What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is an autoimmune disease that causes pain and swelling in the joints. This happens because the immune system attacks the lining of the joints causing inflammation and joint damage.
RA usually affects the smaller joints, such as those in the hands, feet and wrists, although larger joints such as the hips and knees can also be affected.
RA is the second most common form of arthritis (after osteoarthritis), affecting nearly half a million Australians.
What are the symptoms of rheumatoid arthritis?
The symptoms of RA usually develop gradually. The first symptoms are often felt in small joints, such as your fingers and toes, although shoulders and knees can be affected early, and muscle stiffness can be a prominent early feature.
- Flare-ups: The symptoms of RA vary from person to person. They can come and go, and they may change over time. You will experience flare-ups when your symptoms will be more intense and severe.
- Pain: This is usually a throbbing and aching sort of pain. It is usually worse in the mornings and after you have been sitting still for a while.
- Stiffness: Joints affected by RA can feel stiff, especially in the morning.
- Warmth and redness: The lining of the affected joint becomes inflamed, causing the joints to swell, become hot, tender to touch and painful.
RA can also cause inflammation around the joints.
You might also experience:
- fatigue and lack of energy
- poor appetite
- weight loss
- dry eyes
- chest pain (if the heart or lungs are affected)
If you think you may have the symptoms of RA, it’s important to see a doctor because early diagnosis and correct treatment can reduce the impact of the disease. If left untreated, RA may permanently damage joints.
CHECK YOUR SYMPTOMS — Use our joint pain and swelling Symptom Checker and find out if you need to seek medical help.
What causes rheumatoid arthritis?
The causes of RA are unknown, but it is more common in people who smoke or have a family history of this disease.
We know how the condition attacks the joints, but it is not yet known what triggers the initial attack. Some theories suggest that an infection or a virus may trigger RA, but none of these theories has been proven.
RA can run in families but having a family member with RA does not necessarily mean that you will inherit the condition. Even an identical twin of someone with RA only has a small chance of developing it, so genes do not explain much of the risk.
RA is 3 times more common in women than in men. Research has suggested that the female hormone oestrogen may be involved in the condition, but this has not been conclusively proven.
RA is an autoimmune condition. Normally, your immune system makes antibodies that attack bacteria and viruses, helping protect your body against infection. If you have RA, your immune system sends antibodies to the lining of your joints, where instead of attacking harmful bacteria, they attack the tissue surrounding the joint.
When you have RA, antibodies attack the synovium, a membrane (thin layer of cells) that covers each of your joints. The synovium becomes sore and inflamed, which causes chemicals to be released and synovium to thicken. These chemicals can also damage bones, cartilage (the stretchy connective tissue between bones), tendons (tissue that connects bone to muscle) and ligaments (tissue that connects bone and cartilage). The chemicals gradually cause the joint to lose its shape and alignment and, eventually, can destroy the joint.
How is rheumatoid arthritis diagnosed?
RA can be difficult to diagnose because many conditions cause joint stiffness and inflammation. Your doctor will do a physical examination, checking your joints to see if they are swollen and to find out how easily they move. It is important to tell your doctor about all of your symptoms, not just the ones you think are important.
If your doctor thinks you have RA, they should refer you to a specialist called a 'rheumatologist'. A rheumatologist can diagnose this disease and ensure you receive the right treatment. If you have RA and have not yet seen a rheumatologist, you can ask your doctor for a referral.
Your doctor may carry out a series of tests, which may help to confirm the diagnosis, or they may refer you at the same time as requesting tests. Tests that you may have are outlined below.
No blood test can definitively diagnose RA. While a number of tests can indicate to your doctor that you may have developed the condition, they will not necessarily prove or rule out the diagnosis.
C-reactive protein (CRP)
A CRP test can indicate if there is inflammation in the body. CRP is produced by the liver. If there is more CRP than usual, there is inflammation in your body.
Full blood count
The full blood count will measure your red cells to rule out anaemia, a condition where the blood is unable to carry enough oxygen, due to a lack of blood cells. Eight out of 10 people with RA have anaemia. However, anaemia can have many causes, including a lack of iron in your diet, so having anaemia does not prove that you have RA.
This blood test checks to see if an antibody called 'rheumatoid factor' is present in your blood. This antibody is present in 8 out of 10 people with RA but it cannot always be detected in the early stages of the condition. The antibody is also found in 1 in 20 people who do not have RA, so this test cannot confirm RA. If it is negative, another antibody test may be done.
