Rheumatoid Arthritis

Rheumatoid arthritis is a long-term autoimmune condition that mainly affects the joints. Normally the immune system protects the body from infection, but in rheumatoid arthritis it mistakenly attacks the thin lining of the joints, called the synovium. This causes inflammation, which can lead to pain, swelling and stiffness, and over time may damage the joint.

It commonly affects the small joints of the hands, wrists and feet, and often several joints on both sides of the body at the same time. Because it is a condition of the whole immune system, it can sometimes affect other areas too, such as the eyes, lungs, heart and blood vessels.

Rheumatoid arthritis and osteoarthritis are different conditions. Rheumatoid arthritis is driven by the immune system attacking the joints, causing inflammation that often affects matching joints on both sides and tends to be worse in the morning. Osteoarthritis is caused by gradual wear of the cartilage that cushions the joints, usually with age or after injury.

Telling them apart matters because they are treated differently. If you are unsure which type of arthritis you have, a doctor can help clarify the diagnosis and guide the right care.

The main symptoms are joint pain, swelling and stiffness. The stiffness is often worst in the morning or after resting and can last for more than half an hour. Joints may feel warm and tender, and the small joints of the hands and feet are frequently affected, usually on both sides of the body.

Some people also feel generally unwell, tired or feverish, or notice a loss of appetite or weight. Symptoms can come and go, with flare-ups when the condition is more active and calmer periods in between.

Rheumatoid arthritis happens when the immune system attacks the joints, but the exact reason this begins is not fully understood. A combination of genetic and environmental factors is thought to play a part.

It can develop at any age but often starts in middle age, and it is more common in women. A family history of the condition and smoking are recognized risk factors. Smoking may also make the condition more severe.

There is no single test for rheumatoid arthritis, so doctors make the diagnosis by combining several pieces of information. This starts with your symptoms and a physical examination of the joints to check for swelling, warmth and tenderness.

Blood tests can support the diagnosis, including tests for inflammation and for antibodies such as rheumatoid factor and anti-CCP antibodies. Imaging such as X-rays, ultrasound or MRI may be used to look at the joints and monitor any changes over time. Because early treatment matters, it is important not to delay seeing a doctor if you have persistent joint symptoms.

There is currently no cure, but treatment can control the condition well, ease symptoms and reduce the risk of lasting joint damage. Medicines called disease-modifying anti-rheumatic drugs, or DMARDs, are used to calm the overactive immune response. Where needed, newer biological medicines that target specific parts of the immune system may be added.

Other medicines, such as anti-inflammatory drugs, can help relieve pain and stiffness during flare-ups. Physiotherapy helps keep joints moving and muscles strong, and occupational therapy can suggest ways to protect the joints in daily life. Starting treatment early gives the best chance of protecting the joints, so timely diagnosis is important.

Rheumatoid arthritis cannot be prevented, but with modern treatment the outlook has improved greatly. Many people are able to control their symptoms, stay active and lead full lives, especially when the condition is found and treated early.

Ongoing care usually involves regular reviews to check how active the condition is and to adjust treatment as needed. Staying active within comfortable limits, not smoking and looking after general health all support wellbeing. If your symptoms change or a flare-up does not settle, it is worth speaking with your care team.