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.
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 usually affected include 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 find that only one or two joints are affected at a time and that 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 of rheumatoid arthritis is usually worse in the mornings and often towards the end of the day again. People with active arthritis especially have problems gripping objects in the morning, and the joints tend to loosen up as the day goes on. Many people with rheumatoid arthritis feel especially tired at times and sometimes low in mood. Rheumatoid arthritis can also affect other parts of the body other than the joints including the skin, lungs and eyes. Many people have dry eyes and mouth (“sicca” symptoms or Sjogren’s syndrome) associated with the arthritis.
Although many people find that there arthritis is well-controlled, others sometimes have flare-ups affecting one or more joints. These flares can last a day or so or much longer.
Rheumatoid arthritis is usually diagnosed with a combination of your history, an examination of your joints, blood tests and X-rays of the joints. Sometimes, swelling of the joints is difficult to detect from the outside so if there is any doubt about whether or not your joints are swollen rather than just tender, you may have other tests such as an ultrasound scan of the hands, MRI scan, or special test called an isotope bone scan.
Medical treatments for rheumatoid arthritis
As rheumatoid arthritis is a problem caused by the immune system, it is most likely that you will need some sort of medicines which will stop the immune system from damaging your joints. The sooner you start these medicines, the less damage will happen inside your joints.There are many different types of medicine that do this but at the start you will usually be offered one or more so-called “disease-modifying drugs” 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 cocodamol or non-steroidal anti-inflammatory drugs (NSAIDS) such as naproxen or ibuprofen. Painkillers and NSAIDs do not affect the immune system and 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 of 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 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 and exercises
- 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?
There is nothing that you can do to stop yourself from developing rheumatoid arthritis but if you stop smoking and try to stay a healthy weight you can reduce your risk and these things will also mean that you respond better 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 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) 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 in order to live a better life with less pain and improved function. For further information refer to our Self-Management section.