Rheumatoid arthritis is a long-term autoimmune condition that causes inflammation in joints. It most often affects the hands, wrists, and feet, but it can affect other joints and other parts of the body.
Unlike osteoarthritis, which is mainly linked to wear and structural change in joints, rheumatoid arthritis is driven by the immune system attacking tissue around the joints. Early diagnosis and treatment are important because persistent inflammation can damage cartilage, bone, tendons, and ligaments.
Symptoms
Common symptoms include:
- Joint pain.
- Joint swelling.
- Warmth around affected joints.
- Stiffness, often worse in the morning or after rest.
- Fatigue.
- Reduced grip strength or difficulty using affected joints.
- Flares, where symptoms become worse for a period.
The pattern is often symmetrical, meaning joints on both sides of the body are affected. Small joints in the hands, wrists, and feet are common early sites.
Causes and Risk Factors
Rheumatoid arthritis is an autoimmune disease. The immune system attacks the lining of joints, causing inflammation. Over time, this can damage cartilage and bone.
The exact trigger is not known. Risk is influenced by a mixture of genetic and environmental factors. NHS information identifies increased risk in women, people with a family history of rheumatoid arthritis, and people who smoke.
Diagnosis
Diagnosis is based on symptoms, examination, blood tests, and imaging. Blood tests may include inflammatory markers, rheumatoid factor, and anti-CCP antibodies. X-rays, ultrasound, or MRI may be used to assess joint inflammation or damage.
NICE guidance stresses rapid access to specialist care. Early referral to rheumatology is important when persistent synovitis is suspected, especially if small joints are affected, more than one joint is involved, or symptoms have been present for several weeks.
Treatment
There is no cure, but treatment can reduce inflammation, control symptoms, prevent or slow joint damage, and help people stay active.
Treatment may include:
- Disease-modifying anti-rheumatic drugs, often called DMARDs.
- Biological or targeted synthetic medicines for people whose disease is not controlled with standard DMARDs.
- Short courses of corticosteroids in selected situations.
- Pain relief and anti-inflammatory medicines for symptom control.
- Physiotherapy and occupational therapy.
- Podiatry for foot problems.
- Surgery for severe joint damage in some cases.
Methotrexate is commonly used as an initial DMARD, but treatment choices depend on disease activity, other health conditions, pregnancy plans, monitoring requirements, and response to previous medicines.
Treat-to-Target Care
Modern rheumatoid arthritis care often uses a treat-to-target approach. Disease activity is measured regularly, and treatment is adjusted until remission or low disease activity is reached where possible.
This approach is intended to prevent hidden inflammation from continuing to damage joints even when symptoms have partly improved.
Living With Rheumatoid Arthritis
Rheumatoid arthritis can affect work, sleep, mood, family life, and everyday tasks such as dressing, cooking, writing, walking, or using a phone. Occupational therapy, workplace adjustments, pacing, exercise, and assistive equipment may help.
Exercise is usually encouraged within personal limits because it supports strength, flexibility, cardiovascular health, and mood. During flares, people may need rest, temporary adjustments, and review of treatment.
Complications
Possible complications include:
- Joint deformity or loss of function.
- Tendon problems.
- Carpal tunnel syndrome.
- Eye inflammation or dryness.
- Lung inflammation or scarring.
- Increased cardiovascular risk.
- Osteoporosis, sometimes related to inflammation or steroid use.
- Infection risk, particularly with some immune-suppressing medicines.
Good disease control can reduce the risk of some complications.
References
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