What is rheumatoid arthritis?
Rheumatoid arthritis, often called RA, is an autoimmune disease. The immune system, which normally fights germs, mistakenly attacks the lining of the joints. The lining becomes inflamed and thick, causing pain, swelling and stiffness. Over time, this inflammation can damage cartilage and bone and change the shape of the joints.
RA is different from osteoarthritis, which is related to age and wear. RA can start at any age, though it most often begins between 30 and 60, and it is more common in women. It can also affect other organs, such as the lungs, eyes, blood vessels and heart.
Rheumatoid arthritis: causes and risk factors
The exact cause is not known. It is thought to be a mix of genes and triggers in the environment. Having a family member with RA or another autoimmune disease raises the risk. Smoking is a well-known risk factor, and it also makes RA more severe and treatment less effective. Being overweight and gum disease may also play a part.
RA is not caused by eating sour foods, curd or cold foods, as is sometimes believed. It is also not contagious. Understanding this helps avoid unnecessary food restrictions that can lead to poor nutrition. Instead, focus on a varied diet with vegetables, fruits, pulses, whole grains and some fish or nuts, which supports overall health.
Early signs and symptoms
RA usually starts slowly over weeks or months, although sometimes it starts suddenly. It typically affects the same joints on both sides of the body. Recognising the early pattern and seeing a doctor quickly makes a big difference. Look out for: Early treatment within the first few months gives the best chance of protecting the joints.
- Pain and swelling in small joints of the hands, wrists and feet
- Morning stiffness lasting more than half an hour
- Joints that feel warm, soft and puffy
- Difficulty making a fist, holding objects or buttoning clothes
- Tiredness, mild fever, loss of appetite and weight loss
- Firm lumps under the skin near the elbows (rheumatoid nodules)
How RA is diagnosed
There is no single test for RA. A doctor, ideally a rheumatologist, makes the diagnosis based on your symptoms, examination of the joints and tests. Blood tests include rheumatoid factor (RF) and anti-CCP antibodies, which are often positive in RA, and ESR and CRP, which show inflammation.
Some people with RA have negative antibody tests, and some healthy people have a positive RF, so results must be read together with symptoms. X-rays or ultrasound of the hands and feet can show joint damage or inflammation. A blood count, liver and kidney tests are done before starting medicines.
Treatment: why early matters
The most important step is starting disease-modifying anti-rheumatic drugs, called DMARDs, early. These medicines calm the immune system and slow or stop joint damage. Methotrexate is often the first choice. Others include hydroxychloroquine, sulfasalazine and leflunomide. When these are not enough, biologic or targeted medicines may be used. All are taken only on a doctor's prescription with regular blood tests.
Painkillers and short courses of steroids may be used to control pain and swelling while DMARDs start working, which can take weeks to months. Steroids are taken only on a doctor's prescription and should not be started or stopped on your own. Doctors often combine DMARDs when one is not enough.
Safety, pregnancy and infections
Some RA medicines, such as methotrexate and leflunomide, can harm an unborn baby. Both women and men should discuss pregnancy plans with their doctor well in advance, and use reliable contraception while on these medicines. Some other RA medicines are safe in pregnancy and breastfeeding, so the plan can be changed.
Because RA medicines lower immunity, infections can be more serious. Report fever, cough or other signs of infection early. Ask your doctor about vaccines such as flu and pneumococcal vaccines. Avoid alcohol with methotrexate, as both can affect the liver.
Living well with RA
Regular gentle exercise, such as walking, swimming, stretching and strengthening, keeps joints flexible and muscles strong. Rest during flares, but avoid long periods of inactivity. A physiotherapist or occupational therapist can suggest joint protection tips and aids for daily tasks.
Stop smoking, eat a balanced diet with enough protein, calcium and vegetables, and keep a healthy weight. RA increases the risk of heart disease, so keep blood pressure, sugar and cholesterol in check. Keep all appointments and blood tests, and speak with your doctor or pharmacist about any side effects or concerns.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Conventional DMARDs such as methotrexate, hydroxychloroquine, sulfasalazine or leflunomideCalm the immune system to control RA and prevent joint damage.Only on a doctor's prescription with regular blood tests; methotrexate and leflunomide must not be used in pregnancy.
- Folic acid (with methotrexate)Reduces side effects of methotrexate such as mouth ulcers and nausea.Take exactly as your doctor advises, as the schedule differs from methotrexate.
- Corticosteroids such as prednisoloneQuickly reduce inflammation during flares or until DMARDs start working.Only on a doctor's prescription; long-term use can raise sugar, weaken bones and cause weight gain, and should not be stopped suddenly.
- NSAIDs such as naproxen or etoricoxibRelieve pain and stiffness but do not stop joint damage.Can cause stomach ulcers and kidney problems; use only as your doctor advises.
- Biologic and targeted medicinesUsed by specialists when standard DMARDs do not control the disease.Screening for tuberculosis and hepatitis is needed before starting, as they raise infection risk.
See a doctor urgently if
- Fever, chills or signs of infection while on RA medicines
- Breathlessness, persistent dry cough or chest pain
- Mouth ulcers, unusual bruising or bleeding while on methotrexate
- A single joint that suddenly becomes very hot, red and swollen
- Red, painful eyes or change in vision
- Neck pain with tingling or weakness in the arms or legs
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.