Overview
Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The symptoms usually affect the hands, feet and wrists.
There may be periods where symptoms become worse, known as flare-ups or flares.
A flare can be difficult to predict, but with treatment it's possible to decrease the number of flares and minimise or prevent long-term damage to the joints.
Some people with rheumatoid arthritis also experience problems in other parts of the body, or more general symptoms such as tiredness and weight loss.
When to get medical advice
See a GP if you think you have symptoms of rheumatoid arthritis, so they can try to identify the underlying cause.
Diagnosing rheumatoid arthritis quickly is important, because early treatment can prevent it getting worse and reduce the risk of joint damage.
Causes of rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disease. This means your immune system (which usually fights infection) attacks the cells that line your joints by mistake, making the joints swollen, stiff and painful.
Over time, this can damage the joint itself, the cartilage and nearby bone.
It's not clear what triggers this problem with the immune system, although you're at an increased risk if:
- you are a woman
- you have a family history of rheumatoid arthritis
- you smoke
Treating rheumatoid arthritis
There's no cure for rheumatoid arthritis. However, early diagnosis and appropriate treatment enables many people with the condition to have periods of months or even years between flares. This can help them to lead full lives and continue regular employment.
The main treatment options include:
- medicine that is taken in the long-term to relieve symptoms and slow the progress of the condition
- supportive treatments, such as physiotherapy and occupational therapy, to help keep you mobile and find ways around any problems you have with daily activities
- surgery to correct any joint problems that develop
Depending on how much pain, stiffness and joint damage you have, daily tasks may become difficult or take you longer to do. You may have to adapt the way you do everyday tasks.
Complications of rheumatoid arthritis
Having rheumatoid arthritis can lead to several other conditions that may cause additional symptoms and can sometimes be life-threatening.
Possible complications include:
Making sure that rheumatoid arthritis is well controlled can help reduce your risk of these complications.
Symptoms
The main symptoms of rheumatoid arthritis are joint pain, swelling and stiffness. It may also cause more general symptoms, and inflammation in other parts of the body.
The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days.
The symptoms vary from person to person. They may come and go, or change over time. You may experience flares when your condition deteriorates and your symptoms become more severe.
Symptoms affecting the joints
Rheumatoid arthritis mainly affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.
Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this isn't always the case.
Pain
The joint pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.
Stiffness
Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist.
Like joint pain, the stiffness is often more severe in the morning or after a period of inactivity.
Morning stiffness associated with another type of arthritis called osteoarthritis usually wears off within 30 minutes of getting up, but rheumatoid arthritis morning stiffness often lasts longer than this.
Swelling, warmth and redness
The lining of joints affected by rheumatoid arthritis become inflamed, which can cause the joints to swell, and become hot and tender to touch.
In some people, firm swellings called rheumatoid nodules can also develop under the skin around affected joints.
Additional symptoms
As well as problems affecting the joints, some people with rheumatoid arthritis experience a range of more general symptoms, such as:
- tiredness and a lack of energy
- a high temperature (fever)
- sweating
- a poor appetite
- weight loss
The inflammation that's part of rheumatoid arthritis can also sometimes cause problems affecting other areas of the body, such as:
- dry eyes – if the eyes are affected
- chest pain – if the heart or lungs are affected
Diagnosis
Rheumatoid arthritis can be difficult to diagnose because many conditions cause joint stiffness and inflammation and there's no definitive test for the condition.
See a GP if you have these symptoms so they can try to determine the cause.
Seeing a GP
A GP will do a physical examination, checking your joints for any swelling and to assess how easily they move. The GP will also ask you about your symptoms.
It's important to tell the GP about all your symptoms, not just ones you think are important, as this will help them to make the correct diagnosis.
If the GP thinks you have rheumatoid arthritis, they'll refer you to a specialist (rheumatologist).
Blood tests
The GP may arrange blood tests to help confirm the diagnosis.
No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but several tests can show indications of the condition.
