Rheumatoid arthritis: all you need to know

Why women need to talk about rheumatoid arthritis

You might think of rheumatoid arthritis as something that affects only older people – and that it's just a part of getting older. But it affects significantly more women than men, often from your 40s, and can have a huge impact on your life. Yet there are treatments that can really help.

“RA isn’t something you just have to accept, and it isn’t just about joint pain,” says Dr Adiele Hoffman, family doctor and Healthily expert. “Fatigue and other symptoms can go with it, along with lower self-esteem and body image.”

But there are new and better treatments being developed all the time, so the outlook is getting brighter – and the important thing is to get diagnosed as soon as possible.

Early and quick diagnosis is the key to better health

“It’s vital that RA is diagnosed quickly,” says Dr Adiele. “The earlier you start treatment, the more likely it is to work. There is a window after symptoms start where you can get a better result from treatment with medication, which can slow down (or even switch off) the progress of the disease.”

What is rheumatoid arthritis?

Rheumatoid arthritis is a long-term (chronic) condition.

“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,” explains Dr Adiele. This causes swelling (inflammation) around your body.

“It most often causes joint inflammation, usually in the same joint on both sides of your body – both knees or both hands, for example,” says Dr Adiele. “But sometimes, the inflammation can also affect other parts of your body, including your eyes, skin and heart.”

Rheumatoid arthritis vs osteoarthritis

“These conditions often have similar symptoms, and both can affect the same joints,” says Dr Adiele.

You can have both conditions at the same time. And osteoarthritis can start earlier in joints where you have rheumatoid arthritis. But there are key differences:

• rheumatoid arthritis – is inflammation caused by an autoimmune condition, which affects your whole body
• osteoarthritis
  – is caused by wear and tear of the joints themselves, so it doesn’t affect other parts of your body

Who is more likely to get RA?

“As early diagnosis is so important, it’s a good idea to know if you might be at higher risk,” says Dr Adiele. So here are the risk factors you need to know about, according to research.

Women are at higher risk of RA

“Rheumatoid arthritis rates are about 2 to 4 times higher in women than men,” says Dr Adiele. “And women are also more likely to develop RA at a younger age.” Women:

• have more than double the risk of being affected by rheumatoid arthritis
• are more likely to be diagnosed at a younger age – most commonly between the ages of 30 and 60, while it’s rare in men under 45
• report more symptoms of pain and depression

We don’t understand exactly why RA affects women more than men, but there are 2 theories.

1. Differences between women’s and men’s immune systems:

   • women are also more likely to get other autoimmune diseases such as
     Lupus
     and
     Sjögren's syndrome

2. Hormones:

   • more than half of women with RA find their symptoms improve during pregnancy (though a smaller number find they get worse). Studies have also found a risk of flare-ups after giving birth
   • women who have breastfed have a lower risk of RA
   • a recent study found RA can get worse after menopause, and that early
     menopause
     can increase your risk of RA

Is rheumatoid arthritis genetic?

If you have a family member with RA, you’re at higher risk of getting it. In a study comparing twins with RA, both twins had RA in 15% of identical twins, compared with 4% of non-identical twins.

It’s thought that having genes that are more often found in people with RA (we know of 100 so far) can increase your risk in 2 ways:

• some genes can increase your risk on their own – such as genes called HLA class II

• some genes work together with factors in your lifestyle or environment to increase your risk. For example, people with HLA class II genes have the highest risk of RA if they also smoke or are obese

Smoking and rheumatoid arthritis

Smoking can:

• increase your risk of getting RA – a review of studies found that smokers had a 26% higher risk of developing RA than non-smokers
• make RA symptoms worse – remember, it’s never too late to
  quit smoking

Does obesity cause arthritis?

Being overweight is another key factor in rheumatoid arthritis:

• it can make you more likely to get RA
• It can also make RA worse, as well as increasing your risk of conditions such as
  type 2 diabetes
  and
  heart disease

If you have RA, it’s important to stay active to help keep your weight at a healthy level (which will also cut your risk of heart attack(heart-attack) and stroke). But managing pain is key, as it can be harder to stay active when it hurts. Read more about managing RA.

