Rheumatoid arthritis

What is it?

Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints, most often the hands, feet and wrists.¹ It is an autoimmune disease: the immune system, which normally fights infection, attacks the lining of the joints by mistake.^1,3 Over time this can damage the joints, the cartilage and the bone nearby.¹ It can also cause inflammation in other parts of the body, such as the eyes, lungs and heart.^1,4

It can start at any age, but the risk goes up as people get older.⁴ It is more common in women than in men.^3,4 It can run in families, but genes seem to play only a small part.³ Smoking may raise the risk.^3,4 What sets it off is not known.³

The first signs

The signs usually come on slowly over a few weeks, sometimes over a few days.² The small joints of the hands and feet are often affected first, usually on both sides of the body.²

• a throbbing, aching pain in the joints;²
• stiff joints, often worse in the morning or after resting, and often lasting longer than 30 minutes;²
• joints that are swollen, warm and tender;²
• feeling tired and low on energy;²
• a high temperature, sweating, poor appetite or weight loss.²

Some people get firm lumps under the skin near the affected joints.^2,4 The signs can come and go, with flare-ups when they get worse.^2,1

How doctors find out

There is no single test that proves it.^4,5 Your family doctor checks your joints for swelling and how well they move, and asks about all your symptoms, even small ones.⁵ If it could be rheumatoid arthritis, you are sent to a joint specialist (rheumatologist).^5,4 Blood tests look for signs of inflammation and for certain antibodies, such as rheumatoid factor and anti-CCP, that many people with the condition have.⁵ X-rays or an MRI scan show inflammation and damage in the joints.⁵

Current treatment

Treatment usually starts with methotrexate, often with another DMARD and a short course of steroids, and biological medicines or JAK inhibitors are added when these are not enough.Source: NHS

Will it get worse?

It is different for everyone, and the signs can come and go or change over time.^2,4 With early diagnosis and the right treatment, many people go months or even years between flare-ups and can lead full lives.¹ Keeping it well controlled lowers the risk of problems elsewhere in the body, such as inflammation in the lungs, heart or eyes, and a higher risk of heart attack and stroke.¹

Medicines: what helps, and what to watch for

Disease-modifying medicines (DMARDs) are the main treatment.⁶ They calm the immune attack on the joints, which slows the damage and eases the symptoms.⁶ Methotrexate is usually the first, often with another DMARD and a short course of steroids.⁶ If these are not enough, biological medicines (given by injection) or JAK inhibitors can be added.⁶

Good to know:

• DMARDs can take a few months to work, so keep taking them even if you do not feel better at first;^6,7
• Methotrexate can affect your blood cells and liver, so you will have regular blood tests. Less often it can affect the lungs, so you may have a chest X-ray when you start taking it.⁶
• side effects of methotrexate can include feeling sick, a sore mouth, diarrhoea, headaches and hair loss;⁶
• biological medicines can wake up old infections such as tuberculosis (TB);⁶
• steroids used for a long time can cause weight gain, weaker bones, easy bruising and thin skin;⁶

Exercise and therapy help too

• regular exercise keeps joints moving and muscles strong; swimming, cycling, walking and water aerobics are gentler on the joints than running or football;⁷
• balance rest and activity, and rest if a joint becomes warm, swollen or very painful;⁷
• a physiotherapist helps with fitness, strength and flexibility, and can use heat or ice packs;⁶
• an occupational therapist shows you how to protect your joints at home and at work, and can suggest splints and aids;⁶
• a foot specialist (podiatrist) can help with foot problems and insoles;⁶
• no special diet is proven to help, but a balanced, Mediterranean-style diet is recommended.⁶

Surgery, for some people

If joints are damaged despite medicines, surgery can ease pain or correct their shape.⁶ Options include operations on the hand and wrist, keyhole surgery to remove inflamed tissue from a joint, and replacing a hip, knee or shoulder.⁶ A joint replacement is a big operation, and recovery takes months.⁶

Is there a cure?

There is no cure for rheumatoid arthritis.^1,4 Treatment aims to control the symptoms and limit damage to the joints, and starting it early helps most.^4,1

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Sources

Written in plain words by Frontlight from these pages:

1. NHS: Rheumatoid arthritis
2. NHS: Rheumatoid arthritis – Symptoms
3. NHS: Rheumatoid arthritis – Causes
4. MedlinePlus: Rheumatoid Arthritis
5. NHS: Rheumatoid arthritis – Diagnosis
6. NHS: Rheumatoid arthritis – Treatment
7. NHS: Rheumatoid arthritis – Living with