffness eg if you can’t bend your fingers
  • Loss of function with certain tasks or movement
  • Aching and throbbing joints, especially in the morning
  • Swollen joints that are also painful — this can affect any joint but usually starts in small joints before progressing to bigger joints
  • Tendonitis
  • Trigger finger

You may also experience general symptoms outside your joints, including: 

Symptom patterns

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.

Talk to your doctor if you’re concerned about symptoms

You can book an appointment with a Spire private GP today.

Diagnosis and tests for rheumatoid arthritis

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: 

  • Anti-cyclic citrullinated peptide (anti-CCP) — antibodies that attack healthy tissue in your body
  • C-reactive protein (CRP) levels — a measure of inflammation
  • Erythrocyte sedimentation rate (ESR) — a measure of inflammation
  • Rheumatoid factors — proteins produced by your immune system when it mistakenly attacks healthy tissue
  • Your full blood count — this can:
    • Check if you have anaemia, which is common in people with rheumatoid arthritis
    • Help rule out other conditions 
    • Indicate your general health 

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.

Causes of rheumatoid arthritis

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:

  • Drinking a lot of coffee or eating a lot of red meat
  • Genetics — rheumatoid arthritis doesn't usually run in families but there is evidence of genes playing a small role; the risk of inheriting rheumatoid arthritis is low 
  • Infection
  • Injury
  • Smoking — this increases your risk of rheumatoid arthritis
  • Stressful or emotional events such as a bereavement or childbirth

Women are more likely to develop rheumatoid arthritis, which may be due to the female sex hormone oestrogen, although this hasn’t been proven.

Common treatments for rheumatoid arthritis

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: 

  • A sore mouth
  • Diarrhoea
  • Headaches, nausea and loss of appetite
  • Hair loss
  • Negative effects on your blood cells and liver — you will have regular blood tests to check for this
  • Negative effects on your lungs — this is less common but you may need to have a breathing test and chest X-ray

Biologics 

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: 

  • Feeling nauseous
  • Fever
  • Headaches
  • Infections
  • Skin reactions at the injection site 

In some people, dormant infections eg tuberculosis (TB) and shingles can recur. 

JAK inhibitors

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.

Painkillers

Eg over-the-counter painkillers, ibuprofen or paracetamol.

Steroids

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: 

  • Bruising easily
  • Muscle weakness
  • Osteoporosis 
  • Thinning skin
  • Weight gain

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.

Surgery

If your joints are badly damaged, you may need surgery to restore their mobility. Surgeries include: 

  • Arthroscopy to remove inflamed tissue — a thin, telescope-like tube with a camera and light at the end is inserted into your joint through a small cut in your skin; other surgical instruments are inserted into the joint through other small cuts in your skin and are used to remove the inflamed tissue
  • Finger, hand and wrist surgery — this includes: 
    • Carpal tunnel release
    • Release of tendons in the fingers to resolve abnormal bending
    • Removal of inflamed tissue lining your finger joints
  • Joint replacement eg hip replacement — in severe cases, all or part of a joint (eg hip, knee or shoulder) will be replaced with a prosthetic joint, which usually lasts 10–20 years

Complications of rheumatoid arthritis

Rheumatoid arthritis can be life-threatening as it increases your risk of developing other serious conditions and symptoms, including:

  • Cardiovascular disease — a group of conditions affecting your heart and blood vessels, which can lead to a heart attack or stroke; you can reduce your risk by eating a healthy diet, exercising and, if you smoke, quitting
  • Carpal tunnel syndrome — this is common and is caused by compression of a nerve in your forearm
  • Cervical myelopathy — dislocation of joints in your spine that cause the spinal cord in your neck to be compressed; this can occur if you have rheumatoid arthritis for a long time and can cause permanent damage; it needs urgent treatment
  • Inflammation elsewhere in your body — this includes in inflammation in your: 
    • Blood vessels (vasculitis) — this causes narrowing, scarring, thickening and weakening of your blood vessel walls
    • Eyes — this can cause scleritis or Sjogren's syndrome
    • Heart — this can cause pericarditis, which in turn causes chest pain
    • Lungs — this can cause pleurisy or pulmonary fibrosis, which can cause a persistent cough, chest pain and shortness of breath
  • Joint damage — erosion of joint bones, damage to cartilage and breaking of tendons (eg in the backs of your fingers), which can cause permanent joint deformities; joint damage varies from mild to severe
  • Osteoporosis — weak bones that are more likely to break; rheumatoid arthritis increases your risk due to poor mobility resulting from the condition and  potential treatment with steroids


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.

Outlook for rheumatoid arthritis

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.

Living with 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. 

Rheumatoid arthritis and coronavirus

Treatments for rheumatoid arthritis often suppress your immune system, which can increase your risk of getting coronavirus. Treatments that suppress your immune system include: 

  • Biologics — this includes abatacept, adalimumab, anakinra, belimumab, certolizumab pegol, etanercept, golimumab, infliximab, ixekizumab, rituximab (if taken in the last 12 months), sarilumab, secukinumab, tocilizumab and ustekinumab
  • DMARDs — this includes azathioprine, ciclosporin, leflunomide, methotrexate, mycophenolate mofetil, mycophenolic acid, sirolimus and tacrolimus
  • JAK inhibitors — this includes baricitinib, tofacitinib and upadacitinib

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: 

  • Not seeing anyone outside your social bubble
  • Staying at home whenever possible and avoiding crowded spaces
  • Staying two metres away from people
  • Washing your hands regularly and using hand sanitiser
  • Wearing face coverings when you are outside
  • Working from home

You should be extra careful if you:

  • Are on immune-suppressing drugs and daily steroids
  • Are on two or more immune-suppressing drugs and are aged 70 or older
  • Are on two or more immune-suppressing drugs and have another long-term condition
  • Have a lung disease caused by an inflammatory condition
  • Have been treated with cyclophosphamide in the last six months
  • Take steroid tablets daily

What are the 4 stages of rheumatoid arthritis?

The four stages of rheumatoid arthritis are: 

  • Stage 1 (early stage) — your joint linings become inflamed and the surrounding tissue swells, causing joint pain and stiffness; however, your bones are not damaged
  • Stage 2 (moderate stage) — inflammation damages the cartilage of your joints, reducing how far you can move your joints
  • Stage 3 (severe stage) — inflammation wears away your cartilage and the bones in your joints; your joints may become deformed and unstable; symptoms include joint pain, reduced movement of your joints and swelling
  • Stage 4 (end stage) — inflammation stops but damage to your joints continues; your joints may stop working, your muscles may be weak and your doctor may recommend joint replacement surgery; you will have significantly reduced movement of your joints, pain, stiffness and swelling

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: 

  • Drinking a lot of coffee
  • Eating a lot of red meat
  • Smoking
  • Stressful or emotional events eg bereavement or childbirth

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: 

  • Alcohol — drinking alcohol while taking certain medications for rheumatoid arthritis can lead to severe side effects, including liver damage, stomach bleeding and ulcers
  • Corn oil — this contains omega-6 fatty acids, which in large amounts can cause inflammation and weight gain 
  • Dairy and red meat — these are high in saturated fats, which can promote inflammation
  • Fried and processed foods — these are high in trans fats, which promote inflammation, increase your LDL cholesterol (commonly called bad cholesterol) and reduce your HDL cholesterol (commonly called good cholesterol)
  • High-salt foods — in large amounts salt can increase your blood pressure and if you take steroids to treat your rheumatoid arthritis, this happens more easily
  • High-sugar foods — these increase the production of chemicals called cytokines that promote inflammation

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.