Rheumatoid arthritis, also called RA, is an autoimmune disease that causes inflammation, pain and swelling in the joints. It can occur at any age but most often develops between the ages of 25 and 50, and affects more women than men.
RA usually starts in the small joints of the hands and feet but it can also affect other parts of the body.
People with rheumatoid arthritis may experience fatigue and malaise, with low-grade fever and loss of appetite.
What is rheumatoid arthritis?
Your body’s immune system fights off infections. In an autoimmune disease, your immune system attacks healthy tissue instead, creating inflammation.
In rheumatoid arthritis, the immune system attacks the synovium, a thin membrane that lines the joints and makes a fluid that helps them move smoothly. Inflammation thickens the synovium, resulting in swelling and pain in and around the joints.
If inflammation is not controlled in the early stages of the disease, it can cause damage to bone and cartilage. This can lead to joint deformities.
Who gets rheumatoid arthritis?
The exact causes of rheumatoid arthritis are not known but these factors may increase risk:
Age: Anyone can get rheumatoid arthritis at any age, but it commonly develops between the ages of 25 and 50.
Gender: Women are 2 to 3 times more likely to have RA than men.
Family history: In some people, rheumatoid arthritis is linked to specific genes. However, this does not necessarily mean you will develop the condition.
Hormones: Changes to hormones during and after pregnancy, breastfeeding and use of oral contraceptives may be linked to the development of rheumatoid arthritis. They can also relieve or trigger symptoms.
Smoking: Smokers have a higher rate of rheumatoid arthritis than non-smokers.
Infection: RA may be triggered by infection in people who have genetic links. But rheumatoid arthritis itself is not infectious or contagious – you cannot catch or spread the disease.
Warning signs of rheumatoid arthritis
Rheumatoid arthritis usually starts slowly and affects joint symmetrically, i.e. the same joints on both sides of the body. For some people, it develops rapidly.
- Discomfort and swelling in the fingers, wrists or balls of the feet
- Feeling stiff when you wake up in the morning
- Joints feel hot, swollen and painful
- Fever, fatigue, weight loss and decreased appetite
RA is unpredictable. Symptoms may come and go with no particular pattern and you may have flares. This is when joints are more inflamed and painful than at other times.
Rheumatoid arthritis affects people differently. Some people will have flares and periods of remission. A small percentage will develop a severe form with extensive disability and inflammation in other parts of their body – such as eyes, skin, heart, lungs or nerves.
How is rheumatoid arthritis diagnosed?
Blood tests and X-rays help your doctor assess how fast your arthritis is developing. This helps determine the best treatment to recommend and the likely future outlook
You will be referred to a specialist (rheumatologist). People who are diagnosed and treated early are much more likely to avoid damage to their joints.
Will I see a rheumatology nurse or a rheumatologist at my specialist appointment?
Whether or not you see the rheumatology nurse or the rheumatologist at your specialist appointment depends on your clinic.
Sometimes you will see both, and sometimes one or the other. This will vary in Rheumatology clinics across the country and will often depend on the reason for your appointment. You can ask your nurse directly how often and in what circumstances you are likely to see the Rheumatologist.
Rheumatology nurses are generally very skilled, and seeing the Rheumatology nurse can be an opportunity to discuss your many different concerns, including lifestyle management of your condition. If you have concerns/questions that your nurse can not answer immediately, they will discuss this with the specialist and then get back to you.
There is a nationwide shortage of rheumatologists; many of you will have noticed this, with some localities being without a rheumatologist for several months.
Making sure you are well connected to the other people in your healthcare team can offer some reassurance and extra support to manage your condition and medicines while you are waiting to see the rheumatologist.
How can I manage my rheumatoid arthritis?
There is no cure for rheumatoid arthritis. RA affects people differently, so your doctor or rheumatologist will tailor your treatment to the symptoms and severity of your condition. They may need to trial different treatments to find which one works best for you.
By working with your healthcare team, being active and practising self-management techniques, you can stop RA taking control of your life.
Medication used to treat rheumatoid arthritis
- non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or creams and gels that can be applied directly into the skin. These reduce pain and swelling but may have side-effects.
- steroids to reduce inflammation, taken as injections or tablets. Side-effects can include weight gain, bone-thinning, and a rise in blood sugar or blood pressure.
- disease-modifying anti-rheumatic drugs (DMARDS) gradually reduce pain, swelling and stiffness by slowing the disease’s progression and effects on your joints. Some DMARDS affect the immune system, the blood and liver so you may be more likely to pick up infections.
- Biological therapies (biologics). These target proteins involved in the processes of inflammation and joint damage and are often given in combination with DMARDS.
Exercise that may help rheumatoid arthritis
Exercise helps to reduce pain and fatigue, increases strength and flexibility and keeps you feeling better overall.
These different types of exercises lessen pain and stiffness:
- Range of motion exercises keep your joints moving. These practice how far you can move your joints in different directions. These should be done daily.
- Strengthening exercises maintain muscle tone and protect your joints.
- Stretching exercises relieve pain and keep the muscles and tendons around the joints flexible.
- Cardiovascular exercises like walking, swimming and cycling strengthen your heart, give you energy and help control your weight. It’s best to avoid high-impact activities like aerobics or running.
- Hydrotherapy. Exercising and relaxing in warm water relieves pain and reduces muscle tension.
Everyday activities like housework and gardening are also excellent forms of exercise. You need to pace yourself so you don’t overdo it and trigger a flare. Talk to your physiotherapist about exercises that are appropriate for you.
Heat and cold
Heat relieves pain and stiffness, reduces muscle spasms and tightness, and increases range of motion.
Do not apply heat to an inflamed joint, which will already feel warm. Use a cold pack instead to reduce pain and swelling by restricting blood flow to the inflamed joint.
Supportive, cushioned footwear will act as shock absorbers for the feet, knees, hips and back. ‘Gizmos and gadgets’ and other useful strategies may help you overcome everyday challenges, especially in using your hands and fingers. An occupational therapist can give you tips to make it easier to get around, protect your joints and minimise fatigue.
Stress and fatigue can make pain worse. Learn how to pace yourself, set priorities and plan your day around what you can realistically achieve.
Practise relaxation techniques to ease tension and pain.
Healthy eating for rheumatoid arthritis
A balanced diet will give you energy, strengthen your immune system and promote bone and tissue health.
Fish oil, containing anti-inflammatory omega-3 fatty acids, is beneficial for inflammatory arthritis. Some foods may trigger a flare while others may reduce your symptoms, but this is different for everyone.
No particular diet or supplement will cure rheumatoid arthritis and what works for others may not work for you.
Be prepared to experiment a little, and talk to a registered nutritionist or your rheumatologist before adopting a special diet or taking supplements.
Emotional and social support
The pain and unpredictable nature of rheumatoid arthritis can be hard on people mentally and emotionally.
It’s natural to feel scared, frustrated, sad and angry. Acknowledging your feelings and seeking support is important for your health and wellbeing.
Surgery for people with rheumatoid arthritis
This is not common, but it is occasionally needed. Operations vary from minor surgery to release a nerve or tendon, to major joint replacement.
- Smoking can increase the chances of developing RA by 40 times.
- Smoking reduces the effectiveness of the medication used to treat RA
- Smoking may worsen joint damage
- Smoking leads to an increased risk of heart disease
- Smoking contributes to osteoporosis (thinning of the bones)