Rheumatoid Arthritis (RA): Causes, Treatments and More

What is Rheumatoid Arthritis?

Rheumatoid arthritis is a condition that can cause pain, swelling and stiffness in joints.

It is an auto-immune disease, which is also pretty scary. This leads the immune system — your body’s natural self-defence system — to become confused and begin to attack your body’s healthy tissues. With rheumatoid arthritis, it does this primarily with inflammation in your joints.

Rheumatoid arthritis is an autoimmune disease that primarily affects the joints, but it can also have broader impacts on other parts of your body. 

RA affects approximately 400,000 adults (16 years and older) in the UK. It can strike anyone at any age. It can deteriorate rapidly, so early diagnosis and aggressive treatment are key. The earlier you begin treatment, the more likely it is to work.

To understand how rheumatoid arthritis occurs, it may help to understand how a normal joint functions.

How a Normal Joint Works

First, it helps to understand the anatomy of a healthy joint. A joint is the place where two bones come together. However, most of our joints are made in a way that enables the bones to move in specific directions and to specific limits.

The knee, for instance, is the largest joint in human physiology and among the most complex. It has to be solid enough to bear our weight and secure enough that we can stand upright.

It also has to function as a hinge, so we can walk, and needs to twist and turn when we run or play sports.

In a normal joint, the joint surface of each bone is covered with cartilage that has a great deal of smooth, slippery surface. This cartilage cushions the joint, absorbing shocks as bones slide over each other. The thin membrane surrounding the joint (the synovium) produces synovial fluid that lubricates the joint, keeping it flexible and enabling it to move smoothly.

What Happens in a Joint with Rheumatoid Arthritis?

When you have rheumatoid arthritis, your immune system can provoke inflammation within a joint or multiple joints. Inflammation is a natural and important component of your immune system at work.

But in rheumatoid arthritis: your immune system gets mixed up and attacks the synovium, the lining around the joints. This leads to inflammation, swelling and pain. Over time, this chronic inflammation can destroy the cartilage, bones and ligaments within the joint, leading to deformities and decreased mobility.

The capsule around the synovium is stretched out, and when the inflammation subsides, it can’t hold the joint in its correct position. This can cause the joint to become unstable and move into unusual positions.

When to Get Medical Advice

If you suffer from any persistent joint pain, swelling, or stiffness, especially in the morning or after periods of rest, you should seek medical advice. Early diagnosis and treatment are crucial for controlling symptoms and preventing long-term damage. Left unchecked, RA can cause permanent joint damage and disability. Find out more about diagnosing rheumatoid arthritis.

Complications of Rheumatoid Arthritis

Rheumatoid arthritis can be associated with several other conditions that may cause more symptoms and can occasionally be life threatening.

The following could happen:

If not managed appropriately, RA can give rise to several complications, such as:

carpal tunnel syndrome

inflammation of other parts of the body (such as the lungs, heart and eyes)

a greater likelihood of heart attack and stroke

Ensuring that symptoms of rheumatoid arthritis are well controlled can help lower your risk of these complications.

Learn more about complications of rheumatoid arthritis.

Symptoms

Joint pain, swelling and stiffness are the primary symptoms of rheumatoid arthritis. It can also create more generic symptoms, and inflammation elsewhere in the body.

The symptoms of rheumatoid arthritis generally grow slowly over a period of weeks, though some cases become action within days.

The symptoms differ from individual to individual. They might fade in and out, or change with time. You may have flares, when your disease gets worse and your symptoms get worse.

Symptoms Affecting the Joints

Rheumatoid arthritis is mainly a disease of the joints. It can affect any joint in the body, though the small joints of the hands and feet are usually the first to be involved.

Rheumatoid arthritis usually symmetrically affects the joints (both sides of the body at the same time and right to the same degree), but it is not always the same case.

Pain

In RA, pain can be mild to debilitating. The pain is usually felt in the morning after getting out of bed or after periods of inactivity. This is when the joints are generally the most stiff.

Stiffness

Rheumatoid arthritis can stiffen joints. If your hands are affected, for example, the joints can prevent you from bending your fingers or making a fist.

Like joint pain, stiffness is usually worse in the morning or after inactivity.

Morning stiffness that is characteristic of another type of arthritis, called osteoarthritis, usually goes away within half an hour of getting out of bed, but morning stiffness in rheumatoid arthritis often lasts longer than that.

