Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The symptoms usually affect the hands, feet and wrists.
There may be periods where symptoms become worse, known as flare-ups or flares.
A flare can be difficult to predict, but with treatment, it's possible to decrease the number of flares and minimise or prevent long-term damage to the joints.
Some people with rheumatoid arthritis also experience problems in other parts of the body or more general symptoms such as tiredness and weight loss.
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When to seek medical advice
You should see a doctor if you think you have symptoms of rheumatoid arthritis, so they can try to identify the underlying cause.
Diagnosing rheumatoid arthritis quickly is important because early treatment can help stop the condition from getting worse and reduce the risk of further problems such as joint damage.
Causes of rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disease. This means your immune system – which usually fights infection – attacks the cells that line your joints by mistake, making the joints swollen, stiff and painful.
Over time, this can damage the joint itself, the cartilage and nearby bone.
It's not clear what triggers this problem with the immune system, although you're at an increased risk if:
- you're a woman
- you have a family history of rheumatoid arthritis
- you smoke
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Treating rheumatoid arthritis
There's no cure for rheumatoid arthritis. However, early diagnosis and appropriate treatment enable many people with rheumatoid arthritis to have periods of months or even years between flares. This can help them lead full lives and continue regular employment.
The main treatment options include:
- medication that's taken in the long-term to relieve symptoms and slow the progress of the condition
- supportive treatments, such as physiotherapy and occupational therapy, to help keep you mobile and find ways around any problems you have with daily activities
- surgery to correct any joint problems that develop
Depending on how much pain, stiffness and joint damage you have, you may have to adapt the way you carry out simple daily tasks. They can become difficult or take longer to complete.
Complications of rheumatoid arthritis
Having rheumatoid arthritis can lead to several other conditions that may cause additional symptoms and can sometimes be life-threatening.
Possible complications include:
- inflammation of other areas of the body (such as the lungs, heart and eyes)
- an increased risk of and
Ensuring rheumatoid arthritis is well controlled helps reduce your risk of complications like these.
The main symptoms of rheumatoid arthritis are joint pain, swelling and stiffness. It may also cause more general symptoms, and inflammation in other parts of the body.
The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days.
The symptoms vary from person to person. They can come and go, and may change over time. You may occasionally experience flares when your condition deteriorates and your symptoms become more severe.
Symptoms affecting the joints
Rheumatoid arthritis mainly affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.
Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this isn't always the case.
The main symptoms affecting the joints are outlined below.
Theassociated with rheumatoid arthritis is usually a throbbing and aching pain. It's often worse in the mornings and after a period of inactivity.
Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist.
Like joint pain, the stiffness is often more severe in the morning or after a period of inactivity. Morning stiffness associated with another type of arthritis called osteoarthritis usually wears off within 30 minutes of getting up, but rheumatoid arthritis morning stiffness often lasts longer than this.
Swelling, warmth and redness
The lining of joints affected by rheumatoid arthritis becomes inflamed, which can cause the joints to swell, and become hot and tender to touch.
In some people, firm swellings called rheumatoid nodules can also develop under the skin around affected joints.
As well as problems affecting the joints, some people with rheumatoid arthritis experience a range of more general symptoms, such as:
- tiredness and a lack of energy
- a high temperature (fever)
- a poor appetite
- weight loss
The inflammation associated with rheumatoid arthritis can also sometimes cause problems affecting other areas of the body, such as:
- – if the eyes are affected
- – if the heart or lungs are affected
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Rheumatoid arthritis is an autoimmune condition, which means it's caused by the immune system attacking healthy body tissue. However, it's not yet known what triggers this.
Your immune system normally makes antibodies that attack bacteria and viruses, helping to fight infection.
If you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.
This causes the thin layer of cells (synovium) covering your joints to become sore and inflamed, releasing chemicals that damage nearby:
- cartilage – the stretchy connective tissue between bones
- tendons – the tissue that connects bone to muscle
- ligaments – the tissue that connects bone and cartilage
If the condition isn't treated, these chemicals gradually cause the joint to lose its shape and alignment. Eventually, it can destroy the joint completely.
Various theories of why the immune system starts to attack the joints have been suggested, such as an infection or virus being a trigger, but none of these theories has been proven.
Possible risk factors
There are a number of things that may increase your risk of developing rheumatoid arthritis, including:
- your genes – there's some evidence that rheumatoid arthritis can run in families, although the risk of inheriting the condition is thought to be low as genes are only thought to play a small role in the condition
- hormones – rheumatoid arthritis is more common in women than men, which may be because of the effects of the hormone oestrogen, although this link hasn't been proven
- – some evidence suggests that people who smoke are at an increased risk of developing rheumatoid arthritis
Rheumatoid arthritis can be difficult to diagnose because many conditions cause joint stiffness and inflammation and there's no definitive test for the condition.
