Introduction 

Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints.

The hands, feet and wrists are commonly affected, but it can also cause problems in other parts of the body.

There may be periods where your symptoms become worse, known as a flare-up or flare. A flare can be difficult to predict, but with treatment it is possible to decrease the number of flares and minimise or prevent long-term damage to the joints.

When to seek medical advice

You should see your GP if you think you have symptoms of rheumatoid arthritis, so your GP can try to identify the underlying cause.

Diagnosing rheumatoid arthritis quickly is important because early treatment can help stop the condition getting worse and reduce the risk of further problems such as joint damage.

What causes rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease. This means that your immune system – which usually fights infection – attacks the cells that line your joints by mistake, making them swollen, stiff and painful.

Over time, this can damage the joint itself, the cartilage and nearby bone.

It's not clear what triggers this problem with the immune system, although you are at an increased risk if you are a woman, you have a family history of rheumatoid arthritis, or you smoke.

Who is affected

Rheumatoid arthritis affects around 400,000 people in the UK.

It can affect adults at any age, but most commonly starts between the ages of 40 and 50. About three times as many women as men are affected.

How rheumatoid arthritis is treated

There is no cure for rheumatoid arthritis, but early diagnosis and appropriate treatment enables many people with rheumatoid arthritis to have periods of months or even years between flares and to be able to lead full lives and continue regular employment.

The main treatment options include:



medication that is taken in the long-term to relieve symptoms and slow the progress of the condition



supportive treatments, such as physiotherapy and occupational therapy, to help keep you mobile and find ways around any problems you have with daily activities



surgery to correct any joint problems that develop 



Possible complications

Having rheumatoid arthritis can lead to several other conditions that may cause additional symptoms and can sometimes be life-threatening.

Possible complications include carpal tunnel syndrome, inflammation of other areas of the body (such as the lungs, heart and eyes), and an increased risk of heart attacks and strokes.

Ensuring that rheumatoid arthritis is well controlled helps reduce your risk of complications such as these.

Symptoms of rheumatoid arthritis 

Rheumatoid arthritis mainly affects the joints, although it can cause problems in other parts of the body too.

The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days.

The symptoms vary from person to person. They can come and go, and may change over time. You may occasionally experience flares when your condition deteriorates and your symptoms become more severe.

Symptoms affecting the joints

Rheumatoid arthritis is primarily a condition that affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.

Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this is not always the case.

The main symptoms of rheumatoid arthritis affecting the joints are outlined below.

Pain

The joint pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.

Stiffness

Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist.

Like joint pain, the stiffness is often more severe in the morning or after a period of inactivity. Morning stiffness associated with another type of arthritis called osteoarthritis usually wears off within 30 minutes of getting up, but rheumatoid arthritis morning stiffness often lasts longer than this.

Swelling, warmth and redness

The lining of joints affected by rheumatoid arthritis become inflamed, which can cause the joints to swell, and become hot and tender to touch.

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

Additional symptoms

As well as problems affecting the joints, some people with rheumatoid arthritis experience a range of more general symptoms, such as:



tiredness and a lack of energy



a high temperature (fever)



sweating



a poor appetite



weight loss



The inflammation associated with rheumatoid arthritis can also sometimes cause problems affecting other areas of the body, including dry eyes if the eyes are affected and chest pain if the heart or lungs are affected. 

When to seek medical advice

You should see your GP if you think you have symptoms of rheumatoid arthritis.

There are a number of conditions that can cause problems such as joint pain and stiffness, so it's important to get a proper diagnosis.

Diagnosing rheumatoid arthritis as soon as possible is particularly important because early treatment can help stop the condition getting worse and reduce the risk of further problems such as joint damage.

Causes of rheumatoid arthritis 

Rheumatoid arthritis is an autoimmune condition, which means it is caused by the body’s immune system attacking itself. However, it is not yet known what triggers this.

Normally, your immune system makes antibodies that attack bacteria and viruses, helping fight infection. But if you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.

This causes the thin layer of cells (synovium) covering your joints to become sore and inflamed.

This inflammation in turn causes chemicals to be released that thicken the synovium and damage nearby:



bones



cartilage – the stretchy connective tissue between bones



tendons – the tissue that connects bone to muscle



ligaments – the tissue that connects bone and cartilage



If the condition is not treated, these chemicals gradually cause the joint to lose its shape and alignment and, eventually, can destroy the joint completely.

Various theories of why the immune system starts to attack the joints have been suggested, including that an infection or virus may trigger this, but none of these theories has been proven.

Possible risk factors

There are a number of things that may increase your risk of developing rheumatoid arthritis, including:



your genes – there is some evidence that rheumatoid arthritis can run in families, although the risk of inheriting the condition is thought to be low as genes are only thought to play a small role in the condition



hormones – rheumatoid arthritis is more common in women than men, which may be due to the effects of a hormone called oestrogen that is found at higher levels in women, although this has not been conclusively proven



smoking – some evidence suggests that people who smoke are at an increased risk of developing rheumatoid arthritis




Rheumatoid arthritis