Rheumatoid Arthritis

Rheumatoid arthritis causes inflammation, pain, and swelling of joints. In time, affected joints typically become damaged.
The severity can vary from mild to severe.
Treatments include medication to ease the pain, and medication to slow down the progression of the disease.
Surgery is needed in some cases if a joint becomes badly damaged.

Arthritis means inflammation of the joints. Rheumatoid arthritis (RA) is a common form of arthritis. About 1 in 50 people develop RA at some stage in their life. It can happen to anyone, and it is not a hereditary disease. It can develop at any age, but most commonly starts in middle adult life (aged 40-60). It is three times more common in women than in men.

Symptoms

Joint symptoms

The common main symptoms are pain and stiffness of affected joints. The stiffness is usually worse first thing in the morning, or after you have been resting. This phenomenon is usually referred as morning stiffness. The inflammation causes swelling around the affected joints.

Other symptoms

These are known as 'extra-articular' symptoms of RA (meaning 'outside of the joints'). A variety of symptoms may occur. The cause of some of these is not fully understood.

• Small painless lumps or 'nodules' develop in about 1 in 4 cases. These commonly occur on the skin over the elbows and forearms, but usually do no harm.
• Inflammation around tendons may occur. This is because the tissue which covers tendons is similar to the synovium around the joints.
• Anaemia and tiredness are common.
• A fever, feeling unwell, weight loss, and muscle aches and pains sometimes occur.
• In a few cases inflammation develops in other parts of the body such as the lungs, heart, blood vessels, or eyes. This is uncommon but can cause various symptoms and problems which are sometimes serious.

Diagnosis

There is no single test which clearly diagnoses early RA. When you first develop joint pains, it may be difficult for a doctor to say that you definitely have RA. This is because there are many other causes of joint pains. Blood tests can detect inflammation, characteristic antibodies, and anaemia. These may suggest that you have RA, but do not prove that you definitely have it as these blood results can be caused by other conditions. You may have a time of uncertainty when early symptoms 'could be' RA. In time, X-rays of joints may begin to show typical erosions (early damage) and other features of RA which makes the diagnosis more certain.

Treatments

There is no cure for RA. However, much can be done to help. The aims of treatment are:

• To reduce pain and stiffness in affected joints as much as possible.
• To prevent joint damage as much as possible.
• To minimise any disability caused by pain, joint damage, or deformity.
• To reduce the risk of developing associated conditions such as heart disease.

Other treatments

Some people try complementary therapies such as special diets, bracelets, acupuncture, etc. There is little research evidence to say how effective such treatments are for RA. In particular, beware of paying a lot of money to people who make extravagant claims of success. For advice on the value of any treatment it is best to consult a doctor, or contact one of the groups below.

In summary

• Rheumatoid arthritis can range from relatively mild to severe.
• The outlook cannot be predicted for an individual when the disease starts.
  
• Treatment usually includes:

- A disease-modifying drug which reduces joint damage. You should take this all the time. It may take up to 4-6 months to begin working

- An anti-inflammatory painkiller to ease pain. This helps symptoms but does not affect the progress of the disease. You do not need to take this if symptoms settle.

• A painkiller such as paracetamol or codeine may be added for extra pain relief.
• A short course of steroids may be advised now and then to relieve a severe flare-up of symptoms.
• Other treatments such as physiotherapy, occupational therapy, and surgery may also be advised, depending on the severity of the disease and other factors.
• If possible, leading a healthy lifestyle such as not smoking, eating healthily, taking regular exercise, etc, can help to reduce the chance of developing associated diseases such as heart disease, stroke, osteoporosis, and certain cancers.