What is rheumatoid arthritis?
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Rheumatoid arthritis is a condition that can cause pain, swelling and stiffness in joints.
It is what is known as an auto-immune condition. This means that the immune system, which is the body’s natural self-defence system, gets confused and starts to attack your body’s healthy tissues. In rheumatoid arthritis, the main way it does this is with inflammation in your joints.
Rheumatoid arthritis affects around 400,000 adults aged 16 and over in the UK. It can affect anyone of any age. It can get worse quickly, so early diagnosis and intensive treatment are important. The sooner you start treatment, the more effective it’s likely to be.
To understand how rheumatoid arthritis develops, it helps to understand how a normal joint works.
How does a normal joint work?
A joint is where two bones meet. Most of our joints are designed to allow the bones to move in certain directions and within certain limits.
For example, the knee is the largest joint in the body and one of the most complicated. It must be strong enough to take our weight and must lock into position, so we can stand upright.
It also has to act as a hinge, so we can walk, and needs to twist and turn when we run or play sports.
The end of each bone is covered with cartilage that has a very smooth, slippery surface. The cartilage allows the ends of the bones to move against each other, almost without rubbing.
The joint is held in place by the synovium, which contains thick fluid to protect the bones and joint.
The synovium has a tough outer layer that holds the joint in place and stops the bones moving too far.
Strong cords called tendons anchor the muscles to the bones.
What happens in a joint affected by rheumatoid arthritis?
If you have rheumatoid arthritis, your immune system can cause inflammation inside a joint or a number of joints. Inflammation is normally an important part of how your immune system works. It allows the body to send extra fluid and blood to a part of the body under attack from an infection. For example, if you have a cut that gets infected, the skin around it can become swollen and a different colour.
However, in the case of rheumatoid arthritis, this inflammation in the joint is unnecessary and causes problems.
When the inflammation goes down, the capsule around the synovium remains stretched and can’t hold the joint in its proper position. This can cause the joint to become unstable and move into unusual positions.
The main symptoms of rheumatoid arthritis are:
- joint pain
- joint swelling, warmth and redness
- stiffness, especially first thing in the morning or after sitting still for a long time.
Other symptoms can include:
- tiredness and lack of energy – this can be known as fatigue
- a poor appetite (not feeling hungry)
- weight loss
- a high temperature, or a fever
- dry eyes – as a result of inflammation
- chest pain – as a result of inflammation.
Rheumatoid arthritis can affect any joint in the body, although it is often felt in the small joints in the hands and feet first. Both sides of the body are usually affected at the same time, in the same way, but this doesn’t always happen.
A few people develop fleshy lumps called rheumatoid nodules, which form under the skin around affected joints. They can sometimes be painful, but usually are not.
The following can play a part in why someone has rheumatoid arthritis:
Rheumatoid arthritis affects adults of any age, although most people are diagnosed between the ages of 40 and 60.
Around three-quarters of people with rheumatoid arthritis are of working age when they are first diagnosed.
Rheumatoid arthritis is two to three times more common among women than men.
Rheumatoid arthritis develops because of a combination of genetic and environmental factors, such as smoking and diet. It is unclear what the genetic link is, but it is thought that having a relative with the condition increases your chance of developing the condition.
If you are overweight, you have a significantly greater chance of developing rheumatoid arthritis than if you are a healthy weight.
The body mass index (BMI) is a measure that calculates if your weight is healthy, using your height and weight.
For most adults, an ideal BMI is in the 18.5 to 24.9 range.
If your BMI is:
- below 18.5 – you're in the underweight range
- between 18.5 and 24.9 – you're in the healthy weight range
- between 25 and 29.9 – you're in the overweight range
- between 30 and 39.9 – you're in the obese range.
To work out your BMI, use the healthy weight calculator.
Cigarette smoking significantly increases the risk of developing rheumatoid arthritis. If you would like to stop smoking, visit the Smokefree website.
There is some evidence that if you eat a lot of red meat and don’t consume much vitamin C, you may have an increased risk of developing rheumatoid arthritis.
How will rheumatoid arthritis affect me?
Because rheumatoid arthritis can affect different people in different ways, we can’t predict how the condition might develop for you.
If you smoke, it’s a very good idea to quit after a diagnosis of rheumatoid arthritis. This is because:
- rheumatoid arthritis may be worse in smokers than non-smokers
- smoking can weaken how well your medication works.
Physical activity is also important, as it can improve your symptoms and benefit your overall health.
Blood tests and x-rays will help your doctor assess how fast your arthritis is developing and what the outlook for the future may be. This will also help your doctor to decide which form of treatment to recommend.
The outlook for people with rheumatoid arthritis is improving all the time, as new and more effective treatments become available. It is possible to lead a full and active life with the condition, but it is important to take your medication as prescribed and make necessary lifestyle changes.