Additional Symptoms

In addition to joint problems, some people with rheumatoid arthritis have more general symptoms that can include:

fatigue and low energy

a high temperature

sweating

a poor appetite

weight loss

The inflammation involved in rheumatoid arthritis can sometimes also cause issues in other parts of the body, including:

dry eyes: if it is associated with the eyes

chest pain – if the heart or lungs are involved

Causes

Rheumatoid arthritis is an autoimmune disease, meaning it occurs when the immune system attacks healthy tissue in the body. But it’s not clear what sets this off.

Your immune system ordinarily produces antibodies that target bacteria and viruses, aiding in the fight against infection.

In the case of rheumatoid arthritis, however, your immune system mistakenly dispatches antibodies to the lining of your joints, where they go after the tissue surrounding the joint.

This makes the thin layer of cells (synovium) that covers your joints tender and swollen, releasing chemicals that destroy surrounding:

• bones
• cartilage — the flexible connective tissue that cushions and preserves joints
• tendons — the tissue that attaches bone to muscle
• ligaments – the tissue that links bone and cartilage

These chemicals slowly deform the joint and throw it out of alignment over time if rheumatoid arthritis is not treated. It can eventually destroy the joint altogether.

Various theories about why the immune system attacks the joints have been proposed, including an infection as a potential trigger, but none of the theories has been proven.

Age

Rheumatoid arthritis can affect adults at any age, but most people are diagnosed between the ages of 40 and 60.

Approximately three out of four people with rheumatoid arthritis are of working age at the time of initial diagnosis.

Sex

Women are two to three times more likely to have rheumatoid arthritis as men.

Genetics

Rheumatoid arthritis is caused by a combination of genetic and environmental factors, including smoking and diet. The exact genetic association is still being figured out, but it seems that having relatives with the condition gives you a higher risk of developing the disorder.

Weight

If you’re overweight, your risk of developing rheumatoid arthritis is much higher than if you’re a healthy weight.

Body mass index (BMI) is a measure that determines whether your weight is healthy based on your height and weight.

For most adults, a healthy BMI is between 18.5 and 24.9.

If your BMI is:

below 18.5 – you’re in the underweight zone

between 18.5 and 24.9 — you’re in the healthy weight range

between 25 and 29.9 – you fall into the overweight category

30 to 39.9 — you’re in the obese category.

To work out your BMI, use the healthy weight calculator.

Smoking

Smoking is a significant risk factor for developing RA and can worsen the disease for those who already have it. The toxins in cigarettes can trigger inflammation and increase the risk of RA.

 If you would like to stop smoking, visit the Smokefree website.

Diet

There’s also some evidence that eating large amounts of red meat and low amounts of vitamin C may increase the risk of rheumatoid arthritis developing.

How Will Rheumatoid Arthritis Affect Me?

Since rheumatoid arthritis is not the same in everyone, we cannot tell you how the condition will progress for you.

If you smoke it is a good decission for quit it after the diagnosis of rheumatoid arthritis. This because:

• smokers with rheumatoid arthritis worse than non-smokers
• Smoking can reduce the effectiveness of your medication.

RA can also affect your emotional well-being. Chronic pain, fatigue, and the fear of worsening symptoms can lead to feelings of frustration, anxiety, or even depression.

Physical activity, too, is vital; it can help manage your symptoms and boost your overall health.

Based on blood tests and x-rays, your doctor will be able to determine how quickly your arthritis is progressing and what the future prognosis may be. It will also assist your doctor in determining what type of treatment to suggest.

The outlook for people with rheumatoid arthritis continues to get better as newer, more effective treatments are becoming available. You can still live a full and active life with this condition, but you must take your medication as directed and make any lifestyle changes your doctor recommends. However, with proper treatment, it’s possible to manage the condition and maintain a good quality of life.

How Can I Identify Rheumatoid Arthritis Symptoms in Me?

Rheumatoid arthritis (RA) typically builds slowly over time, so its earliest symptoms can be easy to miss. Key signs include:

1. Chronic Joint Pain – Particularly in the hands, wrists, knees, or feet.
2. Morning Stiffness – Duration of more than 30 minutes early morning stiffness.
3. Swelling & Redness — Inflamed joints might feel warm and tender.
4. Tiredness & Weakness – Excessive tiredness despite adequate rest.
5. Reduced Movement – Limited range of motion in joints.
6. Symmetrical Pain – Pain on both sides of the body.
7. Other Symptoms – Low grade fever, loss of weight, or dry eyes/mouth.

If either lasts more than a couple of weeks, then see a physician for early diagnosis and treatment to avoid joint damage and control RA.

Diagnosis

The first step toward effective RA treatment is obtaining a correct diagnosis as early as possible. A doctor with specialized training in treating arthritis — a rheumatologist — is the best person to make an accurate diagnosis, using medical history, a physical examination and lab tests.

