What is Rheumatoid Arthritis?

In the UK, around 1% of the population has rheumatoid arthritis, or RA, which makes it the most common type of inflammatory arthritis according to statistics by NICE. Each year, around 3.6 women and 1.5 men per 10,000 develop the condition and though onset can happen at any time, the most common age of diagnosis is between 30 and 50 years. After being diagnosed with this condition, around one-third of people have to stop work within two years.

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a long-term medical condition causing pain, stiffness and swelling of the joints. It typically affects the wrists, hands and feet.

It is a condition with ‘flares’ or ‘flare-ups’ and so the symptoms might be better at some times than others. It’s not easy to predict a flare-up but treatment helps to prevent the incidence of flares and long-term joint damage.

Some people diagnosed with RA will also have problems elsewhere in their body or they may have other symptoms like weight loss and tiredness.

What is the difference between osteoarthritis and rheumatoid arthritis?

Arthritis comes in many forms. Two of the most common types are osteoarthritis and rheumatoid arthritis. Reactive arthritis is rarer. Both of these conditions have symptoms that are similar but it’s important to know the difference so that the right condition is treated.

Osteoarthritis happens when the smooth cartilage on the surface of the joint wears out. This condition usually happens in a single joint.

Rheumatoid arthritis, on the other hand, is an autoimmune disease. This happens when the body’s immune system doesn’t work properly and attacks the person’s own body instead of foreign intruders. In the case of rheumatoid arthritis, the immune system attacks the synovial membrane. This is wrapped around the joints to protect them.

Unlike osteoarthritis, rheumatoid arthritis will usually target more than one joint at the same time.

To distinguish between the two, rheumatoid arthritis often has these unique symptoms (that osteoarthritis does not):

• It is symmetrical, e.g., it would affect both knees or both hips.
• You might experience fever, fatigue, or loss of appetite.
• Anaemia might be present.

What causes rheumatoid arthritis?

As previously mentioned, RA is an autoimmune disease, which means a person’s own immune system attacks cells in the joints making them stiff, painful and swollen. The immune system normally attacks viruses and bacteria by making antibodies. In the case of rheumatoid arthritis, the immune system doesn’t function correctly and sends antibodies to the lining of the joints, which then attack the tissue.

Over time, the joints, bones, cartilage, tendons and ligaments can all be damaged. If the condition is left untreated, the joint can lose alignment and shape. Ultimately, it can be completely destroyed.

No one knows exactly what causes people to develop this condition but you’re more likely to have it if you’re female, you smoke, and you have family members with it.

Genetic factors

Even if you have no direct family members with rheumatoid arthritis, you might carry a gene that makes you susceptible to developing it.

Environmental factors

Arguably the biggest environmental factor in rheumatoid arthritis development is smoking. The more heavily you smoke and the longer you smoke, the higher your risk. Another environmental factor is being overweight or obese.

Hormonal factors

It’s believed that hormones might have a role to play in causing RA to develop. Rheumatoid arthritis is more prevalent in women than men and tends to appear during times of hormonal change, e.g., just after giving birth or when menopause starts.

So, it could be that you’re already susceptible to developing RA, but your risk is increased by environmental factors and hormones.

RA triggers

The least understood part about rheumatoid arthritis is what triggers its onset. If you listen to anecdotes, lots of people talk of the onset of the condition happening after a stressful period, mental or physical trauma, after an illness, or after having a baby.

The truth is, it’s impossible to predict when or if RA will ever occur and no one who has the condition should ever blame themselves for its onset. In most cases, it’s likely to be a perfect storm of genetics, environmental factors and a trigger.

What are the signs and symptoms of rheumatoid arthritis?

The primary rheumatoid arthritis symptoms are stiffness, pain and swelling in the joints. RA can also cause other generalised symptoms like inflammation elsewhere in the body.

Typically, symptoms will come on gradually over a few weeks, but for some people, the symptoms progress over a matter of days.

Each person’s case is different, and every day can also be different. There might be times when the condition is much more manageable than others.

Symptoms affecting the joints

The main symptom of RA is problems with the joints. This can be any joint but the most commonly affected at first are the feet and hands. It is characteristic of this condition to affect both joints simultaneously and symmetrically.

Pain

The type of pain in the joints is typically an aching and throbbing pain. It is usually worse in the morning or if you’ve been inactive for a period.

Stiffness

Stiffness of the affected joints is common. For example, the hands might not be able to function fully and forming a fist might be difficult or impossible.

As with joint pain, stiffness caused by RA is usually worse after being inactive or in the morning.

It is common to have this stiffness with osteoarthritis too, but this will wear off in half an hour. With RA, it takes a longer time to wear off.

Redness, swelling and warmth

The joint lining becomes inflamed when it is affected by RA. This can cause swelling and make the joint become tender and hot to the touch.

Some people will develop rheumatoid nodules, which are firm swellings that develop underneath the skin.

Other symptoms

In addition to joint symptoms, sufferers of RA often have other symptoms, which include:

• Lethargy and fatigue.
• A fever.
• A lack of appetite.
• Weight loss.
• Sweating.
• Inflammation in other parts of the body like dry eyes or chest pain.

What are the risk factors of rheumatoid arthritis?

