Rheumatoid arthritis (RA) attacks the whole body rather than just the joints as in osteoarthritis. Here, our experts explain the importance of early diagnosis and treatment.
Rheumatoid arthritis (RA) attacks the whole body rather than just the joints as in osteoarthritis. Rheumatoid arthritis is a progressive auto-immune disease where the body’s immune system attacks the joints, causing pain and inflammation.
If left untreated and allowed to progress, it can ‘eat away’ at, and severely damage the joints.
The key to preventing damage is early diagnosis and beginning treatment as early as possible – at least within the first three months.
The good news is that treatments have advanced considerably in the last 10 years.
Symptoms of rheumatoid arthritis
Symptoms usually start in the small joints of the hands and feet – particularly the main knuckle joints in the hand and usually affect at least two joints, which become painful, red and inflamed, and may start to swell.
Symptoms usually progress rapidly within days and weeks. The pain is severe, persistent and doesn’t go away.
Other symptoms of RA can include:
- Morning joint stiffness (lasting more than half an hour)
- Sleep problems
- Extreme tiredness
- Loss of appetite and weight loss
- Flu-like illness.
If you have some of these symptoms, see your GP.
Distinguishing rheumatoid arthritis from osteoarthritis
RA is a systemic disease, which means that it affects the whole body, including sometimes the heart, eyes, skin, lungs and blood. It’s an auto-immune condition – which means the body’s own immune system begins to attack the body.
Although osteoarthritis can also cause joint pain – including morning stiffness – this usually disappears after half an hour, but in RA it often lasts for many hours.
Patients with RA can wake up in the middle of the night with joint pain and stiffness, often experiencing fatigue and weight loss, which doesn’t happen with osteoarthritis.
How common is it?
According to the NHS, rheumatoid arthritis affects more than 400,000 people in the UK- around 1 per cent of the population. It often starts when a person is between 40 and 50 years old and women are 3 times more likely to be affected than men, although it can start at any age and affect men too. Rheumatoid arthritis is much less common than osteoarthritis, which affects around 8.5 million people.
What causes rheumatoid arthritis?
Doctors aren’t certain what causes it, but some experts believe it could be triggered by a virus, infection or an injury. Although family history plays a role, it doesn't necessarily follow that you will develop RA if a close relative has the condition.
Because many more women have RA than men, it's possible that hormones may have a role in its development. Prolonged use of the oral contraceptive pill may have a protective role, reducing the risk of developing RA, but it may just delay the onset rather than prevent it developing.
How is it diagnosed?
Various blood tests can identify RA, including the rheumatoid factor test and the anti-citrullinated protein antibody test. Ultrasound and magnetic resonance imaging can also reveal early signs of joint inflammation.
Treatment for rheumatoid arthritis
- Non-steroidal anti-inflammatory drugs: These are given to ease pain and reduce inflammation and include ibuprofen and naproxen, but do not slow down the RA process.
- Disease modifying therapy (DMARDs): These slow down the progression of the disease and can be used alone or in combination therapies.
- Biologics: These are newer types of DMARDS which target several different proteins responsible for inflammation. They are only prescribed when at least two standard DMARDs have been tried (one of which must be methotrexate) and the patient’s disease is not well-controlled.
Physiotherapy, occupational therapy, pain management techniques, injections and surgery, including joint replacement, are other treatment options.
RA and heart disease
RA increases the risk of a heart attack or stroke. It’s important to see your GP to prescribe preventative treatments to control your blood pressure and cholesterol levels. Following a healthy diet, exercising and stopping smoking will also reduce your risks.
- Exercise: Although a very inflamed joint needs to be rested, as soon as it improves you should try to be active and take exercise, to keep the joint mobile and strengthen the muscles and tendons that move the joint.
- Losing weight: If you’re overweight, losing weight can relieve pressure on weight-bearing joints.
- Keep a food diary: There’s no special diet that has proven to help in RA, but some patients notice symptoms flare up after eating certain foods. For this reason it can be helpful to keep a food diary to see if any foods trigger you symptoms and try avoiding them.
- Stop smoking: For some people, stopping smoking may reduce symptoms, and you’ll also be at a lower risk of heart attack or stroke.
- Get informed: Contact the National Rheumatoid Arthritis Society http://www.nras.org.uk or call free phone 0800 298 7650.
Further reading and resources
NHS 2021 Rheumatoid Arthritis. (Accessed on 18/03/2021)
Rhematoid Arthritis Society (2021) (Accessed 18/03/2021)