The diagnosis of rheumatoid arthritis is made on the basis of your symptoms, a physical examination and the results of x-rays, scans and blood tests.

Rheumatoid arthritis is hard to diagnose because many things cause joint stiffness and inflammation, and there’s no definitive test for the condition.

Your doctor will ask you about your symptoms — and conduct a physical exam. They will examine you for swollen joints and assess the range of motion in your joints. Rheumatoid arthritis can change different parts of your body at the same time, so it’s essential to inform your doctor about all the symptoms you’ve experienced, even if it doesn’t seem to be connected.

If they suspect you have rheumatoid arthritis, they’ll refer you to a rheumatologist and may arrange blood tests here as well to help confirm a diagnosis.

Blood Tests

No blood test can definitively tell you that you have rheumatoid arthritis. But there are a few tests that may reveal possible signs of the condition. Below are some of the key tests.

Erythrocyte sedimentation rate (ESR)

A small portion of your red blood cells are placed in a test tube of liquid. The cells are timed to measure how long it takes for them to travel down to the base of the tube. If the cells drop more quickly than normal, you might have higher than normal levels of inflammation. It could be rheumatoid arthritis, among other things.

C-reactive protein (CRP)

This test can also indicate if you have inflammation in your body. It does this by measuring levels of CRP in your blood. High levels of CRP are associated with several inflammatory conditions that affect the body.

Full blood count

A full blood count measures your red blood cell count. These transport iron throughout your body, and when red blood cells are low, so is your iron content. This might indicate anaemia (an-ee-me-er), and is common among people with RA, but anaemia doesn’t necessarily mean you have RA.

Rheumatoid factor and anti-CCP antibodies

One blood test checks the amount of these rheumatoid factors in the blood. The “rheumatoid factor” is a protein produced by the immune system when it attacks healthy tissue.

More than half of all people with rheumatoid arthritis have high concentrations of rheumatoid factors in their blood when the disease begins, but about 1 in 20 people who don’t have rheumatoid arthritis also have positive tests.

An associated blood test called anti-cyclic citrullinated peptide (anti-CCP) test is also offered. Anti-CCPs are also antibodies that the immune system makes.

Individuals who test positive for anti-CCP are likely to develop rheumatoid arthritis, but not every patient with rheumatoid arthritis has this antibody.

People who test positive for both rheumatoid factor and anti-CCP may have a higher chance of having severe rheumatoid arthritis that needs more aggressive treatment.

Scans Joint

Scans may help look for inflammation and damage to your joints. Which can be used to diagnose rheumatoid arthritis and to see how the condition is progressing.

These may include:

x-rays – to look for any changes in your joints

ultrasound scans – creates a picture of your joints using high-frequency sound waves

magnetic resonance imaging (MRI) scans – images of your joints are created using strong magnetic fields and radio waves.

Assessing Your Physical Ability

If you have rheumatoid arthritis, your specialist will assess how well you are managing with daily activities.

You might be given a questionnaire about how well you’re able to perform tasks such as dressing, walking and eating, and how strong your grip is.

This evaluation can be performed again during or after your treatment to measure any progress.

Treatment

Rheumatoid arthritis treatments can help reduce inflammation in the joints, relieve pain, prevent or slow joint damage and help reduce disability so you can be as active as possible.

Early treatment and support (whether through medicine, lifestyle changes, supportive treatments and surgery) cannot cure rheumatoid arthritis but can decrease the risk of joint damage and reduce the effects of the disease.

There are many different treatments for rheumatoid arthritis. The sooner intensive treatment is initiated, the more likely it is to be effective.

The three main treatments of rheumatoid arthritis are:

1. drugs
2. physical therapies
3. surgery

Drugs

There are four major classes of agents used to treat rheumatoid arthritis. These are:

1. Painkillers
2. Non-steroidal anti-inflammatory drugs (NSAIDs)
3. Disease-modifying anti-rheumatic drugs (DMARDs)

Steroids (sometimes called corticosteroids).

Most people with rheumatoid arthritis must take more than one drug. That’s because different drugs work different things.

You may need to change your drug treatments time to time. This can depend on how bad your symptoms are, or because something relating to your condition has changed.

Drugs can also be sold under many different names. Every drug has an approved name — sometimes called a generic name.

Manufacturers typically also attribute the drug a brand name, or trade name. For instance, Tofacitinib is widely known under the brand name Tofacent.

The name approved for the pharmacist’s label should always be present, even if a brand name is on the packaging. If you’re unsure about anything, check with your doctor, rheumatology nurse specialist or pharmacist.

Painkillers

You might be recommended painkillers like paracetamol or paracetamol with codeine (co-codamol) to ease rheumatoid arthritis pain.