Some of the main blood tests used include:
- erythrocyte sedimentation rate (ESR) - which can help assess levels of inflammation in the body
- C-reactive protein (CRP) - another test that can help measure inflamation levels
- full blood count - this test can be used to help rule out other possible causes of your symptoms as well as provide an indicator of your general health
The full blood count test can also be used to check if you have anaemia. Anaemia means the blood is unable to carry enough oxygen, because of a lack of blood cells.
Anaemia is common in people with rheumatoid arthritis, although having anaemia does not prove you have rheumatoid arthritis.
Rheumatoid factor and anti-CCP antibodies
One blood test measures levels of rheumatoid factors in the blood. Rheumatoid factors are proteins that the immune system produces when it attacks health tissue.
About half of all people with rheumatoid arthritis have high levels of rheumatoid factors in their blood when the disease starts, but about 1 in 20 people without rheumatoid arthritis also test positive.
A related blood test known as anti-cyclic citrullinated peptide (anti-CCP) test is also available. Anti-CCPs are antibodies also produced by the immune system.
People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody with rheumatoid arthritis has this antibody.
Those who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe rheumatoid arthritis requiring higher levels of treatment.
Joint scans
Scans may be done to check for joint inflammation and damage.
These can help tell the difference between types of arthritis and can be used to monitor how your condition is progressing over time.
Scans that may be done to diagnose and monitor rheumatoid arthritis include:
- X-rays
- MRI scans (where strong magnetic fields and radio waves are used to produce detailed images of your joints)
Assessing your physical ability
If you have been diagnosed with rheumatoid arthritits, your specialist will do an assessment to see how well you're coping with everyday tasks.
You may be asked to fill in a questionnaire on how well you can do things like dress, walk and eat, and how good your grip strength is.
This assessment may be repeated later on after your treatment to see if you have made any improvements.
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Treatment
Treatment for rheumatoid arthritis can help reduce inflammation in the joints, relieve pain, prevent or slow joint damage, reduce disability and enable you to be as active as possible.
Although there's no cure for rheumatoid arthritis, early treatment and support (including medicine, lifestyle changes, supportive treatments and surgery) can reduce the risk of joint damage and limit the impact of the condition.
Your treatment will usually involve care from your GP and a number of different specialists.
There are medicines available to help stop rheumatoid arthritis from getting worse and reduce your risk of further problems.
These are often divided into main 2 types: disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments.
Disease-modifying anti-rheumatic drugs (DMARDs)
If you've been diagnosed with rheumatoid arthritis, you'll usually be offered a combination of DMARD tablets as part of your initial treatment.
These medicines ease the symptoms of the condition and slow down its progression.
DMARDs work by blocking the effects of the chemicals released when the immune system attacks your joints, which could otherwise cause further damage to nearby bones, tendons, ligaments and cartilage.
There are many different DMARDs that can be used, including:
- methotrexate
- leflunomide
- hydroxychloroquine
- sulfasalazine
Methotrexate is usually the first medicine given for rheumatoid arthritis, often alongside another DMARD and a short-course of steroids (corticosteroids) to relieve any pain.
These may be combined with biological treatments.
Common side effects of methotrexate include:
- feeling sick
- loss of appetite
- a sore mouth
- diarrhoea
- headaches
- hair loss
The medicine can also affect your blood cells and liver, so you'll have regular blood tests to monitor this.
Less commonly, methotrexate can affect the lungs, so you may have a chest X-ray and possibly a breathing test when you start taking it. This is to provide a comparison if you develop shortness of breath or a persistent dry cough while taking it. But most people tolerate methotrexate well.
It can take a few months to notice a DMARD working. It's important to keep taking the medicine, even if you do not notice it working a the beginning.
You may have to try 2 or 3 types of DMARD before you find the one that's most suitable for you.
Once you and your doctor find the most suitable DMARD, you'll usually have to take the medicine long term.
