Rheumatoid Arthritis
Also known as RA
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is rheumatoid arthritis?
Rheumatoid arthritis is a chronic autoimmune disease in which the immune system attacks the joint lining, causing pain, swelling and progressive joint destruction. It typically affects small joints of the hands and feet symmetrically. Early aggressive treatment within the first months substantially changes long term outcome, which makes prompt referral important.
Causes
- Autoimmune attack on the synovial joint lining
- Genetic susceptibility including the shared epitope
- Smoking, which interacts strongly with genetic risk
- Gum disease and lung mucosal inflammation as possible triggers
- Citrullination of proteins driving antibody formation
Symptoms
- Symmetrical swelling and pain in small joints of hands and feet
- Morning stiffness lasting over an hour
- Fatigue and general malaise
- Low grade fever
- Reduced grip strength
- Rheumatoid nodules under the skin
- Joint deformity in untreated disease
Risk factors
- Female sex
- Age between 30 and 60 at onset
- Smoking
- Family history of rheumatoid arthritis
- Obesity
- Periodontal disease
Diagnosis
- Clinical assessment of joint swelling pattern
- Rheumatoid factor and anti CCP antibodies
- Raised ESR and C reactive protein
- Ultrasound or MRI to detect early synovitis
- X-rays for baseline erosions
- Urgent rheumatology referral when suspected
Treatment
- Methotrexate as first line disease modifying therapy
- Combination conventional DMARDs
- Biologic therapies targeting TNF, IL 6 or B cells
- JAK inhibitors in selected patients
- Short courses of corticosteroids to control flares
- Physiotherapy and occupational therapy
- Smoking cessation and cardiovascular risk management
Self care
- Take disease modifying medicines consistently, including in remission
- Attend regular blood monitoring
- Stay active with a mix of strengthening and aerobic exercise
- Use joint protection techniques and assistive devices
- Stop smoking, which reduces treatment effectiveness
- Keep vaccinations current, avoiding live vaccines on immunosuppression
- Rest during flares but resume movement promptly
When to see a doctor
Book an appointment if:
- New or increasing joint swelling
- Morning stiffness lengthening
- Flares becoming more frequent
- Side effects or abnormal blood results
- New breathlessness or a persistent dry cough
- Planning pregnancy, since some medicines must be stopped
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Rheumatoid arthritis cannot be prevented
- Joint damage is prevented by early aggressive treatment
- Stop smoking, which is the strongest modifiable risk factor
- Maintain good dental and gum health
- Keep to a healthy weight
- Do not delay assessment of persistent joint swelling
Outlook
Outlook has transformed with early treatment and modern medicines. Many people achieve sustained remission with minimal joint damage and continue working normally. Outcomes depend heavily on how quickly disease modifying therapy starts, since erosions occur early and do not reverse. Cardiovascular risk is raised and is managed alongside the joints.
Common questions
How does it differ from osteoarthritis?
Rheumatoid arthritis is autoimmune, symmetrical, affects small joints first, and causes morning stiffness lasting over an hour with systemic symptoms. Osteoarthritis is mechanical, often asymmetrical, and stiffness typically lasts under 30 minutes.
Why is early treatment emphasised?
Joint erosion begins early and is irreversible. Starting disease modifying therapy within the first three to six months, sometimes called the window of opportunity, markedly improves long term function.
Is methotrexate chemotherapy?
It is used in cancer at far higher doses, but in rheumatoid arthritis the weekly low dose works as an immune modulator. Folic acid is given alongside to reduce side effects, and blood monitoring is routine.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.