Rheumatoid arthritis

Rheumatoid arthritis is a long-term condition. It can cause:

• pain
• swelling
• stiffness in the joints

It can also cause deformity of the joints.

It usually affects the hands, wrists and feet, but other joints and parts of the body are sometimes affected too.

Rheumatoid arthritis is an autoimmune condition. This means the body's immune system attacks the body itself.

Normally the immune system helps defend us from infections. In rheumatoid arthritis, though, it sends antibodies to the lining of the joints by mistake. These antibodies then attack the tissues around the joint. The thin layer of cells covering the joints (the synovium) becomes sore and inflamed as a result.

The inflammation also causes chemicals to be released. These chemicals thicken the synovium and damage the:

• bones
• cartilage, the stretchy connective tissue between bones
• tendons, the tissue that connects bone to muscle
• ligaments, the tissue that connects bone and cartilage

Over time, the chemicals can also change the shape of the joint.

Rheumatoid arthritis doesn't look the same in everyone. The symptoms can come and go, and they may change over time.

When rheumatoid arthritis affects the joints, you may notice:

• pain
• swelling
• stiffness and difficulty moving affected joints
• redness
• heat around the joints

In some people, firm swellings called rheumatoid nodules also develop under the skin around the affected joints.

Some people with rheumatoid arthritis have other symptoms as well. These include:

• tiredness and lack of energy
• a high temperature (fever)
• sweating
• a poor appetite
• weight loss

Rheumatoid arthritis can be hard to diagnose, because many conditions cause joint stiffness and inflammation.

If you think you have symptoms of rheumatoid arthritis, speak to your doctor. They will ask about your symptoms and examine you, to:

• check your joints for any swelling
• look at how easily your joints move

Your doctor may also arrange blood tests.

If your doctor thinks you have rheumatoid arthritis, they will refer you to a specialist (a Rheumatologist). The Rheumatologist will meet you to go over your history and examine your joints. They may need to arrange extra tests, like more blood tests or scans, before they can make a diagnosis and decide if treatment is needed. These tests will:

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

There's no cure for rheumatoid arthritis, but treatment can ease the joint pain, swelling and stiffness. It can also lower the risk of damage to your joints.

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

The two main types are:

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

You will usually need to take these for a long time. They work best when you start them early, soon after the first symptoms appear.

You may also need other medicine to relieve the joint pain and stiffness. For example:

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

Your doctor may offer other treatments to help with your rheumatoid arthritis symptoms. These include:

• physiotherapy, which helps improve muscle strength, flexibility and fitness
• occupational therapy, which gives you training and advice if you need help with everyday tasks or are having difficulty at work
• podiatry, which helps if you have problems with your feet

Sometimes people with rheumatoid arthritis need surgery. It can help to:

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

The surgery for rheumatoid arthritis includes:

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

Some people with rheumatoid arthritis try complementary therapies, such as:

• massage
• acupuncture
• osteopathy
• chiropractic

Rheumatoid arthritis can be hard to live with because the symptoms are unpredictable. Some days the pain and stiffness are worse than others, and there's no way of knowing when a flare-up will come.

For some people this leads to stress, anxiety or depression. It can also bring fear, frustration and anger.

If you're struggling to cope with your condition, speak to a doctor.

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

If you're taking medicine for rheumatoid arthritis, tell your doctor if you:

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

They will make sure your arthritis is controlled while you're trying to get pregnant.

Looking after babies and young children is hard on the body and the mind for any parent. Rheumatoid arthritis can make it harder still.

If you're struggling to cope, speak to your doctor.

Living with rheumatoid arthritis can change your sex life. Pain, discomfort and changes in the way you feel can all play a part. Your self-esteem or how you feel about the way you look may also shake your confidence.

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

Rheumatoid arthritis can sometimes lead to other health problems. These include:

• carpal tunnel syndrome, which causes 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 these complications developing is lower if your rheumatoid arthritis is controlled well.

It's not clear what triggers rheumatoid arthritis. But some things could raise the risk of developing it. These include:

• genetics, because it may run in families
• hormones, because it's more common in women, which may be due to the effects of a hormone called oestrogen
• smoking