Further information
Biological treatments
Biological treatments, such as adalimumab, etanercept and infliximab, are a newer form of treatment for rheumatoid arthritis.
They're usually taken in combination with methotrexate or another DMARD, and are usually only used if DMARDs have not been effective on their own.
Biological medicines are given by injection. They work by stopping particular chemicals in your blood from activating your immune system to attack your joints.
Side effects from biological treatments are usually mild but include:
- skin reactions at the site of the injections
- infections
- feeling sick
- a high temperature
- headaches
Some people may also be at risk of getting more serious problems, including the reactivation of infections such as tuberculosis (TB) if they have had them in the past.
Further information
Jak inhibitors
JAK inhibitors are a new type of medicine available on the NHS to adults with severe rheumatoid arthritis.
It is offered to people who cannot take DMARDs or biologicals, or tried them but found they were not effective.
This medicine is usually used in combination with methotrexate.
JAK inhibitors can also be taken on their own by adults who cannot take methotrexate.
Further information
Medicine to relieve pain
In addition to the medicines used to control the progression of rheumatoid arthritis, you may also need to take medicine specifically to relieve pain.
Painkillers
In some cases, you may be advised to use painkillers such as paracetamol, or a combination of paracetamol and codeine (co-codamol), to relieve the pain associated with rheumatoid arthritis.
These medicines do not treat the inflammation in your joints, but they may be helpful in relieving pain.
For example, they may be recommended while you're waiting to see a specialist or when your symptoms are particularly bad (flare-ups).
Non-steroidal anti-inflammatory drugs (NSAIDs)
In addition to, or instead of, the painkillers mentioned above, your doctor may prescribe a non-steroidal anti-inflammatory drug (NSAID).
This may be a traditional NSAID, such as ibuprofen, naproxen or diclofenac. Or your doctor may prescribe a type called a COX-2 inhibitor, such as celecoxib or etoricoxib.
These medicines can help relieve pain while also reducing inflammation in the joints, although they will not stop rheumatoid arthritis getting worse over time.
Your doctor will discuss with you what type of NSAID you should take, and the benefits and risks associated with it.
Although uncommon, taking NSAIDs can increase the risk of serious stomach problems, such as internal bleeding.
This is because the medicines can break down the lining that protects the stomach against damage from stomach acids.
If you're prescribed an NSAID tablet, you'll often be given another medicine to take with it, such as a proton pump inhibitor (PPI).
Taking a PPI reduces the amount of acid in your stomach, which reduces the risk of damage to your stomach lining.
Steroids
Steroids are powerful medicines that can help reduce pain, stiffness and inflammation.
They can be given as:
- a tablet (for example, prednisolone)
- an injection directly into a painful joint
- an injection into the muscle (to help lots of joints)
They're usually used to provide short-term pain relief – for example, while you're waiting for DMARD medicines to take effect or during a flare-up.
Steroids are usually only used for a short time because long-term use can have serious side effects, such as:
- weight gain
- osteoporosis (weakening of the bones)
- easy bruising
- muscle weakness
- thinning of the skin
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Supportive treatments
Your doctor may also refer you to other services that might be able to help you with your rheumatoid arthritis symptoms.
Physiotherapy
A physiotherapist may help you improve your fitness and muscle strength, and make your joints more flexible.
If your hands or wrists are affected, you can try a tailored hand exercise programme. This involves face-to-face sessions with a trained therapist and doing the exercises yourself at home.
A physiotherapist may also be able to help with pain relief using heat or ice packs, or transcutaneous electrical nerve stimulation (TENS).
A TENS machine applies a small pulse of electricity to the affected joint, which numbs the nerve endings and can help ease the pain of rheumatoid arthritis.
Occupational therapy
If rheumatoid arthritis causes you problems with everyday tasks, occupational therapy may help.
An occupational therapist can provide training and advice that will help you to protect your joints, both while you're at home and at work.