X-rays of your joints can help diagnose different types of arthritis and also show how your condition is progressing. A chest x-ray may also be taken as both the disease and certain treatments (such as methotrexate) can affect the chest.
Musculoskeletal ultrasound may be used to look at inflammation and joint damage.
Magnetic resonance imaging (MRI) scans can help show what damage has been done to a joint.
How is rheumatoid arthritis managed?
Most people with RA can lead full and active lives. Taking control of RA will help you cope with its impact on your lifestyle. As there is no known cure, early diagnosis and treatment can control its symptoms and help prevent disability.
People with RA are usually looked after by several health professionals. This might include a general practitioner, a rheumatologist, physiotherapist and occupational therapist.
Treatment will be tailored to your symptoms. Options include:
- medicines to relieve symptoms or slow progress of the condition
- heat and cold treatments, such as warm baths, and hot or cold packs
- TENS (transcutaneous electrical nerve stimulation) electrical device, which is thought to reduce pain by stimulating the nerves
- surgery to correct joint problems
- supportive treatments such as physiotherapy
- exercise to keep your joints flexible and muscles strong
- complementary therapies such as relaxation techniques, massage, hypnosis or acupuncture
It is possible to use more than 1 of these approaches at the same time (for example, using a drug treatment, heat pack and relaxation techniques). The experience of pain is also unique to everybody, so what works for you may not work for someone else.
There is no cure for RA but medicines can reduce pain and stiffness and prevent long-term joint damage.
The medications used to treat RA fall into 2 main groups. The first group reduces the activity of the immune system that is attacking and damaging healthy joints. These medications are referred to as disease modifying anti-rheumatic drugs (DMARDs). They relieve symptoms and also reduce the risk of long-term damage to your joints. Commonly used DMARDs are methotrexate, sulfasalazine, leflunomide, prednisone and hydroxychloroquine.
DMARDs might be used on their own or used with other medicines. There is also a group of DMARDs called biologicals, which work by stopping certain substances in the blood and joints that cause inflammation. Biological DMARDs can only be used if other DMARDs have not worked.
Unfortunately, while DMARDs work well, most take several weeks to months to have their full effects. So don’t worry if they don’t work straight away.
Also, like all medications, these drugs can have some side effects. Most patients need to have regular blood tests while they are on medication for their RA. This is also the reason that people are started on lower doses of some medications like methotrexate and then have them increased.
To find out more about RA medications, use the Arthritis Australia medication search page.
If joints have been damaged extensively, the only option may be surgery to replace the joint.
Learning how to manage your RA
There are things you can do to improve your quality of life with RA and ease symptoms. Eating well, staying physically active, stop smoking and reducing stress can all help. Arthritis Australia’s tips for living with arthritis may help.
Can rheumatoid arthritis be prevented?
There is no sure way to prevent RA, but there are ways to reduce your risk, such as not smoking.
What are the complications of rheumatoid arthritis?
RA can increase the risk of developing other conditions:
- Carpal tunnel syndrome — this is a common condition in people with RA when there is too much pressure on the nerve in the wrist. It can cause aching, numbness and tingling in your thumb, fingers and part of the hand.
- Inflammation — RA can sometimes cause inflammation to develop in other parts of your body, such as your lungs, heart, blood vessels or eyes.
- Tendon rupture — tendons are pieces of flexible tissue that attach muscle to bone. RA can cause your tendons to be become inflamed, which in severe cases can cause them to rupture. This most commonly affects the tendons on the backs of the fingers.
- Cervical myelopathy — this condition is caused by dislocation of joints at the top of the spine, which put pressure on the spinal cord. Although relatively uncommon, it is a serious condition that can greatly affect your mobility. If you have had RA for some time, you are at increased risk of developing cervical myelopathy and you may need special assessment of your neck before any operation where you are given general anaesthetic.
- Vasculitis — this rare condition causes inflammation of the blood vessels. It can lead to the thickening, weakening, narrowing and scarring of blood vessel walls. In serious cases, it can affect blood flow to your body's organs and tissues.
- Joint damage — you can experience permanent damage to your joints if your RA isn’t well controlled. This might need surgery.
- Cardiovascular disease — people with RA are at higher risk of heart attacks and strokes.
Resources and support
Arthritis Australia can provide more information on rheumatoid arthritis on their website or by calling their Arthritis Information Line on 1800 011 041.
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Last reviewed: October 2019