Rheumatoid arthritis is completely different to osteoarthritis which affects most of us as we get older. Rheumatoid arthritis can affect people of any age including very young children and it is a condition where the immune system which usually protects us from infections, starts to attack the joints causing pain, stiffness and swelling.
It is very important to diagnose rheumatoid arthritis as soon as possible because there are very effective treatments and if the symptoms are ignored or not treated properly, joint damage can happen very quickly. If rheumatoid arthritis is treated as soon as possible after the symptoms start, joint damage and disability can often be prevented. Most hospital rheumatology departments now have rapid access early arthritis clinics to see people with suspected rheumatoid arthritis as soon as possible, so that treatment can start straight away and joint damage can be prevented.
What causes rheumatoid arthritis?
No one knows exactly why some people develop rheumatoid arthritis. It is more common in women and sometimes runs in families. It is more common in people who smoke and in people who are above a healthy weight, but no-one knows the reasons for this.
Symptoms of rheumatoid arthritis
Rheumatoid arthritis causes pain, stiffness and swelling of the joints. The joints most commonly affected are the small joints of the fingers and toes, the wrists, elbows, shoulders and knees as well as the neck and jaw. The low back is not affected by rheumatoid arthritis, neither are the joints at the ends of the fingers.
Some people with rheumatoid arthritis will only have one or two joints affected at a time and sometimes the arthritis seems to move round the joints. Others find that they have episodes of swollen joints for a day or so and things then settle for days or weeks. The stiffness and pain of rheumatoid arthritis are usually worse in the morning which can make it difficult to grip objects, then the symptoms tend to improve during the day
Many people with rheumatoid arthritis feel especially tired at times and sometimes low in mood. Many people have dry eyes and mouth (“sicca” symptoms or Sjogren’s syndrome) associated with the arthritis. Rarely, rheumatoid arthritis can also affect the skin, heart, lungs and kidneys.
What is the future for people with rheumatoid arthritis?
Before there were effective medicines for rheumatoid arthritis, some people went on to develop severe joint damage and disability. In addition, people with active rheumatoid arthritis were at increased risk of heart attacks and strokes. The future now for people with rheumatoid arthritis is much brighter. For over 20 years there have been very effective treatments which when used early, can prevent joint damage and disability, and reduce the risk of cardiovascular disease, and healthcare professionals now have the goal of “remission” for most people who are newly diagnosed with rheumatoid arthritis.
Although medicines can control most of the symptoms of rheumatoid arthritis, some people can still have occasional flare-ups affecting one or more joints. These flares can last a day or so or much longer.
How is rheumatoid arthritis diagnosed?
Rheumatoid arthritis is usually diagnosed with a combination of the joints, blood tests and X-rays of the joints. Sometimes, swelling of the joints is difficult to see, so you may need other tests such as an ultrasound scan or MRI scan to look inside the joints in more detail.
Medical treatments for rheumatoid arthritis
As rheumatoid arthritis is a problem caused by the immune system, the treatments are designed to stop the immune system from damaging your joints. The sooner you start these medicines, the less damage will happen. There are many different types of medicine that do this but at the start you will usually be offered a so-called “disease-modifying drug” (DMARD) such as methotrexate, sulfasalazine or hydroxychloroquine and often medicines called steroids or corticosteroids as well.
You may also be offered painkillers such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen. Painkillers and NSAIDs do not affect the immune system that causes arthritis, and they will not prevent joint damage, but they can help with the pain and stiffness of rheumatoid arthritis.
Once you and your joints start to feel better, the number of tablets that you need can be reduced and you may be able to stop most or all your painkillers. The most important thing to remember is that treatment is designed to stop joints from being damaged and to reduce the risk of disability.
Most people with rheumatoid arthritis will need to take some form of medicines for life but some people remain very well on minimal or even occasionally no medication if the arthritis is caught in the very early stages.
Most people with rheumatoid arthritis will be referred at some time for help with specific problems to professionals such as:
- Physiotherapists who provide manual (hands-on) treatments and advice on exercise, exercises and staying active with arthritis.
- Occupational therapists who can offer advice on how to protect your joints, provide splints and help with devices which can make everyday tasks easier.
- Podiatrists who can help with insoles and foot care.
- Psychologists who can help with pain coping techniques and mood
- Dietitians who can help advise you on healthy eating and weight management when you have arthritis.
If you become a member of Arthritis action, you can have free or heavily subsidised access to physical therapists including physiotherapists, osteopaths and acupuncturists as well as dietary and nutritional advice from our Registered Dietitian
What can I do to help myself?
Rheumatoid arthritis is more common in people who smoke or who are overweight, so altering your lifestyle can reduce your risk of developing arthritis. Stopping smoking and reducing your weight can also mean that if you have already developed arthritis, you will have a much better response to medication.
- Try to keep to a healthy weight – For every pound that you are above a healthy weight, an extra 4 or 5 pounds of weight goes through your hips knees and feet and this can increase the pain. Reducing weight can help a lot with pain.
- Keep your muscles strong and do some exercise – Exercise that increases muscle strength can really help support the joints and reduce the pain of arthritis. Exercise will not harm your joints even if they are inflamed and will also help with weight control, improve posture and flexibility and reduce stress. You should try to balance active (aerobic) exercise with increasing strength (resistance) exercise plus work on flexibility (stretching) and balance to get the best results.
- Keep to a healthy diet – Eating healthily can help maintain muscle and bone strength and help you keep to a healthy weight. Eating a more Mediterranean diet with less red meat, more fruit and vegetables and more omega-3 fish oils can help.
- Self-management – Self-management is about taking control of your symptoms and lifestyle to live a better life with less pain and improved function. For further information refer to our Self-Management approach.