Using a support for your joints, such as a splint, may also be recommended, or devices that can help open jars or turn on taps.
Podiatry
If you have problems with your feet, a podiatrist may be able to help.
You may also be offered some type of support for your joints or shoe insoles that can ease pain.
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Surgery
Sometimes, despite taking medicines, your joints may still become damaged. If this happens, you may need surgery to help restore your ability to use your joint.
Surgery may also be recommended to reduce pain or fix deformities.
Finger, hand and wrist surgery
There are different types of surgery to correct joint problems in the hand.
Examples include:
- carpal tunnel release (cutting a ligament in the wrist to relieve pressure on a nerve) . Find out more about carpal tunnel syndrome
- release of tendons in the fingers to treat abnormal bending
- removal of inflamed tissue that lines the finger joints
Arthroscopy
This is a procedure to remove inflamed joint tissue.
During an arthroscopy, a thin tube with a light and camera attached to it (arthroscope) is inserted into the joint through a small cut in the skin so the surgeon can see the affected joint.
Special instruments are inserted through other small cuts in the skin to remove the damaged tissue.
You usually do not have to stay in hospital overnight for this kind of surgery, but the joint will need to be rested at home for several days.
Joint replacement
Some people with rheumatoid arthritis need surgery to replace part or all of a joint, such as the hip, knee or shoulder joint.
This is known as a joint replacement or arthroplasty.
Replacement of these joints is a major operation that involves several days in hospital followed by months of rehabilitation.
The latest prosthetic joints have a limited lifespan of 10 to 20 years and some function may not be restored after a damaged joint is replaced by a prosthetic one.
Find out more about knee replacement and hip replacement.
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Complementary therapies
Many people with rheumatoid arthritis try complementary therapies, such as:
In most cases, there's little or no evidence these are effective in the long term, although some people may experience a short-term benefit from them.
Nutritional supplements and dietary changes
There's no strong evidence to suggest that specific dietary changes can help improve rheumatoid arthritis, although some people with rheumatoid arthritis feel their symptoms get worse after they have eaten certain foods.
If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve.
But it's important to ensure your overall diet is still healthy and balanced. A Mediterranean-style diet, which is based on vegetables, fruits, legumes, nuts, beans, cereals, grains, fish and unsaturated fats such as olive oil, is recommended.
There's also little evidence supporting the use of supplements in rheumatoid arthritis, although some can be useful in preventing side effects of medicines you may be taking.
For example, calcium and vitamin D supplements may help prevent osteoporosis if you're taking steroids, and folic acid supplements may help prevent some of the side effects of methotrexate.
There's some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis.
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Living with
Rheumatoid arthritis can be life-changing. You may need long-term treatment to control the symptoms and joint damage.
Depending on how much pain and stiffness you feel and how much joint damage you have, simple daily tasks may become difficult or take longer to do.
You may need to adapt the way you do everyday tasks, or make changes to your lifestyle, to help you manage your condition.
Here are some things you can do to help.
Self-care
Self care is an important part of daily life. It involves taking responsibility for your own health and wellbeing with support from people involved in your care.
It includes what you do every day to stay fit and maintain good physical and mental health, prevent illness and accidents, and manage minor ailments and long-term conditions.
People who have a long-term condition, such as rheumatoid arthritis, can benefit enormously from being supported to care for themselves. They can live longer, have a better quality of life, and be more active and independent.
Take your medicine
It's important to take your medicine as instructed, even if you start to feel better, as medicine can help prevent flare-ups and reduce the risk of further problems, such as joint damage.
If you have any questions or concerns about the medicine you're taking or side effects, talk to your healthcare team.
It may also be useful to read the information leaflet that comes with the medicine, as this tells you about possible interactions with other medicines or supplements.
Check with your healthcare team before taking any over-the-counter remedies, such as painkillers or nutritional supplements. These may interfere with your medicine.
