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Rheumatoid arthritis

Published by Bupa's health information team, November 2009.

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

Rheumatoid arthritis (RA) occurs as a result of the immune system causing inflammation of the lining of joints and surrounding structures.

About rheumatoid arthritis
Symptoms of rheumatoid arthritis
Causes of rheumatoid arthritis
Diagnosis of rheumatoid arthritis
Treatment of rheumatoid arthritis
Living with rheumatoid arthritis
Questions and answers
Video
Related topics
Further information
Sources

About rheumatoid arthritis

Arthritis means inflammation of the joints. Rheumatoid arthritis (RA) is an autoimmune disease. This means that the white cells and antibody proteins in your blood that usually fight infections enter your joints and cause inflammation. This causes heat, swelling and excess fluid to be produced.

Eventually, this may lead to thinning of the cartilage that covers the ends of your bones, and may cause the bone to be worn away. RA may also cause inflammation of the sheaths around your tendons. Rarely, the condition can affect other parts of your body, such as your lungs.

RA affects more than 350,000 people in the UK and can start at any age.

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 may notice discomfort initially in a few joints such as your fingers, knuckles, wrists or the balls of your feet. Typically RA is a 'symmetrical' arthritis - this means it affects both wrists or both hands in the same way. For most people, RA develops quite slowly at first. Other people find the condition comes on quickly and painfully, making it difficult to carry out daily activities. Symptoms include:

pain and swelling around the joint, making it tender and warm
stiffness in the morning, or if you sit for a long time
poor grip strength
tiredness, making you feel irritable and depressed
flu-like symptoms such as fever
weight loss
rheumatoid nodules - fleshy lumps that usually appear on your hands, feet and elbows

RA affects everyone differently. You may find that your symptoms come and go with little pain, swelling or inflammation in between the flare-ups. Flare-ups can last for a few days to a couple of months. You probably won't be able to predict when they will occur.

Causes of rheumatoid arthritis

The exact reasons why you may develop RA aren't fully understood at present. There are a number of things that seem to be involved. Women are nearly three times more likely to get RA than men. Symptoms tend to improve during pregnancy, suggesting that hormones and the immune system may be involved. It's possible that RA is triggered by an infection or virus, but there isn't any evidence to prove this.

Having certain genes makes it more likely that you will get RA, and the disease runs in some families. Lifestyle factors may also increase your risk, for example, if you smoke or are obese.

Diagnosis of rheumatoid arthritis

If you think you may you have RA, even if your symptoms are mild, see your GP. It's important to be referred to a specialist to start treatment as early as possible, especially if you have had symptoms for more than three months. Treatment focuses on reducing inflammation to limit the damage to your joints. If left untreated, RA may lead to serious disability.

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. There's no single test that can diagnose RA but your GP may refer you for one or more of the following.

A blood test for a marker called rheumatoid factor, present in eight in ten people with RA.
Anti-CCP antibody testing.
Blood tests for anaemia (a condition when you have too few red blood cells or not enough haemoglobin in your blood) - eight in ten people with RA have anaemia.
X-ray, ultrasound or magnetic resonance imaging (MRI) to look for changes in your 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. It's important to exercise to stop your joints from becoming weak and stiff but don't do too much. Swimming is excellent because it strengthens your muscles and joints without putting any strain on them. A physiotherapist can tailor a programme to suit you.
Losing excess weight 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.
Eat a healthy, balanced diet and cut down on saturated fats.
Use a splint on the affected joint and rest it during a flare-up.

There is limited evidence that taking certain food supplements can help RA. These include:

omega-3 fatty acids - found in oily fish such as mackerel, salmon and sardines, and some plant seed oils and nuts
borage seed oil
evening primrose oil

Speak to your GP if you're thinking of taking any supplements.

Medicines

No medicine can cure RA, but there are many that can help symptoms.

Painkillers such as paracetamol may help to relieve pain and stiffness.
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce symptoms of inflammation, relieving pain and swelling.
Disease-modifying anti-rheumatic drugs (DMARDs) slow down the progression of RA and ease its symptoms. They can take several months to work so it's important to continue taking them. You may need to try one or more.
Biological medicines made from animal or human proteins block the progress of RA in your immune system. You may be eligible to try these if other medicines haven't helped your symptoms.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Non-surgical treatments

NSAIDs are available as creams or gels that you can rub onto painful areas. They aren't usually sufficient for treating inflamed joints.

If you have a bad flare-up, you may be offered a corticosteroid injection into a specific joint to reduce inflammation.

Surgery

As medical treatments have improved it's now less likely that you will need surgery to treat RA. However, if you have severely damaged joints and medicines haven't helped, your doctor may recommend one of the following operations to reduce pain and discomfort.

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.

Complementary therapies

Complementary therapies such as acupuncture and aromatherapy may relieve pain and make you feel more relaxed. However, they have no effect on how fast the disease progresses. Speak to your doctor before trying any complementary therapy as it may affect conventional medicines.

Living with rheumatoid arthritis

You may find RA upsetting and frustrating at times. It's important to tell your doctor how it's affecting your life so you get the most suitable treatment. You may need to make changes to your daily life but there are people who can help to make this easier.

There is some evidence to suggest that if you have an inflammatory condition such as rheumatoid arthritis, you may be at a greater risk of heart disease. Therefore, it's important to take steps to minimise your risk of developing this, for example by reducing the amount of saturated fat in your diet and taking regular exercise. Your GP can give you more advice and information.