Rheumatoid arthritis – what you need to know

Spot the signs and symptoms of rheumatoid arthritis (RA). Find out about causes and flare-ups, why women get RA more than men, and how to manage it.


What are the symptoms?

What are the causes and who’s at risk? 

When to see a doctor 

Getting diagnosed

What’s the treatment?

Self-care tips 

Rheumatoid arthritis (RA) can drain your energy and give you a lot of pain if it’s not diagnosed and treated effectively. Find out about symptoms, why it’s important to start treatment as soon as possible, and where to get support.  

Rheumatoid arthritis (RA) is a long-term (chronic) condition that affects around 18 million people worldwide. 

It’s an autoimmune disease – where your body’s own immune system (which normally works to protect you from getting unwell), attacks the lining of your joints and other areas. This causes swelling (inflammation) around your body.

RA usually causes joint inflammation in the same joint on both sides of your body – both knees or both hands, for example. Read on to find out more about the signs.

## What are the symptoms?

Any joint in your body can be affected, but the joints first hit by rheumatoid arthritis (RA) are often smaller ones in your hands and feet. Symptoms of rheumatoid arthritis in hands are common, along with the knees and ankles.

In the early stages, you might only have pain and tenderness, without any swelling or redness.

Key joint symptoms include:

- painful, aching, or throbbing joints 
- swollen, warm, and red joints – they might feel squishy when you touch them
- stiffness – this is often worse first thing in the morning, lasting longer than 30 minutes after you wake up, or after sitting for a long time.

There are other more general symptoms of RA that are good to note and flag to your doctor if you get them, including:

- fatigue
- fever
- weight loss
- loss of appetite
- sweating. 

Because RA results in inflammation, some people develop problems in other parts of their bodies including their eyes, skin and lungs. 

### Rheumatoid arthritis vs osteoarthritis

These conditions often have similar symptoms, and can both affect the same joints.

You can have both rheumatoid arthritis and [osteoarthritis](https://www.livehealthily.com/health-library/conditions/osteoarthritis) at the same time. Osteoarthritis can start earlier in joints where you have rheumatoid arthritis. But there are key differences, as this infographic shows. 

![Rheumatoid arthritis vs osteoarthritis infographic ](//images.ctfassets.net/iqo3fk8od6t9/3Ps9BG4r2IdHs3DvxmwUEd/0c12d68d40e481d6140b25858ef36ad7/Athritis_SVG.svg)

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## What are the causes and who’s at risk? 

Rheumatoid arthritis (RA) is an autoimmune condition, meaning your immune system – your body’s defense against infections – mistakenly sends antibodies to attack the tissue lining your joints. 

As a result the synovium – the thin layer of cells surrounding your joints – becomes sore and inflamed, causing damage to nearby bones, cartilage, ligaments and tendons. 

If left untreated, joints could become misaligned and eventually destroyed.

It’s not yet know why people get rheumatoid arthritis, but there are things that can increase your risk of RA:

- __gender__ – women are 2-3 times more likely to develop RA than men – this increased risk is thought to be due to the hormone estrogen 
- __age__ – you can get RA at any age, although it’s most likely to be diagnosed between the ages of 40 and 60
- __being overweight__ – puts you at higher risk of RA 
- __genes__ – having a family member with the condition may increase your risk, although this is low risk as genetics are thought to play a small role in causing RA
- __smoking__ – some research suggests smoking increases risk 
__a diet high in red meat and low in vitamin C__ – evidence suggests this may increase risk.

### RA flare-up – what’s the cause? 

The joint inflammation you get with rheumatoid arthritis can come and go – often known as a ‘flare-up’ or ‘flare’. 

One day you might feel fine, and the next you’re unable to get out of bed with stiff, swollen joints. Here’s what you need to know about a flare-up: 

1. __Sometimes there’s a clear trigger__ – common ones include:

- overdoing things (overexertion)
- poor sleep
- physical or mental [stress](https://www.livehealthily.com/mind/effects-of-stress-on-body)
- an infection, such as [flu](https://www.livehealthily.com/health-library/conditions/flu), a [chest infection](https://www.livehealthily.com/health-library/conditions/chest-infection-adult) or [urinary tract infection (UTI)](https://www.livehealthily.com/health-library/conditions/urinary-tract-infection-adults)

2. __They can also be hard to predict__ – sometimes, flare-ups can come out of the blue and put you out of action for days or weeks until you get control of your symptoms again

3. - __Flare-ups vary between people__ – pain, stiffness and tiredness are common, but there can be different symptoms and different joints affected from person to person 

4. - __One flare-up can be different to the next__ – including which joints are affected, what symptoms you get and how long they last.

