Rheumatoid Arthritis

Rheumatoid arthritis 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.

Rheumatoid arthritis typically starts in the small joints of the hands and feet but it can also affect other parts of the body as well as causing fatigue and malaise, with low-grade fever and loss of appetite.

What is rheumatoid arthritis?

The normal role of your body’s immune system is to fight 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, leading 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 the risk increases with age, commonly developing between the ages of 25 and 50.

Gender: Women are two to three times more likely to have rheumatoid arthritis 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: Rheumatoid arthritis may be triggered by infection in people who have genetic links. But rheumatoid arthritis is not itself infectious – you cannot catch or spread the disease.

Warning signs

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 very 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.

One of the features of rheumatoid arthritis is its unpredictability. Symptoms may come and go with no particular pattern and you may have ‘flares’ 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 will help your doctor assess how fast your arthritis is developing, the best treatment to recommend and the possible outlook for the future. 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.

How can I manage my rheumatoid arthritis?

There is no cure for rheumatoid arthritis and because it affects people differently, your doctor or rheumatologist will need to 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.

Early treatment is essential to prevent joint damage later on. By working with your healthcare team, being active and practising self-management techniques, you can stop rheumatoid arthritis taking control of your life.

Medication

Medications commonly prescribed for rheumatoid arthritis include:

  • 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

The right kind of 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. Range of motionis how far you can move your joints in different directions. For the most benefit, they 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.

Don’t forget that everyday activities like housework and gardening are also excellent forms of exercise, but you will need to pace yourself so you don’t overdo it and trigger a flare. Talk to your physiotherapist about the exercises that are most appropriate for you.

Heat and cold

Heat is good for relieving pain and stiffness, reducing muscle spasms and tightness, and increasing 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.

Joint protection

Supportive, cushioned footwear will act as shock 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-relief

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 the tension and pain out of your body.

Healthy eating

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, has been shown to be beneficial for inflammatory arthritis. Some foods may trigger a flare-up 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. As with any chronic condition, it is natural to feel scared, frustrated, sad and sometimes angry. Acknowledging your feelings and seeking support is important for your overall health and wellbeing.

Surgery

This is not common, but it is occasionally needed. Operations vary from minor surgery to release a nerve or tendon, to major joint replacement.

For more information on Rheumatoid Arthritis, follow the links below:

Learn more about and manage your RA

RA explained – a cartoon depiction

Enbrel

Humira

The link between smoking and RA

  • 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)

www.quit.org.nz

For more information download a brochure about rheumatoid arthritis or ring 0800 663 463 to speak with an Arthritis Educator.

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Download the Rheumatoid Arthritis Brochure:

Order brochures by downloading the order form and returning to info@arthritis.org.nz

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