RA is generally more likely if you’re over 40

• it can start at any age, but the chance of you getting it increases as you get older
• it most often starts between the ages of 30 and 60. Women tend to be slightly younger at diagnosis, while in men it’s rarely seen under age 45
• around 3 quarters of people are of working age when they’re diagnosed

What are the symptoms of RA?

There are 2 kinds of RA symptoms – joint symptoms and ‘general’ or more unusual symptoms of rheumatoid arthritis.

Joint symptoms

It can affect any joint in your body, but joints affected by rheumatoid arthritis first 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

Treatment for joint symptoms

“There are now effective treatments for RA to ease the pain and stiffness and to prevent the loss of bone,” says Dr Adiele. “This used to cause deformities for many more people before these medications were available.”

Here’s what you need to know:

• medications called disease-modifying anti-rheumatic drugs (DMARDs) can prevent the inflammation that causes loss of bone, cartilage and ligament damage
• starting treatment early is the key to reducing your risk of joint destruction, the deformities it can cause and the issues they bring for everyday life, such as making it harder to do up buttons or open packets of food
• medications are working to prevent issues such as claw-toe deformity – when your toes are permanently bent and curl under your foot – or swan-neck deformity – where your finger base and outermost joints bend and the middle joint straightens

Read more about rheumatoid arthritis treatments.

More unusual symptoms of rheumatoid arthritis

“There are other more general symptoms of RA that are good to note and flag to your doctor if you get them,” says Dr Adiele.

These include:

• fatigue
• fever
• weight loss
• loss of appetite
• sweating

Up to 4 out of 10 people with RA also have inflammation in other parts of their bodies including:

• eyes – RA can cause dry eyes and sometimes pain, redness, sensitivity to light and trouble seeing
• skin – rheumatoid nodules (lumps) can develop under your skin near bony areas
• heart – inflammation can cause swelling of the sac surrounding your heart (
  pericarditis
  ) and put you at higher risk of
  cardiovascular disease
  , as it causes blood vessels to narrow and block up faster
• lungs – inflammation in your lungs can cause fluid to collect or scarring, leading to trouble breathing
• mouth – RA can cause dryness and gum inflammation, with an increased risk of infections

What does rheumatoid arthritis feel like?

“How RA affects you varies from person to person,” says Dr Adiele.

Some women describe the pain as a “burning, throbbing, gnawing, aching joint pain” and the stiffness as feeling “like the Tin Man from The Wizard of Oz” or “like I’m stuck together with superglue”.

The overwhelming fatigue has been said to feel like “a hangover without the fun night” or “a constant nagging flu.”

These feelings can make life tricky and frustrating, interfering with everyday activities and making it a challenge to dress, prepare meals, hold a knife and fork, type on a keyboard or drive.

Celebrities with rheumatoid arthritis

• actress and singer Kathleen Turner's health issues include RA. She has been very open about her experiences, describing how her wrist pain “would make me want to scream” and how the medication side effects made her mind ‘“fuzzy”
• golfer Kristy McPherson was diagnosed with a rare type of RA in childhood. She has said: “Some days are better than others. If it’s rainy and cool, that’s not good. A nice day is just a bonus for me. Otherwise, I expect to be stiff and tight and hurting some going around the course. But that’s just part of it.’’ Watch this video of Kristy talking about her condition.

What is an RA flare-up?

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

“A flare-up will typically last 6 weeks or more, and usually more than 1 of your joints will be inflamed at 1 time,” says Dr Adiele. “You’ll often feel very tired, too.”