You should see your doctor if you have these symptoms so they can try to determine the cause.
Seeing your doctor
Your doctor will carry out a physical examination, checking your joints for any swelling and to assess how easily they move. Your doctor will also ask you about your symptoms.
It's important to tell your doctor about all your symptoms, not just ones you think are important, as this will help them to make the correct diagnosis.
If your doctor thinks you have rheumatoid arthritis, they'll refer you to a specialist (rheumatologist).
Your doctor may arrange blood tests to help confirm the diagnosis.
No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but a number of tests can show possible indications of the condition.
Some of the main tests used include:
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- full blood count
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The full blood count measures your red cells to rule out anaemia. Anaemia means the blood is unable to carry enough oxygen, because of a lack of blood cells.
Anaemia is common in people with rheumatoid arthritis, although having anaemia doesn't prove you have rheumatoid arthritis.
Rheumatoid factor and anti-CCP antibodies
Specific blood tests can help diagnose rheumatoid arthritis but they aren't accurate in everyone.
About half of all people with rheumatoid arthritis have a positive rheumatoid factor present in their blood when the disease starts, but about 1 in 20 people without rheumatoid arthritis also tests positive.
An antibody test known as anti-CCP (anti-cyclic citrullinated peptide) is available. People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody found to have rheumatoid arthritis has this antibody.
Those who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe rheumatoid arthritis requiring higher levels of treatment.
A number of different scans may also be carried out to check for joint inflammation and damage. These can help tell the difference between different types of arthritis and can be used to monitor how your condition is progressing over time.
Scans that may be carried out to diagnose and monitor rheumatoid arthritis include:
- – where radiation is passed through your body to examine your bones and joints
- – where high-frequency sound waves are used to create an image of joints
- – where strong magnetic fields and radio waves are used to produce detailed images of your joints
Stopping the condition progressing
There are a number of medications available that can be used to help stop rheumatoid arthritis getting worse and reduce your risk of further problems.
These are often divided into two types of medication: 'disease-modifying anti-rheumatic drugs (DMARDs)' and 'biological treatments'.
Disease-modifying anti-rheumatic drugs (DMARDs)
If you've been diagnosed with rheumatoid arthritis, you'll normally be offered a combination of DMARD tablets as part of your initial treatment. These medications are particularly effective in easing symptoms of the condition and slowing down its progression.
DMARDs work by blocking the effects of the chemicals released when the immune system attacks the joints, which could otherwise cause further damage to nearby bones, tendons, ligaments and cartilage.
There are many different DMARDs that can be used, including:
Methotrexate is normally the first medicine given for rheumatoid arthritis, often alongside another DMARD and a short course of corticosteroids to relieve any pain. It may also be combined with the biological treatments mentioned below.
Common side effects of methotrexate include:
- feeling sick
- loss of appetite
- a sore mouth
- hair loss
The medication can also sometimes have an effect on your blood count and your liver, so you'll have regular blood tests to monitor this.
Less commonly, methotrexate can affect the lungs, so you'll usually have a chest X-ray and possibly breathing tests when you start taking methotrexate, to provide a comparison if you develop shortness of breath or a persistent dry cough while taking it. However, most people tolerate methotrexate well.
It can take a few months to notice a DMARD working. It's important to keep taking the medication, even if you don't notice it working at first.
You may have to try two or three types of DMARD before you find the one that's most suitable for you. Once you and your doctor work out the most suitable DMARD, you'll usually have to take the medicine in the long term.
Biological treatments are a newer form of treatment for rheumatoid arthritis. They include:
They're usually taken in combination with methotrexate or another DMARD and are normally only used if these medications alone haven't been effective.
Biological medications are given by injection and they work by stopping particular chemicals in the blood from activating your immune system to attack your joints.
Side effects from biological treatments are usually mild and include:
- skin reactions at the site of the injections
- feeling sick
- a high temperature (fever)
Some people may also be at risk of getting more serious problems, including the reactivation of infections such asin people who have had them in the past.
In addition to the medications used to control the progression of rheumatoid arthritis, you may also need to take medication specifically to relieve pain.
Some of the different medicines that may be used to relieve pain are outlined below.
In some cases, you may be advised to use painkillers such as, or a combination of paracetamol and codeine (co-codamol) to relieve the pain associated with rheumatoid arthritis.