A diagnosis of rheumatoid arthritis is based on your symptoms, a physical examination and the results of x-rays, scans and blood tests.
It can be difficult to diagnose because there isn't a test that can prove you definitely have it. There are also quite a few conditions that have the same symptoms.
Your doctor will ask about your symptoms and do a physical examination. They will look for swollen joints and check how well your joints move. Rheumatoid arthritis can affect different parts of your body at once, so it's important to tell your doctor about all the symptoms you've had, even if they don't seem to be related.
If they think you have rheumatoid arthritis, they will refer you to a rheumatologist and may arrange blood tests to help confirm a diagnosis.
There's no single blood test that can confirm you have rheumatoid arthritis. However, there are a few tests that can show possible signs of the condition. Some of the main tests are outlined below.
Erythrocyte sedimentation rate (ESR)
A sample of your red blood cells are put into a test tube of liquid. The cells are timed to see how long they take to get to the bottom of the tube. If the cells sink faster than usual, you may have levels of inflammation that are higher than normal. Rheumatoid arthritis is just one possible cause.
C-reactive protein (CRP)
This test can show if there is inflammation in your body. It does this by checking how much CRP there is in your blood. If there is more CRP than usual, you may have inflammation in your body.
Full blood count
A full blood count measures the number of red blood cells you have. These carry iron around your body, and a low number of red blood cells means you have a low iron content. This may mean you have anaemia (an-ee-me-er) and is common in people with RA, although having anaemia doesn't prove you have RA.
Rheumatoid factor and anti-CCP antibodies
About half of all people with rheumatoid arthritis have rheumatoid factor in their blood when the condition starts. However, around 1 in every 20 people without rheumatoid arthritis also test positive for rheumatoid factor.
There is another antibody test called anti-CCP that you can take. People who test positive for anti-CCP are very likely to get rheumatoid arthritis. However, not everyone that has the condition has this antibody.
Scans may be used to check for joint inflammation and damage. These can be used to diagnose rheumatoid arthritis and to check how the condition is developing.
These may include:
- x-rays – these will show any changes in your joints
- ultrasound scans – a picture of your joints is created using high-frequency sound waves
- magnetic resonance imaging (MRI) scans – pictures of your joints are produced using strong magnetic fields and radio waves.
There are a variety of treatments available for rheumatoid arthritis. The earlier that intensive treatment is started, the more likely it is to work.
There are three main ways to treat rheumatoid arthritis:
- physical therapies
There are four main groups of drugs that are used to treat rheumatoid arthritis. These are:
- non-steroidal anti-inflammatory drugs (NSAIDs)
- disease-modifying anti-rheumatic drugs (DMARDs)
- steroids (also known as corticosteroids).
Many people with rheumatoid arthritis need to take more than one drug. This is because different drugs work in different ways.
Your drug treatments may be changed from time to time. This can depend on how bad your symptoms are, or because something relating to your condition has changed.
Drugs may be available under several different names. Each drug has an approved name – sometimes called a generic name.
Manufacturers often give their own brand or trade name to the drug as well. For example, Nurofen is a brand name for ibuprofen.
The approved name should always be on the pharmacist’s label, even if a brand name appears on the packaging. Check with your doctor, rheumatology nurse specialist or pharmacist if you’re not sure about anything.
Painkillers can help to relieve the pain caused by rheumatoid arthritis, but should not be the only treatment used.
There are many types and strengths of painkillers available – some can be bought over the counter from a pharmacy, while some are only available on prescription.
For guidance, ask a healthcare professional in charge of your care.
Managing a flare-up
When your symptoms get worse, this is known as a flare-up. These can happen at any time, but can happen after you have been stressed or had an infection.
Over time, you may get better at noticing the early signs of a flare-up.
If you’re having regular flare-ups, you should mention this to your doctor. It may be that you need to review your treatment.
Here are a few things you can do to help yourself during a flare-up:
- Keep taking your medication at the doses you’ve been prescribed.
- Do gentle exercises.
- Put heated items on the joint – these can include a hot water bottle or electric heat pad. See below for more information.
- Put cold items on the joint – these can include a bowl of cold water with ice cubes, a pack of frozen peas wrapped in a towel, or a damp towel that has been kept in the fridge. See below for more information.
- Let people around you know, so they can help and support you.
Tips for using heated items
Heated items that could help your joint pain include a hot water bottle or electric heat pad. Wrap these in a towel, then place on a painful joint. You could also try having a hot or warm shower or bath.
Other heated items that people have found useful are wheat bag, heat pads, deep heat cream, or a heat lamp.
Make sure these items are warm but not hot, as you could risk burning or scalding yourself. Gentle heat will be enough.
A towel should be placed between the heated item and the skin for protection. Check your skin regularly, to make sure it is not burning.
