What is rheumatoid arthritis?

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.

A diagram of the anatomy of a joint which doesn’t have arthritis, showing how bones and muscles are connected.

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.

A diagram showing a front view of a joint that is badly affected by rheumatoid arthritis.

Symptoms

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
  • sweating
  • 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.

Causes

The following can play a part in why someone has rheumatoid arthritis:

Age

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.

Sex

Rheumatoid arthritis is two to three times more common among women than men.

Genetics

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.

Weight

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.

Smoking

Cigarette smoking significantly increases the risk of developing rheumatoid arthritis. If you would like to stop smoking, visit the Smokefree website.

Diet

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.

Diagnosis

A diagnosis of rheumatoid arthritis is based on your symptoms, a physical examination and the results of x-rays, scans and blood tests.

Because rheumatoid arthritis can affect other parts of the body, it’s important to tell your doctor about all the symptoms you’ve had, even if they don’t seem to be related.

Blood tests

Blood tests may be used to find changes in your blood that are produced by inflammation.

They can also show if you’re anaemic (have low levels of iron in your blood), as anaemia is common in people with rheumatoid arthritis.

X-rays and other tests

X-rays will show any damage caused to the joints by the inflammation that occurs in rheumatoid arthritis.

Doctors also use equipment such as ultrasound scans to look for inflammation and early damage to joints.

When your diagnosis has been confirmed, don’t be afraid to ask your doctor questions or talk about any problems the condition causes you. The more your healthcare team know about how arthritis is affecting you, the more they can help.

Treatment

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:

  • drugs
  • physical therapies
  • surgery

Drugs

There are four main groups of drugs that are used to treat rheumatoid arthritis. These are:

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

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 your symptoms

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 therapy

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.

We’re continuing to fund different strands of research into the causes and treatments of rheumatoid arthritis. You can find out more on our website.