These medications don’t address the inflammation in your joints, but they might help alleviate pain in some individuals.

Disease-modifying anti-rheumatic drugs (DMARDs)

There are maybe various things to do but three types of DMARD: 

• conventional synthetic DMARDs (sometimes called csDMARDs)
• biological therapies (sometimes called bDMARDs).
• targeted synthetic DMARDs (sometimes called tsDMARDS).

If you take DMARDs, you will need regular blood tests, because they can affect your liver.

You may not notice your DMARD working for a while – a few months in fact. It is vital to continue to take your medication, in the meantime.

The table below shows available DMARD treatment options for Rheumatoid Arthritis.

For more information on the types of drugs used to treat rheumatoid arthritis, see our Blog Content.

Biological treatments

Biological treatments, including adalimumab, etanercept and infliximab, are a more recent type of treatment for rheumatoid arthritis.

They’re typically used in combination with methotrexate or another DMARD, and are generally only used if DMARDs have not worked alone.

Biological drugs are administered by injection. They function by blocking certain chemicals in your blood from activating your immune system to attack your joints.

Side effects from biological treatments are usually mild but include:

• skin reactions at the site of the injections
• infections
• feeling sick
• a high temperature
• Headaches

People who would also be at risk for more serious conditions, such as the reactivation of some past infections, including tuberculosis (TB), would also be at risk.

Further information

• National Rheumatoid Arthritis Society (NRAS): biologic treatments

JAK inhibitors

JAK inhibitors (Janus kinase inhibitors) are a newer type of medication used for rheumatoid arthritis (RA) treatment. They work by blocking specific enzymes (JAK pathways) that cause the inflammation and joint destruction.

In RA, the immune system mistakenly attacks healthy joints, leading to pain, swelling, and stiffness. JAK inhibitors can help by dampening that overactive immune response, which in turn can slow the rate of joint damage and improve symptoms.

they’re offered to people who can’t take DMARDs or biologicals, or have tried them and found they didn’t work.

This drug is typically used in conjunction with methotrexate.

Adults who cannot take methotrexate can also take JAK inhibitors on their own.

Further information

• National Rheumatoid Arthritis Society (NRAS): JAK inhibitors

Steroids

Steroids are sometimes known by their full name: corticosteroids.

Corticosteroids help to reduce the pain, stiffness and inflammation caused by rheumatoid arthritis.

They can be used as:

• a tablet (for example, prednisolone)
• an injection directly into a painful joint
• an injection into your muscle. (help lots of joints)

They are generally used for short-term pain relief. That’s either during a flare-up, or while you’re waiting for your DMARD medication to take effect.

Corticosteroids are typically used as such only in limited circumstances, as long-term use of corticosteroids can have serious side effects, including weight gain, osteoporosis and thinning of the skin.

You shouldn’t stop taking your steroid tablets, or change the dose, unless your doctor tells you to. It can be dangerous to suddenly stop the use of steroids.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to help control symptoms such as pain, swelling or stiffness. They can be taken alongside painkillers as well.

NSAIDs take effect in a few hours, and they can be effective for a few hours to a day. These medications can stop joint inflammation and relieve pain, but they will not prevent rheumatoid arthritis from progressing over time.

One commonly used NSAID is ibuprofen.

NSAIDs can be taken as a:

• tablet
• capsule
• liquid
• suppository to be inserted into your bum
• cream
• Gel.

Physiotherapy

A physiotherapist can suggest suitable exercises for you and support you in keeping active.

Physiotherapist can help in improving your fitness level and muscle strength, and making your joints more flexible.

If you have problems with your hands or wrists, you may put together a customised hand exercise plan. It involves in-person appointments with a trained therapist combined with doing the exercises at home without a therapist.

A physiotherapist might also assist with pain relief using heat, ice packs or transcutaneous electrical nerve stimulation (TENS).

A TENS machine sends a small pulse of electricity to the affected joint, which numbs the nerve endings and may help soothe the pain of rheumatoid arthritis.

Occupational therapy

Occupational therapists can assist you to continue doing the tasks you need or enjoy – in the home or at work. They will help you come up with alternative approaches.

The benefits of seeing an occupational therapist include:

1. improved confidence
2. having more ability to do things, at home or at work
3. being independent at home
4. enabling you to go back or remain in work.

Check with your GP on any occupational therapists in your local area. If you see a social worker, nurse or other health care professional regularly, they can help you get in touch with an occupational therapist via health or social services.

Be ready to explain any challenges you face and how those complications are impacting you, or caregivers in your life.

If there is a waiting list, remember to also ask how long it will be until you get an appointment.