Tips for using ice packs
Some people find that using an ice pack can help their joint pain. You can buy one from a pharmacy, or you can make one at home, by wrapping ice cubes in a plastic bag or wet tea towel.
Here’s how to apply the ice to your skin:
- Rub a small amount of oil over where you’d like the ice pack to go. Any type of oil can be used. If your skin is broken – for example, if you have a cut – don’t use the oil and cover the area with a plastic bag. This will stop the cut getting wet.
- Put a cold, wet flannel over the oil.
- Put the ice pack over the flannel and hold it there.
- After five minutes, check the colour of your skin. Remove the ice pack if your skin has turned bright pink or red. If it hasn’t, leave it on for another 5 to 10 minutes.
- You can leave the ice pack on for 20-30 minutes. Don’t leave it on for any longer, as you could damage your skin if it is left on for too long.
Living with rheumatoid arthritis
Occupational therapists can help you keep doing the activities you need or want to do – at home or at work. They will work with you to find different ways of doing things.
The benefits of seeing an occupational therapist include:
- improved confidence
- being able to do more things, at home or at work
- being able to live independently at home
- allowing you to return to or stay in work.
Ask your GP about occupational therapists that are local to you. If you regularly see a social worker, nurse or other health care professional, they can help you contact an occupational therapist through health or social services.
Be prepared to describe any difficulties you have and how they are affecting your life, or the lives of those who care for you.
You may want to know how long it will be until you get an appointment, so remember to ask if there is a waiting list.
You can also see an occupational therapist privately. You will be able to get an appointment quicker, but it will cost you money.
Find an occupational therapist that works privately on the Royal College of Occupational Therapist website. All occupational therapists should be registered with the Health & Care Professions Council (HCPC).
Research and new developments
Here, we round up some of the latest developments in rheumatoid arthritis research.
Our previous research has:
- led to the development of a new type of drug. These drugs are called ‘biological therapies’ and have transformed the lives of people with rheumatoid arthritis over the past 20 years.
- highlighted the importance of starting early, intensive treatment for inflammatory arthritis within 12 weeks of symptoms starting. It has also led to the introduction of a best practice tariff for those with rheumatoid arthritis, which means people are being diagnosed quicker.
We're currently funding research projects to find out what causes rheumatoid arthritis, and to develop new and improved treatments. For example:
- our centre for genetics and genomics is trying to understand how genetic factors determine whether certain people are at risk of developing inflammatory arthritis, and what happens when they do
- our rheumatoid arthritis pathogenesis centre of excellence is looking at why rheumatoid arthritis starts, why it attacks the joints, and why the inflammation carries on rather than switching off
- investigating how the organisms that live on our skin and in our gut differ in those with rheumatoid arthritis and how this affects a person’s response to treatment.
I was diagnosed with rheumatoid arthritis at the age of 21.
I was in my third year of university, studying to be a primary school teacher. Suddenly, one morning, my thumbs became very painful. Then my elbows became stiff and sore, and I couldn’t straighten my arms.
At first I only had symptoms in the morning, but eventually I had them all the time. Quite a few of my joints were stiff and painful, which meant I couldn’t get around very well. I was also tired a lot. When this happened, my GP referred me to a rheumatologist.
I graduated from my teacher training course two years later than planned, but have not been able to work as a teacher yet, due to my arthritis. However, I have used my teaching skills to volunteer for Versus Arthritis, leading self-management courses in Northern Ireland, which I find extremely enjoyable and rewarding. I am also the Chairperson of my local Versus Arthritis support group.
Baking is one of my hobbies, although using certain kitchen equipment can be difficult. Being social is important to me too and I enjoy going to cafés to catch up with my friends. When I’m in pain, I can distract myself by reading or listening to music.
Exercise is important to me too, as I find that doing some gentle exercises makes my joints less painful. There are a few chair-based exercises I do regularly and I also enjoy going for short walks.
Swimming is great too and I find that doing exercises in the heated water of the hydrotherapy pool makes me feel less stiff and sore.
Medication-wise, I’m currently using a biological injection called Enbrel. I’ve been using it for five years and inject myself once a week. It’s really helped to control my condition and my flare-ups happen less often.
At the moment, I’m doing ok. There are good days and bad days. I still experience pain every day, but am doing much better than when I was first diagnosed. I have fewer flare ups, which shows that the medication I’m using is really helping me.
My advice to anyone who has recently been diagnosed with rheumatoid arthritis would be to join a support group. Talking to another person who has the same condition as you and knows what you’re going through is really useful and reassuring. It’s helped me a lot in my journey.
I’d also say that getting a good night’s sleep is important, as it can help your body recover from the effects of your arthritis. It’s also important for me to learn more about my condition, as it helps me to understand what my body is going through. I really do believe that knowledge is power!