Regular reviews
As rheumatoid arthritis is a long-term condition, you'll be in contact with your healthcare team regularly so they can check if your condition is being well controlled and if your treatment is right for you.
You may have your disease activity score (DAS) measured regularly, which can help your healthcare team to decide on the best treatment.
Read more about the DAS score on the National Rheumatoid Arthritis website.
The more your healthcare team know, the more they can help you, so discuss any concerns you have with them.
Reducing your medicine
Some people find their symptoms go away or get much better. If your symptoms stay better for at least 1 year without needing to take steroids, your treatment can be reviewed.
Your doctor may suggest slowly reducing your dose of medicine, then seeing if you can stop taking it.
You'll be monitored during this time. If your symptoms come back, you'll need to start taking disease-modifying anti-rheumatic drugs (DMARDs) straight away.
Keeping well
If you have rheumatoid arthritis, you may be advised to have a yearly flu vaccination to protect against flu.
You may also be advised to have a pneumococcal vaccination, a one-off injection that protects against a specific serious chest infection called pneumococcal pneumonia.
Try to get plenty of rest during a flare-up, when your joints can be particularly painful and inflamed.
Putting further strain on very swollen and painful joints can often make the pain and inflammation worse.
Healthy eating and exercise
Regular exercise and a healthy diet are recommended for everyone, not just people with rheumatoid arthritis.
They can help prevent many conditions, including heart disease and many forms of cancer.
Exercising regularly can help relieve stress, help keep your joints mobile and strengthen the muscles supporting your joints.
Exercise can also help you lose weight if you're overweight, which can put extra strain on your joints.
But it's important to find a balance between rest and exercise. Rest will make inflamed joints feel more comfortable, but without movement your joints will stiffen and your muscles will become weaker.
Find the best activities and the right balance for you. It's usually best to increase the amount of exercise you do gradually.
If a particular activity causes your joints to become warm and swollen, or it causes severe pain, then stop and rest. If it does not cause problems, then it is usually fine to continue.
If a particular activity always causes a flare-up, it's best to avoid it and find an alternative.
High-impact activities, such as running or contact sports like rugby and football, are more likely to cause problems.
Try low-impact activities that put less strain on your joints, such as swimming, cycling, walking and aqua aerobics.
If you need more guidance, a physiotherapist is a good person to advise you on suitable types of exercise.
Further information
Self-management
Taking control of rheumatoid arthritis will help you cope with its impact on your lifestyle.
A self-management programme specifically for people with rheumatoid arthritis has been developed by the NRAS.
The 6-week programme can help you learn more about your condition and provide practical tips on how to manage everyday life, such as:
- how to get the best from your medicine
- techniques to manage pain
- goal-setting exercises
Further information
Talk to others
Many people find it helpful to talk to others in a similar position. There may be a local support group where you can meet others with the same condition as you.
Call the NRAS helpline free on 0800 298 7650 from Monday to Friday, 9.30am to 4.30pm. You can speak to a trained rheumatoid arthritis adviser. You can also arrange to speak to someone who has rheumatoid arthritis.
Or call the Versus Arthritis free helpline on 0800 5200 520 from Monday to Friday, 9am to 8pm.
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Your feelings
It can be hard to deal with the unpredictable nature of rheumatoid arthritis.
Some days, the pain and stiffness will be much worse than others, and there may be no way of knowing when a flare-up will happen.
The difficult nature of rheumatoid arthritis can mean some people develop depression or feelings of stress and anxiety.
Sometimes, these feelings can be related to poorly controlled pain or fatigue.
Living with long-term conditions makes you more likely to have a range of emotions such as frustration, fear, anger and resentment.
Speak to your healthcare team if you're struggling to deal with your feelings about the condition.
They may be able to offer medicine or suggest mental health services that may help.
Further information
Starting and raising a family
If you're taking medicines for rheumatoid arthritis, let your healthcare team know if you want to start a family or if you're worried about becoming pregnant while taking medicine.
