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Rheumatoid arthritis

Published by Bupa's health information team, August 2007.

This factsheet is for people with rheumatoid arthritis, or who would like information about it.

Rheumatoid arthritis (RA) occurs as a result of your immune system causing inflammation of the lining of a joint and the tissues surrounding it. It affects more than 350,000 people in the UK and can occur at any age. RA may be very mild with few symptoms, but for about one in 20 people it affects many joints and can be severe and disabling. Rheumatoid arthritis treatment includes painkillers and medicines to reduce inflammation and prevent the disease's progression.

What is rheumatoid arthritis?

Arthritis means inflammation of the joints. Rheumatoid arthritis (RA) is an autoimmune disease. Usually your body's immune system produces white cells and proteins called antibodies to destroy foreign substances such as viruses and bacteria. With autoimmune diseases, your immune system mistakes your own tissue as foreign and attacks it, leading to inflammation.

In RA, your body's immune system attacks the lining of your joints (synovial membrane). The disease may also cause inflammation of the sheaths around your tendons. Eventually, this causes thinning of the cartilage that covers the ends of your bones, and may lead to the bone being worn away.

Illustration showing the areas of the hand commonly affected by rheumatoid arthritis
The areas of the hand commonly affected by rheumatoid arthritis

Symptoms of rheumatoid arthritis

You will probably find that RA develops quite slowly at first. You may notice some discomfort in your hands and feet, and your joints may be swollen. It's possible that you will feel particularly stiff when you get up in the morning. For some people, the condition comes on quickly and painfully and may make it difficult for you to carry out your daily activities. You may also feel tired and generally unwell.

You may develop rheumatoid nodules - fleshy lumps that usually appear on your hands, feet and elbows. These aren't painful but may mean you have difficulty using your hands.

RA affects everyone differently and you are likely to find there are times when your symptoms are worse than at others. It's not usually possible to predict when these flare-ups will occur.

In general, of people with RA:

  • two out of 10 will only have very mild symptoms
  • three-quarters will continue to have flare-ups
  • one in 20 will develop serious RA, leading to severe disability

Causes of rheumatoid arthritis

If you are a woman, you are nearly three times more likely to get RA than a man. It's common for the symptoms of RA to improve during pregnancy - this suggests that hormones and the immune system may be involved in triggering the condition.

There seem to be some genes that make it more likely that you will get RA, and the disease runs in some families.

Certain lifestyle factors may increase your risk, for example, if you smoke or are obese.

Diagnosis of rheumatoid arthritis

If you suspect you have RA, even if your symptoms are mild, it's a good idea to see your GP. If you do have RA, it's important to start treatment soon because the earlier it's started, the more effective it will be. If not treated, the condition may lead to serious disability.

It can be difficult to diagnose RA because many other conditions may make your joints painful. There is no single test that can diagnose it, but your GP will ask about your symptoms and examine you. He or she may refer you for further tests.

  • Your blood may be tested for a marker called rheumatoid factor. This is present in 80 percent of people who have RA. However, rheumatoid factor is also found in one in 20 people who don't have the condition.
  • A new technique called anti-CCP antibody testing is a very specific test for RA.
  • You may have blood tests to see if you have anaemia (when you have too few red blood cells or not enough haemoglobin in your blood) as 80 percent of people with RA have this.
  • You may have an X-ray of your hands and feet to check for changes in these joints.

Treatment of rheumatoid arthritis

Self-help

There are things you can do to help ease the symptoms of RA.

  • Find a balance between exercise and rest. You need to keep active to prevent your joints from becoming weak and stiff but don't try to do too much. Swimming is an excellent activity because it strengthens your muscles and joints without putting any strain on them. A physiotherapist can give you information and advice.
  • Try to lose excess weight as this will reduce the pressure on your joints.
  • An occupational therapist can suggest ways of making everyday tasks easier and may be able to provide you with specialist equipment.
  • Try to eat a healthy, balanced diet and cut down on saturated fats.
  • A hot water bottle may help if your joints feel stiff and painful; try an ice pack if they are hot and irritated.

Medicines

There is a large range of medicines available that can help relieve the symptoms of RA, although no medicine can cure the condition.

  • Painkillers such as paracetamol may help to relieve pain and stiffness although they won't affect the progression of arthritis.
  • Anti-inflammatory medicines, known as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (eg Nurofen) reduce inflammation and so relieve pain and swelling.
  • Disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine and methotrexate work to slow down the disease process and delay joint damage. You may have to take a number of DMARDs at the same time and you may need to try several before you find one that suits you.
  • Four new medicines, infliximab, etanercept, adalimumab and rituximab, have been developed recently. You may be eligible to try these if other medicines have been unsuccessful.

With all medicines, it's important to follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist or doctor for advice.

Complementary therapies

Complementary therapies such as acupuncture and aromatherapy can't cure arthritis, but you may find they help to relieve pain and make you feel more relaxed. Speak to your doctor before trying any complementary therapy as it may affect any conventional medication that you are taking.

Non-surgical treatments

NSAIDs are available as creams or gels that can be rubbed onto painful areas, although these are not usually sufficient for treating inflamed joints.

Your doctor may recommend steroid injections. These are given directly into the specific joint and provide pain relief very quickly.

Surgery

It's unlikely that you will need surgery to treat your RA. However, if you have severely damaged joints and medication has not helped, your doctor may recommend that you have an operation. The surgery won't cure RA but it may help to reduce pain and discomfort. You may be offered:

  • a hip or knee replacement
  • synovectomy to remove the lining of an inflamed joint
  • removal or repair of severely inflamed tendons
  • surgery to fuse a joint to make it more stable, in your neck for example

Living with rheumatoid arthritis

You may find RA upsetting and frustrating. It's important to tell your doctor about how it's affecting you so he or she can make sure you get the most suitable treatment. You may need to make changes to your daily life, but people such as physiotherapists and occupational therapists can help to make this easier. It is likely that you will be able to control the disease very well using rheumatoid arthritis medication.

Further information

 

Related topics

Sources

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  • Rheumatoid arthritis. Arthritis Research Campaign. www.arc.org.uk, accessed 4 April 2007
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  • Sulfasalazine. Arthritis Research Campaign. www.arc.org.uk, accessed 4 April 2007
  • Methotrexate. Arthritis Research Campaign. www.arc.org.uk, accessed 4 April 2007
  • Gold by intramuscular injection. Arthritis Research Campaign. www.arc.org.uk, accessed 4 April 2007
  • Leflunomide. Arthritis Research Campaign. www.arc.org.uk, accessed 4 April 2007
  • Infliximab. Arthritis Research Campaign. www.arc.org.uk, accessed 4 April 2007
  • Etanercept. Arthritis Research Campaign. www.arc.org.uk, accessed 4 April 2007
  • Rituximab. Arthritis Research Campaign. www.arc.org.uk, accessed 5 April 2007
  • Complementary therapy. Arthritis Care. www.arthritiscare.org.uk, accessed 4 April 2007
  • Surgery. Arthritis Care. www.arthritiscare.org.uk, accessed 4 April 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Simon Bowman PhD FRCP, consultant rheumatologist, University Hospital Birmingham NHS Foundation Trust; Dr Sundeept Bhalara MSc MD MRCP, consultant rheumatologist; Dr Daniel Fishman FRCP PhD, consultant rheumatologist, Luton and Dunstable NHS Foundation Trust; and Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2007.

 

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