You could also see an occupational therapist privately. You will be able to get an appointment sooner, but it will come at a price.”

Search the Royal College of Occupational Therapist website for a private occupational therapist. All occupational therapists are registered with the Health & Care Professions Council (HCPC).

A podiatrist may be able to help you if you have problems with your feet.

You might also be prescribed some kind of joint support or inserts for your shoes that can relieve pain.

Further information 

• Versus Arthritis: managing your symptoms
• Versus Arthritis: treatments for arthritis
• National Rheumatoid Arthritis Society (NRAS): rheumatoid arthritis healthcare

Surgery

Your joints may still get damaged even after taking medicines at times. If this occurs, you might require surgery to assist you in regaining your use of your joint.

Surgery also could be suggested to lessen pain or correct deformities.

Foot Surgery

Types of this type of surgery include:

• Resection of the inflamed tissues surrounding the forefoot joints.
• Resection of the small joints of the ball of the foot.
• Straightening of toes.
• Fixation of joints.

Finger, hand and wrist surgery

Hand surgeons use various types of surgical procedures to correct joint disorders.

Examples include:

• carpal tunnel release (the cutting of a ligament in the wrist to relieve pressure on a nerve). Learn more about carpal tunnel syndrome.
• release of toe tendons to treat abnormal bending
• tissue removal of the inflamed tissue that lines the finger joints

Arthroscopy

It is a procedure that removes inflamed joint tissue.

An arthroscopy is a procedure in which the surgeon inserts a thin tube attached to a light and a camera (arthroscope) through a small cut in the skin into the joint so the surgeon can visualize the affected joint.

Small cuts in the skin allow special instruments to be inserted to remove damaged tissue.

You don’t typically need to remain in the hospital overnight for this type of surgery, but the joint will need to be rested at home for some days.

Joint replacement

People with rheumatoid arthritis sometimes require surgery to replace a portion or entire joint – joint replacement or arthroplasty. After the hip, knee and shoulder, the next most common joints to be replaced are the elbow, wrist and ankle.

Replacement of these joints is a big step, needing several days in hospital and rehabilitation afterwards for several months. The latest joints, in general, may last 10 to 20 years, and the new joint is not guaranteed to operate 100%.

Read our content on surgery for more on the topic.0

Complementary therapies

People with rheumatoid arthritis often turn to complementary therapies including:

• acupuncture
• chiropractic
• massage
• osteopathy

In most circumstances, little or no evidence exists that they’re effective over the long term, although some people may get short-term benefit from them.

Nutritional supplements and dietary changes

There is no strong evidence to suggest that any particular dietary changes can help rheumatoid arthritis, although some people find that their symptoms are worse after eating certain foods.

If you suspect this might be the case for you, it can be helpful to avoid problem foods for a few weeks and see if your symptoms improve.

But you want to make sure the rest of your diet remains healthy and balanced. A Mediterranean-style diet based on vegetables, fruits, legumes, nuts, beans, cereals, grains, fish and unsaturated fats like olive oil is recommended.

Little evidence supports the use of supplements in rheumatoid arthritis, either, although some can be helpful in preventing side effects of medicines you may be taking.

For instance, if you take steroids, calcium and vitamin D supplements can help prevent osteoporosis, and taking folic acid supplements may help prevent some of the drug’s side effects if you take methotrexate.

Managing symptoms

Managing a flare-up

When the symptoms worsen, it’s called a flare-up. These may occur at any time, but may occur when you have been under stress or have an infection.

You may also get better at recognizing early signs of a flare-up over time.

If you’re experiencing frequent flare-ups, you should tell your doctor about this. Perhaps you should consider reassessing your treatment.

Such as: when to reach out for support, and few things you can do for yourself during a flare-up.

Continue taking your medications at the doses prescribed to you.

Do gentle exercises.

Apply heat to the joint – this can be done using a hot water bottle or electric heat pad. More information is below.

Apply something cold to the joint – these might be: a bowl of cold water and ice cubes; a pack of frozen peas wrapped in a towel; damp towel stored in fridge. (See below for more information.)

Tell people in your life, so that they can support and assist you.

Tips for using heated items

For things to use for joint pain that can be heated up, try a hot water bottle or an electric heat pad. Pack these in a towel then apply to an affected joint. You could also consider having a shower or bath that is hot or warm.

Other hot items that people found helpful are wheat bag, heat pads, deep heat cream or heat lamp.

Just remember: These things should be warm, not hot, because you could burn or scald yourself. Gentle heat will be enough.

A towel, placed between the heat source and the skin for protection. Make sure none of your skin is burning by regularly checking.