Some medicines, such as methotrexate, leflunomide and biological treatments, should not be taken by men or women while they're trying for a baby.
Your healthcare team will work with you to try to keep your rheumatoid arthritis under control while you're trying to get pregnant.
Babies and young children are physically and mentally demanding for any parent, but particularly if you have rheumatoid arthritis.
If you're struggling to cope, it may help to talk to other people in the same situation as you.
You may also be able to get extra support from your health visitor or occupational therapist to help you manage your young family.
Further information
Sex and relationships
Pain, discomfort and changes in the way you feel can affect your sex life.
Your self-esteem or thoughts about how you look may affect your confidence.
Although many people find it difficult to talk about such private issues, there are resources that may help you.
Talking to your partner or GP about the impact of rheumatoid arthritis on your sexuality and sexual relationships may help.
Further information
Money and benefits
If you have to stop work or work part time because of your rheumatoid arthritis, you may find it hard to cope financially.
You may be entitled to one or more of the following types of financial support:
You may also be eligible for other benefits if you have children living at home or if you have a low household income.
Complications
Rheumatoid arthritis can put you at a higher risk of developing other conditions, particularly if it's not well controlled.
Some of these conditions are described below.
Carpal tunnel syndrome
Carpal tunnel syndrome is a common condition in people with rheumatoid arthritis.
It's the result of compression of the nerve that controls sensation and movement in the hands (median nerve) and can cause symptoms such as:
- aching
- numbness
- tingling in your thumb, fingers and part of the hand
Symptoms of carpal tunnel syndrome can sometimes be controlled with wrist splints or steroid injections, although surgery to release the pressure on the median nerve may be needed in severe cases.
Widespread inflammation
Rheumatoid arthritis is an inflammatory condition which can cause inflammation to develop in other parts of your body, such as the:
- Lungs – inflammation of the lungs or lung lining can lead to pleurisy or pulmonary fibrosis, which can cause chest pain, a persistent cough and shortness of breath.
- Heart – inflammation of the tissue around the heart can lead to pericarditis, which causes chest pain.
- Eyes – inflammation of the eyes can lead to scleritis or Sjogren's syndrome. Scleritis can cause eye redness and pain, whereas Sjogren's syndrome can cause dry eyes.
- Blood vessels - inflammation of the blood vessels, known as vasculitis, is the thickening, weakening, narrowing and scarring of blood vessel walls. In serious cases, it can affect blood flow to your body's organs and tissues and can be life-threatening.
However, with early treatment, inflammation in other parts of the body from rheumatoid arthritis is less likely.
Joint damage
If rheumatoid arthritis is not treated early or is not well controlled, the inflammation in your joints could lead to significant and permanent damage.
Problems that can affect the joints include:
- damage to nearby bone and cartilage (a tough, flexible tissue that covers the surface of joints)
- damage to nearby tendons (flexible tissue that attach muscle to bone), which could cause them to break (rupture)
- joint deformities
These problems sometimes need to be treated with surgery to prevent loss of function in the affected joints.
Cardiovascular disease
If you have rheumatoid arthritis, you're at a higher risk of developing cardiovascular disease (CVD).
CVD is a general term that describes conditions affecting the heart or blood vessels, and it includes life-threatening problems such as heart attacks and strokes.
It's not clear exactly why people with rheumatoid arthritis are at an increased risk of these problems. You can reduce your risk by ensuring your arthritis is well controlled and by:
- stopping smoking
- eating healthily
- exercising regularly
Cervical myelopathy
If you've had rheumatoid arthritis for some time, you're at increased risk of developing a problem at the top of your spine known as cervical myelopathy
You may need a special assessment of your neck before any operation where you're given general anaesthetic.
This condition leads to dislocation of joints at the top of the spine, which puts pressure on the spinal cord. Although uncommon, it's a serious condition that can greatly affect your mobility and can lead to permanent spinal cord damage if not treated quickly with surgery.
Further information