These medications don't help treat the underlying inflammation of your joints, but they can sometimes be helpful in relieving pain. For example, they may be recommended while you're waiting to see a specialist or during periods where your symptoms are particularly bad (flare-ups).
Non-steroidal anti-inflammatory drugs (NSAIDs)
In addition to – or instead of – the painkillers mentioned above, your doctor may prescribe a.
This may be a traditional NSAID (such as, naproxen or diclofenac) or an alternative type called a COX-2 inhibitor (such as celecoxib or etoricoxib).
These medications can help relieve pain while also reducing inflammation in the joints, although they won't stop rheumatoid arthritis getting worse over time.
Your doctor will discuss with you what type of NSAID you should take and the benefits and risks associated with each of them.
Although uncommon, taking an NSAID tablet can increase the risk of serious stomach problems – such as internal bleeding – because the medications can break down the lining that protects the stomach against damage from stomach acids.
If you're prescribed an NSAID tablet, you'll often have to take another medicine, such as a proton pump inhibitor (PPI), as well. Taking a PPI reduces the amount of acid in your stomach, which greatly reduces the risk of damage to your stomach lining.
Corticosteroidsare powerful medications that can help reduce pain, stiffness and inflammation.
They can be used as:
- a (for example, prednisolone)
- an directly into a painful joint
- an injection into the muscle (to help lots of joints)
They're usually used to provide short-term pain relief – for example, while you're waiting for DMARD medication to take effect or during a flare-up.
Corticosteroids are normally only used in this way because long-term use of corticosteroids can have serious side effects, such as:
- weight gain
- (thinning of the bones)
- easy bruising
- muscle weakness
- thinning of the skin
Your doctor may also refer you to other services that might be able to help you with your rheumatoid arthritis symptoms.
A physiotherapist may help you improve your fitness and muscle strength, and make your joints more flexible.
They may also be able to help with pain relief using heat or ice packs, or transcutaneous electrical nerve stimulation (TENS). A TENS machine applies a small pulse of electricity to the affected joint, which numbs the nerve endings and can help ease the pain of rheumatoid arthritis.
If rheumatoid arthritis causes you problems with everyday tasks,may help.
An occupational therapist can provide training and advice that will help you to protect your joints, both while you're at home and at work.
Some type of support for your joints, such as a splint, may also be recommended, or devices that can help open jars or turn on taps.
If you have problems with your feet, a podiatrist may be able to help. You may also be offered some type of support for your joints or shoe insoles that can ease pain.
Sometimes, despite medication, damage to your joints may occur. In such cases, you may need surgery to help restore your ability to use your joint.
Surgery may also be recommended to reduce pain or correct deformities.
Finger, hand and wrist surgery
There are different types of surgery to correct joint problems in the hand. Examples include:
- carpal tunnel release (cutting a ligament in the wrist to relieve pressure on a nerve) – see treating carpal tunnel syndrome for more information
- release of tendons in the fingers to treat abnormal bending
- removal of inflamed tissue that lines the finger joints
Arthroscopyis a procedure to remove inflamed joint tissue.
During the operation, a thin tube with a light source and camera (arthroscope) is inserted into the joint through a small cut in the skin so the surgeon can see the affected joint.
Special surgical instruments are inserted through other small cuts in the skin to remove the damaged tissue. You usually don't have to stay overnight in hospital for this kind of surgery, but the joint will need to be rested at home for several days.
Some people with rheumatoid arthritis need surgery to replace part or all of a joint, such as the hip, knee or shoulder joint. This is known as a joint replacement or arthroplasty.
Replacement of these joints is a major operation that involves several days in hospital followed by months of rehabilitation.
The latest joints have a limited lifespan of 10-20 years. They're not perfect and some function may not be restored after the damaged joint is replaced by a new one.
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Complementary and alternative therapies
Many people with rheumatoid arthritis try complementary therapies, such as:
In most cases, there's little or no evidence these are effective in the long-term, although some people may experience a short-term benefit from them.
Nutritional supplements and dietary changes
There's no strong evidence to suggest that specific dietary changes can help improve rheumatoid arthritis, although some people with rheumatoid arthritis feel their symptoms get worse after they've eaten certain foods.
If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve. However, it's important to ensure your overall diet is still healthy and balanced.
There's also little evidence supporting the use ofin rheumatoid arthritis, although some can be useful in preventing side effects of medications you may be taking. For example, calcium and vitamin D supplements may help prevent osteoporosis if you're taking steroids and folic acid supplements may help prevent some of the side effects of methotrexate.