• sometimes there’s a clear trigger for a flare-up – common triggers include:
  • overdoing things (overexertion)
  • poor sleep
  • physical or mental
    stress
  • an infection, such as
    flu
    , a
    chest infection
    or
    urinary tract infection(UTI)
• but they can also be hard to predict – sometimes, flare-ups can come out of the blue and be exhausting, knocking you out of action for days or weeks until you get control of your symptoms again
• flare-ups vary between people – with different symptoms and different joints affected. Pain, stiffness and tiredness are common, but what a flare-up looks like for you can be different from someone else with RA
• one flare-up can be different to the next – including which joints are affected, what symptoms you get and how long they last

Get to know your triggers and early warning signs of a flare

Knowing what can trigger a flare-up can help you avoid or prepare for them. “Getting to know how you feel when a flare-up is about to happen can help you start self-care or talk to your doctor about treatment more quickly,” says Dr Adiele.

“Sometimes, self-care might be enough, but on other occasions you might need treatments from your doctor. It’s also important that your doctor knows about any flare-ups, as they might need to change or start medication.”

• try keeping a diary or using a symptom tracker – such as the one in the Healthily app – to see what was happening before your flare-up and try to identify any patterns
• if your symptoms get worse over a few days, this can sometimes be a clue that a flare-up is building up
• fatigue can also be a warning sign – feeling wiped out may mean a flare-up is on its way

Getting diagnosed

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

It isn’t always easy to get a diagnosis

“In the early stages, rheumatoid arthritis can look similar to other conditions that also cause painful joints, such as other types of arthritis,” says Dr Adiele. Doctors can use your symptoms and bloodwork to help tell the difference.

You can help your doctor work out what the problem is

• if you get symptoms such as morning stiffness, pain or swelling in your joints, see your doctor to get them checked out
• make notes about how it feels, take pictures, and see if there’s been anything else happening that might have caused it
• ask your family if anyone else has had these symptoms or been diagnosed with arthritis, so you can tell your doctor

Not sure if you need to see a doctor?

You can use the

to help you work out what’s going on and your best next steps.

You should see a doctor as soon as you can if you:

• notice swollen, red, hot or painful joints
• have joint stiffness
• struggle to make a fist or straighten your fingers
• feel unwell, very tired, have night sweats or are losing weight without meaning to
• notice a new skin rash or lumps under your skin

It’s particularly important to see a doctor if you get any of these symptoms and they keep coming back.

Tests for rheumatoid arthritis

“There isn’t a rheumatoid arthritis

that can tell for sure that you do or don’t have the condition,” says Dr Adiele. “So if your doctor suspects it could be RA, it’s important that they quickly refer you to see a specialist called a rheumatologist. They may also send you for tests, including blood tests and X-rays”.

Physical exam

Your doctor will check for any tender or swollen joints, as well as any deformities. They’ll also want to see how your symptoms are affecting you, including whether they’re stopping you doing things such as fastening buttons.

They can also check your joints with

and scans to check for inflammation and damage.

Blood tests for rheumatoid arthritis

There are several blood tests that your doctor is likely to organize, including:

• rheumatoid factor – this is a substance made by your immune system called an antibody, and 60% to 70% of people with RA have it in their blood. It’s not a perfect test, though – about 1 in 20 people without RA test positive for rheumatoid factor
• anti-cyclic citrullinated peptide (anti-CCP) – this is another antibody, found in about 80% of people with RA. People who test positive for anti-CCP are very likely to have or be diagnosed with RA
• ESR and CRP – these are tests to measure inflammation, which aren’t used only for RA, but can help to monitor how active your inflammation is
• complete blood count (CBC) – this can be used to check for anemia (which is common in RA), monitor treatment side effects, and rule out other conditions

Been diagnosed and wondering can rheumatoid arthritis be cured? Read about rheumatoid arthritis treatments.

Ones to watch

Can gut bacteria cause rheumatoid arthritis?

Researchers at the University of Colorado School of Medicine are looking for information to help solve what might trigger RA. They’ve found that certain gut bacteria can trigger an RA-like disease in animals who are already at risk (as shown by their blood markers). If this is the same for humans, it could be a way to predict who will get RA in the future, and also a new target for treatment.

Can the pill protect against rheumatoid arthritis?

Some studies have found that fewer women who take the pill get diagnosed with RA than women who’ve never taken it. However, this is still being debated, as other studies have found that taking the pill has no effect on RA.