Overview
Rheumatoid arthritis is an autoimmune disease. The immune system, which normally fights infection, attacks the lining of the joints by mistake. The lining becomes inflamed, which causes pain, swelling and stiffness, and over time the joint itself can be damaged.
It is a long-term condition that usually comes in flares, with quieter periods between them. It is different from osteoarthritis, which is wear of the joint surfaces, and it can affect other parts of the body as well.
Symptoms
The small joints of the hands, wrists and feet are usually affected first, and the same joints are often involved on both sides, though not always. The joints are swollen, and hot and tender to touch.
Stiffness in the morning typically lasts longer than half an hour. Many people also feel very tired, and there may be fever, sweats, loss of appetite or weight loss. Firm lumps called nodules can form under the skin near affected joints.
When to see a doctor
See a doctor soon if a joint has been swollen, warm and tender for more than a few weeks, if morning stiffness lasts longer than half an hour, or if a flare is not settling on the usual treatment. Early treatment lowers the risk of joint damage.
Causes
The trigger is not known. Rheumatoid arthritis develops through a combination of genes and exposures in the environment, which together lead the immune system to attack joint tissue.
It is not caused by any particular food, and it cannot be caught from another person.
Risk factors
- Being a woman, as it is commoner in women than in men
- Rising age
- A parent, brother or sister with rheumatoid arthritis
- Smoking
- Being overweight
- Gum disease
- Long-standing lung disease
Complications
Inflammation that is not controlled can permanently damage bone, and tendons, and surgery is sometimes needed to keep a joint working.
Other parts of the body can be affected: inflammation in the lungs, in the lining around the heart, in the eyes and in blood vessels, dryness of the eyes, and pressure on the nerve at the wrist, which causes tingling in the thumb and fingers. The risk of heart attack and stroke is higher, and controlling the disease, not smoking, eating well and staying active all bring it down.
Prevention
There is no known way to prevent rheumatoid arthritis. Not smoking is the clearest step a person can take, and keeping to a healthy weight and looking after the teeth and gums are sensible too, because smoking, obesity and gum disease are all linked to a higher risk.
Diagnosis
There is no single test. A doctor takes the history, examines the joints, and arranges blood tests and imaging. Early diagnosis can be difficult, because the disease builds up gradually.
Blood tests may include rheumatoid factor and anti-CCP antibodies, which support the diagnosis although some people with the disease test negative, and markers of inflammation, which also show how active the disease is. X-rays, or MRI are used to look for joint damage and to rule out other conditions.
Treatment
Rheumatoid arthritis cannot be cured, but it can usually be controlled. The aim is to reduce inflammation, slow the disease, ease symptoms and keep the joints working.
Disease-modifying medicines are the mainstay and are taken long term. When they are not enough, biological medicines or tablets that block particular immune signals may be added. Anti-inflammatory painkillers and short courses of steroids help with symptoms and flares but do not slow the disease. Regular blood tests check that treatment is working and safe.
Physiotherapy and occupational therapy keep strength and function and protect the joints during daily tasks. Surgery is considered when a joint has been permanently damaged. Balancing rest with exercise, eating well and getting support for mood and stress all help.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Arthritis is just old age. Everyone gets it, so there is nothing to treat.”What is true?
Fact
Rheumatoid arthritis is not wear and tear. It is an autoimmune disease that can affect the eyes, lungs, heart and blood vessels as well as the joints, and inflammation that is left untreated can damage bone, cartilage and tendons permanently.
Myth“Curd, rice, sour foods or tomatoes cause it, so stopping them will cure it.”What is true?
Fact
No food causes rheumatoid arthritis. It develops from a combination of genes and environmental factors, with smoking, being overweight and gum disease among the known risks. Eating well supports general health, but stopping treatment to try a diet lets joint damage carry on.
Myth“Painkillers and steroid tablets are enough. The stronger medicines are too dangerous.”What is true?
Fact
Anti-inflammatory painkillers and short courses of steroids ease symptoms but do not slow the disease. Disease-modifying medicines are what protect the joints over years. They are monitored with regular blood tests, which is why they are prescribed and followed up by a specialist.
Myth“The pain has settled, so the disease is gone and I can stop the tablets.”What is true?
Fact
Rheumatoid arthritis comes in flares with quieter periods in between, and the medicines that control it are meant to be taken long term. Feeling better usually means the treatment is working. Any change to it should be made by the doctor who prescribed it.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How is rheumatoid arthritis different from ordinary joint pain in old age?
Osteoarthritis comes from wear of the joint surfaces and tends to hurt more with use through the day. Rheumatoid arthritis is inflammation driven by the immune system: the joints are swollen, warm and tender, morning stiffness lasts longer than half an hour, both sides are often affected, and there may be tiredness or fever.
Will I have to take medicines for the rest of my life?
Usually treatment is long term, because the medicines control the disease rather than cure it. Doses and combinations are adjusted over time according to how active the disease is, and a specialist reviews this at regular appointments. Stopping without advice risks a flare and further joint damage.
Can I exercise with rheumatoid arthritis?
Yes, and it is encouraged. The balance is between rest during a bad flare and regular gentle activity the rest of the time, which keeps muscles strong and joints moving. A physiotherapist can work out what suits your joints, and an occupational therapist can suggest ways to protect them during daily tasks.
Is rheumatoid arthritis passed on to children?
It is not inherited in a simple way. Having a close relative with rheumatoid arthritis raises the risk, but genes are only one part of the picture and exposures in the environment matter as well, so a family history does not mean a child will get it.