Tips for using ice packs

Some people find that using an ice pack can help their joint pain. Buy one from a pharmacy — or make one at home, wrapping ice cubes in a plastic bag or wet tea towel.

Here’s how to treat your skin with the ice:

• Massage a tiny bit of oil onto wherever you intend to put the ice pack. Any type of oil can be used. If the skin is broken — for instance, if you get a cut — don’t use the oil and cover with a plastic bag. This will prevent the cut from getting wet.
• Pour the oil under the flannel and place a damp, cold flannel on top.
• Place the ice pack on top of the flannel, and keep it there.
• Do this for five minutes and check the colour of your skin. If your skin is bright pink or red, remove the ice pack. If not, keep it on for 5 to 10 more minutes.
• You should keep the ice pack on for 20-30 minutes. And 10 minutes at most, because your skin can get damage if you leave him on for too long.

Physical activity

Staying physically active can help relieve many symptoms of rheumatoid arthritis as well, including pain.

You may already struggle to be active physically, for one thing — particularly if you’re having a flare-up. But if you do find the right types of activities, support and help, it can be possible to be active in a way that works for you.”

Not being active can contribute to stiff joints and weak muscles. It could also lead you to gain weight.

If you’re new to exercise, or you haven’t worked out in a while, you might be a little sore for the first few sessions of a new activity. It’ll get better as you get used to it.

But, I say, if a type of exercise consistently triggers a flare-up, you’re likely best off finding a different one. The higher the impact, the greater the risk — think step exercises, or contact sports, like rugby and football. Swimming, walking, gentle cycling and aqua aerobics are usually less stressful on your joints.

Yoga and tai chi are generally believed to be safe for people with rheumatoid arthritis. There are lots of different styles though, so do ensure to confirm that the style is appropriate for your condition before signing up to a class.

You should also interrupt long stretches of sitting with light activity, to avoid remaining sedentary for too long.

Hydrotherapy

Hydrotherapy may also provide relief for your symptoms. This is carried out through special exercises, in warm-water pools, and may be led by trained physiotherapists. Hydrotherapy is also referred to as ‘aquatic therapy’ or ‘aquatic physiotherapy’.

If they think you could benefit from hydrotherapy, any member of your healthcare team should be able to refer you to an NHS physiotherapist. In some areas of the UK, you can self-referral to the physiotherapist who will assess your needs in relation to hydrotherapy.

Check with your GP, or with your local rheumatology department, to see if NHS physiotherapists in your area accept self-referrals.

You also have the option of utilizing private healthcare, however, bear in mind that, on rare occasions, private hydrotherapy might be unmonitored leading to variable standards when it comes to the changing facilities, the water or the surrounding environment.

Verify that you’re comfortable with the facility before your treatment begins. An  Health & Care Professions Council (HCPC) accredited physiotherapist will be the person you are looking for.

You should also meet with a member of the Chartered Society of Physiotherapists (CSP) who is accredited by the Aquatic Therapy of Chartered Physiotherapists (ATACP).

It can alleviate the pain in your joints, and you may also find it soothing. If you think hydrotherapy could be helpful for you, consult your doctor or physiotherapist.

Foot problems

For those with rheumatoid arthritis, foot problems can include:

• pain
• soreness
• warmth and swelling that lasts at least a few days
• the foot changing shape
• difficulty walking
• your shoes rubbing
• corns or calluses, and problems with nails
• Athletes foot, verruca or bacterial infections.

If untreated, these issues can result in the infections spreading, and ultimately ulcers forming.

This is why it is important to see a podiatrist, the general foot care specialist. They can offer advice on shoes, advice on how to address foot problems yourself, and they can offer specialized inserts. They can also monitor your foot and general health and refer you to a consultant if they spot any problems.

The rheumatology department where you attend for your care may have a podiatrist, or you might be referred to an NHS-based podiatrist. GPs can also refer you to community-based service.

You can also see a podiatrist privately.

You can search for a private podiatrist on the College of Podiatry website. Podiatrists should all be registered with the Health & Care Professions Council (HCPC).

Complementary treatments

Complementary treatments are useful to try along with spread medicines in the Treatment Rheumatoid arthritis. But they should not be seen as a substitute for any medicines you are prescribed and you should discuss any alternative treatment you are considering with your rheumatology team.

Treatments that are generally complementary are not regarded as evidence-based, and so they are not typically available on the NHS.

Living with rheumatoid arthritis

Rheumatoid arthritis can be life changing. How to treat arthritis Long-term treatment may be required to control the symptoms and prevent joint damage.

Depending on how much pain and stiffness you experience and how much joint damage you have sustained, simple daily tasks may become difficult or take you longer to accomplish.