## When to see a doctor 

You should see a doctor as soon as you can if you have any of the [symptoms](https://www.livehealthily.com/health-library/conditions/rheumatoid-arthritis#symptoms) of rheumatoid arthritis. 

Getting a diagnosis as quickly as you can is very important, both to get treatment that eases your symptoms and your pain right now, and also to help prevent joint damage. 


## Getting diagnosed

It isn’t always easy to get a diagnosis for rheumatoid arthritis (RA) because in the early stages, it can look similar to other conditions, such as different types of arthritis.  

There’s also no single test for RA, but your doctor will ask questions about your medical history and your symptoms, and may carry out the following:

- __a physical exam__ – to check your joints for swelling and movement, along with looking for bumps under the skin, warm joints and a low grade fever
- __blood tests__ – may include erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), to check inflammation levels in your body, as well as a full blood count to rule out other causes
- __tests for rheumatoid factor and anti-CCP antibodies__ – the former is a protein found in half of people with RA (but 1 in 20 people who don’t have RA test positive for it, so it doesn’t guarantee a diagnosis). The latter is an antibody that means you’re likely to get RA if it’s detected (although not everyone with the condition has it)
- __scans – X-rays, ultrasounds and MRIs__ – can be used to check for inflammation and damage to your joints. They might be used to diagnose or see how the condition is progressing. 

## What’s the treatment?

Although rheumatoid arthritis (RA) has no cure, treating it early can reduce the risk of damage to your joints and help you live an active life.

It can be treated through medicines, physical therapies and surgery.

The following medicines may be used:

- __disease-modifying anti-rheumatic drugs (DMARDs)__ – these drugs ease your symptoms and slow down the progression of the condition. There are 3 types of the drug; conventional synthetic DMARDs (csDMARDs), biological therapies (bDMARDs) and targeted synthetic DMARDs (tsDMARDS). Because of the effect they can have on the liver, you’ll need to have regular blood tests. It might take a few months to notice any changes in your symptoms
- __steroids__ – can be used in the short term to treat flare-ups and work to reduce pain, inflammation and stiffness in the joints. They are taken as a tablet or injection applied directly to the joint or muscle 
- __non-steroidal anti-inflammatory drugs (NSAIDs)__ – such as ibuprofen can be used to manage pain, swelling and stiffness. They can be taken alongside other painkillers
- __painkillers__ – used alongside other treatments. Some over-the-counter drugs such as acetaminophen (paracetamol) might be recommended, or stronger drugs such as codeine, available on prescription.

Alongside medication, physical therapy, occupational therapy, and podiatry can help you manage the symptoms of RA and the effect they have on your life.

In some cases, where your joints have become damaged, you may need surgery to help restore joint function, fix deformities, and reduce pain.

Read more about the [treatment options for rheumatoid arthritis](https://www.livehealthily.com/health-library/treatments/rheumatoid-arthritis-treatment).


## Self-care tips 

Alongside medical treatment, try these tips to help you manage your rheumatoid arthritis (RA) symptoms:

- __eat a healthy balanced diet__ – to help you stay well and maintain a healthy weight. Try to reduce your alcohol intake and if you smoke, stop. Some studies have found adding omega-3 to your diet (good sources include oily fish like salmon) may help. Or try a supplement (check with your doctor first) 
- __stay active__ – to help keep your joints mobile. Find an activity that works best for you and balance exercise with rest to allow your body time to recover
- __try hot and cold treatments__ – soothe your muscles by taking warm baths or applying heat pads. Try cold treatments, such as applying frozen peas to hot, swollen joints to numb the area and reduce inflammation
- __get to know flare-up triggers and plan ahead__ – for example, if the cold weather triggers your symptoms, stock up with treatments that help
- __look after your mental health__ – from breathing techniques to massage therapy, try techniques to reduce stress. Focus on doing that to lift your mood, and surround yourself with people who understand your condition, who will provide you with emotional support
- __find a support group__ – connect with people who also have your condition to help you cope with the emotional impact of RA. Take a look at organizations such as [Creaky Joints](https://creakyjoints.org/support/arthritis-support-groups/) (Australia), [National Rheumatoid Arthritis Society](https://nras.org.uk/information-support/connect-with-others/groups/) (UK) and [Arthritis Foundation](https://www.arthritis.org/) (US).

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References

Rosa Bowden

Jo Wheatley

Dr Tamer T Malak

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