Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune illness. In simple terms, this means the body's own defence system starts attacking healthy parts of the body by mistake.

Normally, the immune system protects us from infections. In rheumatoid arthritis, though, it mistakenly sends antibodies to the lining of the joints. These antibodies attack the tissue around the joint, which makes the thin layer covering the joint, known as the synovium, become sore and inflamed.

This inflammation causes certain chemicals to be released in the body. Over time, these chemicals thicken the synovium and damage:

• the bones
• the cartilage, which is the stretchy connective tissue between bones
• the tendons, which connect bone to muscle
• the ligaments, which connect bone to cartilage

Given enough time, these chemicals can even change the shape of the joint.

Risk factors for rheumatoid arthritis

Doctors don't fully know what triggers rheumatoid arthritis. However, certain factors seem to raise the chances of developing it, such as:

• genetics, since it can run in families
• hormones, as the condition is more common in women, possibly linked to the hormone oestrogen
• smoking

Rheumatoid arthritis is not always easy to diagnose, since so many other conditions can also cause joint stiffness and swelling.

If you notice symptoms of rheumatoid arthritis, speak to your GP. They will ask about your symptoms and examine you to:

• check your joints for any swelling
• see how easily your joints move

Your GP may also arrange blood tests.

If your GP thinks you have rheumatoid arthritis, they will refer you to a specialist called a rheumatologist. The rheumatologist will meet with you to go over your medical history and examine your joints. They may also need to arrange extra tests, such as further blood tests or scans, before they can confirm the diagnosis and decide whether you need treatment. These tests will:

• check for joint inflammation and damage
• show what kind of arthritis you have

There's no cure for rheumatoid arthritis, but with the right treatment, joint pain, swelling and stiffness can improve, and the risk of joint damage can be reduced.

Medication

Several types of medicine can be used to treat rheumatoid arthritis and ease joint pain, stiffness and swelling. They also lower the chance of joint damage developing over time.

The two main types of medication are:

• disease modifying anti rheumatic drugs (DMARDs)
• biologic treatments

These usually need to be taken for a long time, and they work best when started early, soon after the first symptoms appear.

You may also need other medicine to relieve joint pain and stiffness, such as:

• painkillers
• non steroidal anti inflammatory drugs (NSAIDs)
• corticosteroids

Supportive treatments

You may also be offered other treatments to help with your symptoms. These include:

• physiotherapy, which helps improve muscle strength, flexibility and fitness
• occupational therapy, which offers training and advice if you're having difficulty with everyday tasks or at work
• podiatry, which can help if you're having problems with your feet

Surgery

For some people with rheumatoid arthritis, surgery becomes necessary to:

• improve movement in the joint
• reduce pain
• correct damage to the shape of the joint

Surgery for rheumatoid arthritis includes:

• finger, hand and wrist surgery, of which there are different types to correct problems in this area
• arthroscopy, a procedure to remove inflamed joint tissue
• joint replacement surgery, to replace part or all of a joint

Complementary and alternative therapies

Some people with rheumatoid arthritis choose to try complementary therapies such as:

• massage
• acupuncture
• osteopathy
• chiropractic care

Living with rheumatoid arthritis

Rheumatoid arthritis can be hard to deal with because the symptoms are unpredictable.

Some days the pain and stiffness will be worse than others and there’s no way of knowing when a flare-up will occur. This may mean that some people develop stress, anxiety or depression. It can also cause fear, frustration and anger.

You should speak to a healthcare professional if you’re struggling to deal with your condition.

The National Rheumatoid Arthritis Society (NRAS) website has information about living with rheumatoid arthritits.

You can also phone the National Rheumatoid Arthritis Society (NRAS) helpline on 0800 298 7650. It’s Monday to Friday, 9.30am to 4.30pm. The helpline offers information and emotional support for people with rheumatoid arthritis.

Starting a family

If you’re taking medication for rheumatoid arthritis, tell your healthcare team if you:

• want to start a family
• are worried about becoming pregnant while on medication

They will make sure your arthritis is controlled whilst you’re trying to get pregnant.

Raising a family

Babies and young children are physically and mentally demanding for any parent. But, rheumatoid arthritis can increase the challenges.

If you’re struggling to cope, you should speak to your health visitor.

Sex and relationships

Pain, discomfort and changes in the way you feel can affect your sex life. Your self-esteem or thoughts about how you look may also affect your confidence.

Talk to your partner or GP about how rheumatoid arthritis is affecting your sexuality and sexual relationships.

Money and benefits

If you have to stop work or work part time because of rheumatoid arthritis, you may find it hard to cope financially.

You may be entitled to financial support like:

• Statutory Sick Pay
• Employment and Support Allowance
• Personal Independence Payment
• Attendance Allowance
• Carer’s Allowance
• Adult Disability Payment

You may also be eligible for other benefits if you have children living at home or if you have a low household income.

Telecare Self-Check online tool

Visit the Telecare Self-Check online tool to find the right support for you in your area. This will help you find information on telecare services that could help you live independently at home for longer.

Complications of rheumatoid arthritis

Having rheumatoid arthritis can sometimes lead to other conditions. This includes:

• carpal tunnel syndrome – tingling and numbness in your hand and fingers
• inflammation in other parts of the body for example in the lungs or around the heart
• joint damage and deformity

If you have rheumatoid arthritis, you’re also at a higher risk of:

• cardiovascular disease (CVD) – which can cause heart attacks or strokes
• cervical myelopathy

The risk of complications developing is lower if rheumatoid arthritis is controlled well.