This may involve making adjustments to the way that you carry out the day-to-day aspects of your life or your lifestyle, in order for you to better control your condition.

Here are ways you can help.

Self care

Self care has become an important part of daily life. It means being responsible for your health and wellbeing with help from those who care for you.

It covers what you do every day to make you fit and healthy, reduce the risk of illness and accidents happening, and manage small changes and long-term conditions.

Individuals with a long-term condition such as rheumatoid arthritis, can gain a huge amount from being supported to self-care for themselves. They can live longer and have a better quality of life, and be more active and independent.

Take your medicine

You should take your medication as prescribed, even if you feel better, because medicine is meant to prevent flares in the future as well as decrease the chance of more damage (like to your joints) in the future.

If you have any questions or concerns regarding a medicine you are taking or any side effects, discuss your questions with your health care team.

It may also be useful for you to read the information leaflet that accompanies the medicine, as this lets you know about potential interactions with other medicines or supplements.

Before trying any over-the-counter remedies, including painkillers or nutritional supplements, check with your health care team. These might interact with your medicine.

Self-management

Managing rheumatic arthritis will allow you to adjust to how it affects your lifestyle.

The NRAS have developed a self-management programme for people with rheumatoid arthritis.

This 6-week programme can help you learn more about your condition and offers some practical hints on how to manage day-to-day life, for example:

• how to take your medicine so that you get the most from it
• techniques to manage pain
• goal-setting exercises

Further information

• National Rheumatoid Arthritis Society: managing your rheumatoid arthritis

Occupational therapy

If rheumatoid arthritis is making it difficult to do things you need to do every day, occupational therapy might help.

An occupational therapist will be able to train you and give you advice in the home and workplace to prevent joint damage.

A joint support, such as a splint, may also be suggested, or devices to enable you to open jars or turn on taps.

Aids and adaptations

You may find it useful to use certain aids and adaptations if you have trouble doing everyday tasks.

Aids can provide assistance with activities of daily living such as bathing, dressing, or cooking. These include shoe horns; rails or handles; and shower seats.

Adaptations are larger items that can assist you to get around your home. Among these are wheelchairs, fixed ramps and bathrooms equipped with handrails.

In England, local councils are required to provide aids and minor adaptations of £1000 or less free of charge to everybody with an eligible care need. This might be referred to as ‘community equipment’ by your council.

There are also adaptations available beyond £1000, however, these must be applied for through a Disabled Facilities Grant.

You may wish to ask your local council to carry out a needs assessment to determine if you qualify for applicable aids and adaptations. You can read more about this and apply for a needs assessment here: https://www.gov.uk/apply-needs-assessment-social-services

Aids and minor adaptations you receive from your local councils should not be means-tested, so no matter how much you have in the bank, the local authority must provide them to you.

If you live in Wales, Scotland or Northern Ireland, contact your GP or local council for more information on access to these items.

Further support

If you have rheumatoid arthritis, you’re probably also dealing with one or more other conditions.

This isn’t uncommon – 54% of seniors over 65 in England have two or more long-term conditions. Depression is by far the most common condition in people with rheumatoid arthritis, affecting one in six.

If you’re depressed, speak to your GP who can direct you to the right services. You can also contact the arthritis helpline for free on 0800 5200 520, where trained advisors can provide you with help and support. Monday to Friday, excluding bank holidays, 9am to 8pm.

If you’re over 55, The Silver Line is around 24 hours a day, 365 days a year, for information, support and friendship.

The Campaign Against Living Miserably (CALM) is there for those men feeling distressed by thoughts and feelings.

Surgery

Some people with rheumatoid arthritis may need surgery. This could be to relieve pain, align joint properly or you to use your joint again. People with rheumatoid arthritis may have the following types of surgery:

Foot Surgery

Examples of this kind of surgery include:

• Excising of inflamed tissues around the joints of the forefoot.
• Arthrodesis (removal of the small joints in the ball of the foot)
• Straightening of toes.
• Fixation of joints.

Finger, hand and wrist surgery

In severe rheumatoid arthritis (RA), damage to the joints in the fingers, hands, and wrists can lead to pain, stiffness, and loss of function. When medications and therapy are no longer effective, surgery can potentially improve mobility and reduce pain.

Types of Surgery

• Synovectomy – Cuts out inflamed lining of a joint (synovium) to lessen pain and swelling.
• Tendon Repair – Repairs torn or damaged tendons to enable movement.
• Joint Fusion (Arthrodesis) – Connects bones to stabilize the joint and relieve pain.
• Joint Replacement (Arthroplasty) – Replace damaged joints with artificial implants, commonly used for severe wrist damage.