As we’ve touched upon, there are lots of risk factors when it comes to rheumatoid arthritis.

Your risk is determined by:

• Your genetics – There is some evidence proving that RA runs in families. However, the risk still remains low even if family members are affected by the condition as your genes are only thought to play a small part.
• Your hormones – The condition is much more prevalent in women, which suggests that oestrogen has a role to play (although this has never been proven).
• Smoking tobacco – There is evidence to suggest that people who use tobacco are more likely to develop rheumatoid arthritis.

Can rheumatoid arthritis impact your life?

Unfortunately, a diagnosis of rheumatoid arthritis can be pretty life-changing. It often requires long-term treatment to control joint damage and associated rheumatoid arthritis symptoms.

Depending on your stiffness, pain and joint damage, daily tasks might take up more of your time and might become increasingly difficult.

People with RA often need to adapt their way of doing things to help them manage the condition.

Having this condition can also be a precursor to other conditions that cause further symptoms.

Complications can include:

• Inflammation of the eyes, heart and lungs.
• Carpal tunnel syndrome.
• An increased risk of stroke or heart attack.

With well-controlled rheumatoid arthritis, the risk of these conditions can be minimised.

How is rheumatoid arthritis diagnosed and treated?

It is often difficult to diagnose RA because there are other similar conditions that cause inflammation and stiffness in the joints. There is no set test for this condition.

If you develop any of the symptoms, you should see a GP.

Seeing your GP

Your GP will carry out a physical examination and will check joints to see how they move. They’ll also ask about other symptoms. If the GP believes RA is a possibility, they will refer you to a rheumatologist.

Having blood tests

Your GP might also run some blood tests to look for certain factors to help confirm a diagnosis.

These tests usually look for:

• CRP (C-reactive protein) – A test that measures levels of inflammation.
• EST (erythrocyte sedimentation rate) – Another test to assess inflammation.
• A full blood count to rule out other causes and to get an overall picture of your health. The full blood count will also check for anaemia, which is common in RA.

Joint scans

You might also have scans of your joints to look for damage and inflammation. These scans can help specialists differentiate between osteoarthritis and rheumatoid arthritis. They can also be used in diagnosed patients to monitor progression.

Types of scans include:

• Ultrasound scans.
• MRI scans.
• X-rays.

Rheumatoid arthritis has no cure, but early diagnosis and effective treatment can mean people live full lives and can continue their employment.

Treatment includes:

• Medicines to relieve symptoms and slow the condition’s progress.
• Supportive treatments like occupational therapy and physiotherapy to keep the joints mobile and help manage problems with activities.
• Surgery to repair joint problems.

DMARDs (disease-modifying anti-rheumatic drugs)

Many people who have been diagnosed with RA are offered DMARDs. This medicine eases symptoms and slows down the progression of the disease. These drugs block the effects of any chemicals that are released when the immune system attacks the joints.

DMARDs include:

• Methotrexate.
• Hydroxychloroquine.
• Leflunomide.
• Sulfasalazine.

These drugs might not have noticeable results for a few months so it’s important not to stop taking them. Patients often try a few different types of DMARDs before they find the one that works for them.

Biological treatments

Other treatments for the condition are biological treatments like infliximab, etanercept and adalimumab. These are new treatments for RA and are usually taken in combination with a DMARD.

These medicines are administered by injection and work by stopping chemicals that tell your immune system to attack the joints.

Pain relief

As well as medicines to control the disease, many patients also take regular pain relief like paracetamol or co-codamol.

NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen, diclofenac and naproxen are also used. These work by relieving pain whilst also reducing joint inflammation.

Steroids

Steroids are often prescribed to RA patients to reduce stiffness, inflammation and pain. You can get them in tablet form (prednisolone, for example), as an injection into a joint or as an injection into a muscle to help numerous joints.

These drugs are only given on a short-term basis when a patient is waiting for other drugs to work or when in a flare-up.

Supportive treatments for rheumatism

With RA and rheumatism, there are lots of supportive treatments to help alleviate symptoms.

These include:

• Physiotherapy to improve flexibility and muscle strength.
• TENS (transcutaneous electrical nerve stimulation) machines to ease pain.
• Occupational therapy to advise patients on how to carry out tasks at work and at home.
• Podiatry help – If your feet are suffering.

Surgery to help rheumatoid arthritis symptoms

Sometimes patients end up with joint damage because of their condition. This often results in surgery to reduce pain or correct deformities.

Wrist, hand and finger surgery

Examples of hand surgery include:

• Surgery to release carpel tunnel syndrome (cutting a ligament within the wrist to reduce pressure on the nerve).
• Tendon release in the fingers.
• Removal of tissue inflammation in finger joints.

Joint replacement

Examples of joint replacement include:

• Hip replacement.
• Shoulder joint replacement.
• Knee replacement.

Final thoughts on rheumatoid arthritis

Rheumatoid arthritis is a painful, life-long condition that affects people in different ways. Though it is difficult to diagnose, early diagnosis is essential for an improved outlook. There is no known cause of the condition.

Rather, it’s believed to be a perfect storm of genetics, environmental factors (hormonal factors) and a trigger. There are many treatments for the condition but, unfortunately, no cure. However, patients with this condition can learn to live happy and fulfilling lives all the same.