However, there's some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis.
Rheumatoid arthritis can put you at a higher risk of developing other conditions, particularly if it's not well controlled.
Some of these conditions are described below.
Carpal tunnel syndromeis a common condition in people with rheumatoid arthritis.
It's the result of compression of the nerve that controls sensation and movement in the hands (median nerve) and can cause symptoms such as:
- tingling in your thumb, fingers and part of the hand
Symptoms of carpal tunnel syndrome can sometimes be controlled with wrist splints or corticosteroid injections, although surgery to release the pressure on the median nerve may be needed in severe cases.
Rheumatoid arthritis is an inflammatory condition that can cause inflammation to develop in other parts of your body, such as the:
- Lungs – inflammation of the lungs or lung lining can lead to or , which can cause chest pain, a persistent cough and shortness of breath.
- Heart – inflammation of the tissue around the heart can lead to , which causes chest pain.
- Eyes – inflammation of the eyes can lead to or . Scleritis can cause eye redness and pain, whereas Sjogren's syndrome can cause dry eyes.
- Blood vessels – known as – can lead to the thickening, weakening, narrowing and scarring of blood vessel walls. In serious cases, it can affect blood flow to your body's organs and tissues and can be life-threatening.
However, thanks to early treatment, inflammation due to rheumatoid arthritis affecting other parts of the body is becoming less common.
If rheumatoid arthritis isn't treated early or isn't well controlled, the inflammation in your joints could lead to significant and permanent damage.
Problems that can affect the joints include:
- damage to nearby bone and cartilage (a tough, flexible tissue that covers the surface of joints)
- damage to nearby tendons (flexible tissue that attach muscle to bone), which could cause them to break (rupture)
- joint deformities
These problems sometimes need to be treated with surgery to prevent loss of function in the affected joints.
If you have rheumatoid arthritis, you're at a higher risk of developing.
CVD is a general term that describes conditions affecting the heart or blood vessels, and it includes life-threatening problems such as heart attacks and strokes.
It's not clear exactly why people with rheumatoid arthritis are at an increased risk of these problems. You can reduce your risk by ensuring your arthritis is well controlled and by reducing the impact of other factors that contribute to CVD, such as:
If you've had rheumatoid arthritis for some time, you're at increased risk of developing cervical myelopathy and you may need a special assessment of your neck before any operation where you're put to sleep.
This condition is caused by dislocation of joints at the top of the spine, which put pressure on the spinal cord. Although relatively uncommon, it's a serious condition that can greatly affect your mobility and can lead to permanent spinal cord damage if not treated promptly with surgery.
Living with rheumatoid arthritis
Taking control of rheumatoid arthritis will help you cope with its impact on your lifestyle. Techniques include:
- relaxation and breathing exercises to help pain control
- goal-setting exercises
- positive thinking
Talk to others
Many people find it helpful to talk to others in a similar position. You may find support from an individual or group of people with rheumatoid arthritis.
Patient organisations have local support groups where you can meet others diagnosed with the same condition.
It can be hard to deal with the unpredictable nature of rheumatoid arthritis. Some days, the pain and stiffness will be much worse than others, and there's no way of knowing when a flare-up will occur.
The difficult nature of rheumatoid arthritis can mean some people develop depression or feelings of stress and anxiety. Sometimes, these feelings can be related to poorly controlled pain or fatigue.
Living with any long-term condition makes you more likely to have a range of emotions such as frustration, fear, pain, anger and resentment.
Speak to your healthcare team if you're struggling to deal with your condition emotionally. They may be able to offer medication or psychological interventions to help.
Starting and raising a family
If you're taking medicines for rheumatoid arthritis, let your healthcare team know if you want to start a family or if you're worried about becoming pregnant while on medication.
Some medications, such as methotrexate, leflunomide and biological treatments, shouldn't be taken by men or women while they're trying for a baby. The doctors and nurses will work with you to ensure your rheumatoid arthritis is controlled while you're trying to get pregnant.
Babies and young children are physically and mentally demanding for any parent, but particularly so if you have rheumatoid arthritis. If you're struggling to cope, it may help to talk to other people in the same situation as you.
You may also be able to get additional support from your health visitor or occupational therapist to help you manage your young family.
Sex and relationships
Pain, discomfort and changes in the way you feel can affect your sex life. Your self-esteem or thoughts about how you look may affect your confidence.
Although many people find it difficult to talk about such private issues, there are resources that might help you.
Talking to your partner or doctor about the impact of rheumatoid arthritis on your sexuality and sexual relationships may help.