What is rheumatoid arthritis?

Rheumatoid arthritis (RA) attacks the whole body rather than just the joints as in osteoarthritis. In this article, Lynn Hunter, musculoskeletal physiotherapist at AXA Health, explains what rheumatoid arthritis is, common symptoms, as well as the importance of early diagnosis and treatment.

Rheumatoid arthritis is a progressive auto-immune disease where the body’s immune system attacks the joints, causing pain and inflammation.¹ If left untreated and allowed to progress, it can ‘eat away’ at, and end up causing damage to the joints in the body.

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 – typically in the main knuckle joints in the hand, usually affecting at least two joints, which become:

• painful,
• inflamed,
• stiff,
• and may start to swell.

Symptoms usually progress over a few weeks, but in some cases, they can develop quickly within a few days.

Other symptoms of RA can include:

• Morning joint stiffness (lasting more than half an hour).
• Sleep problems.
• Extreme tiredness.
• Loss of appetite and weight.
• Flu-like illness.²

If you are experiencing any of these symptoms, you should see your GP.

Distinguishing rheumatoid arthritis from osteoarthritis

Rheumatoid arthritis 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 negatively impact the body.

Although osteoarthritis can also cause joint pain – including morning stiffness – this usually disappears after half an hour, but in rheumatoid arthritis it often lasts for many hours.

People with rheumatoid arthritis can wake up in the middle of the night with joint pain and stiffness, often experiencing associated fatigue and weight loss, which doesn’t happen with osteoarthritis.

How common is it?

According to the Versus Arthritis, rheumatoid arthritis affects 450,000 people in the UK.³ It often starts when a person is between 30 and 50 years old and women are more likely to be affected than men.⁴ Rheumatoid arthritis is much less common than osteoarthritis, which affects around 10 million people.⁵

What causes rheumatoid arthritis?

Doctors aren’t certain what triggers rheumatoid arthritis, but some experts believe it could be caused by a virus, infection, or an injury. Although family history plays a role, it doesn't necessarily follow that you will develop rheumatoid arthritis if a close relative has the condition.

Because many more women have rheumatoid arthritis 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 rheumatoid arthritis, but it may just delay the onset rather than prevent it developing.⁶

How is it diagnosed?

It can be difficult to diagnose due to other conditions also causing joint pain and inflammation, but several blood tests can help identify indications of rheumatoid arthritis. Ultrasound and magnetic resonance imaging can also help reveal signs of joint inflammation and damage.

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 rheumatoid arthritis process.
• Disease-modifying anti-rheumatic drugs (DMARDs): These tablets slow down the progression of the disease and can be used alone or in combination with other treatments.
• Biological treatments: These are newer types of treatment which target several different proteins responsible for inflammation. 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.⁷

Physiotherapy, occupational therapy, pain management techniques, injections, and surgery, including joint replacement, are other treatment options. You should consult a medical professional to help evaluate which treatment options are best for you.

RA and heart disease

Rheumatoid arthritis 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.⁸

>Read more about high blood pressure and how to help manage it

Self-help

• 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 rheumatoid arthritis, 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 your symptoms so you then know to avoid 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.⁹
• Get informed: Read more about the condition on National Rheumatoid Arthritis Society

References

1. Rheumatoid Arthritis – NHS
2. Symptoms – NHS
3. How many people affected UK – Versus Arthritis
4. Age and rheumatoid arthritis – NHS
5. How many people affected by Osteoarthritis UK – Versus Arthritis
6. Contraceptive pill and rheumatoid arthritis – The BMJ
7. Treatment – NHS
8. Rheumatoid arthritis and heart disease – Arthritis Foundation
9. Smoking – National Rheumatoid Arthritis Society