Arthroscopy Living

This is a procedure to remove inflamed joint tissue.

During an arthroscopy, a thin tube with a light and a camera at the end (arthroscope) is inserted into the joint through a small incision in the skin so that the surgeon can visualize the damaged joint.

Special instruments are inserted through other small incisions in the skin to remove the damaged tissue.

You will normally not need to spend the night in the hospital for this type of procedure, but the joint must be rested at home for a number of days.

Joint replacement Life

Some people with rheumatoid arthritis require surgery to replace part of a joint, or a whole joint, called joint replacement or arthroplasty. Joint replacements commonly include hip, knee and shoulder.

Replacing these joints is a major operation that requires several days in hospital, after with rehabilitation, which can take months. The last joints typically last 10 to 20 years, and there is no guarantee that the new joint will work perfectly.

Learn more about surgery in our surgery section.

Diet and nutrition

There isn’t one diet that will help everyone who has rheumatoid arthritis. But some individuals find that adjusting their diet improves their symptoms.

For more details, check out our diet and arthritis content.

Supplements

There is scant evidence that supplements will benefit rheumatoid arthritis, or its symptoms. But some believe some supplements do work for them.

What matters is that you aren’t throwing away your money buying expensive supplements that won’t help for your condition.

Your specialist team or GP may prescribe some supplements. For instance, you may be prescribed folic acid if you’re taking methotrexate or calcium and vitamin D if you’re taking steroids.

If you are eating a healthy, well-balanced diet, you should get all of the vitamins and minerals that you need.

But in autumn and winter they advise that vitamin D should be taken daily at the dose of 10 micrograms, to avoid getting too little due to a lack of adequate sunlight.

People who have little or no sun exposure to their skin are also advised to take a vitamin D supplement all year around. This might include those living in care homes and those who cover their skin when outdoors.

Ethnic minorities with dark skin — of African, Afro-Caribbean and South Asian origin — should also think about taking a supplement all year round as they may not receive sufficient vitamin D from sunlight in the summer.

Sleep

Getting a good night’s sleep can certainly be a challenge when you are contending with the aches, pains and inflammation of rheumatoid arthritis.

For advice on getting a good night’s sleep read our Sleep and Arthritis booklet or visit The Sleep Council website.

Sex and relationships

Most couples—whether they have arthritis or not—experience periods when their sex life is less vivid or satisfying than it once was. This can be due to physical reasons, but emotional and stress components are likely in the mix.

Living with arthritis comes with its own set of trials in a relationship, such as:

• Pain and fatigue can dull your enjoyment of sex, and of other things you do together with your partner that you love.
• Having arthritis may mean that you can’t always handle the household jobs that you normally do, or may need assistance with them.
• If your arthritis interferes with your work, it may cause financial stress.
• Having arthritis can have an impact on your mood and self-esteem.
• Your partner will worry about how the condition is impacting you.
• To see more, visit our sex, relationships and arthritis content.

Money and benefits

If rheumatoid arthritis forces you to stop working or cut back to part-time work, you could struggle financially.

You might be eligible for one or more:

• if you have a job but aren’t able to do it because of your condition, you are entitled to Statutory Sick Pay from your employer for up to 28 weeks.
• if you are unemployed and unable to work because of your condition, you might qualify for Employment and Support Allowance.
• if you’re 64 or younger and require assistance with personal care or struggle with walking, you might qualify for a Personal Independence Payment.
• if you’re 65 or over, you could claim Attendance Allowance.
• you might be eligible for Carer’s Allowance if you care for someone with rheumatoid arthritis
• If you have children living at home or a low household income, you may also be entitled to other benefits.

Paying for your medicines

If you have rheumatoid arthritis, you’ll probably need repeat prescriptions of medication to control your disease.

Rheumatoid arthritis is not one of the medical conditions that gives an individual an entitlement to free prescriptions in England.]

But if your condition comes under the umbrella of “a continuing physical disability which means the person cannot go out without the help of another person” you might qualify for free medicine.

You’re also entitled to free prescriptions if you’re aged 60 or over, or if you receive one of the following:

Income Support

Incapable of working due to illness or disability: income-based Jobseeker’s Allowance

income-based Employment and Support Allowance.

If you do not qualify for free prescriptions then it may be more cost-efficient for you to purchase a prescription prepayment certificate (PPC).

This is a kind of prescription “season ticket,” which applies to all your prescriptions within a 3- or 12-month period.

Find out more about who can get free prescriptions.

Further information

• Social care and support guide
• Versus Arthritis: work
• GOV.UK: benefits
• National Rheumatoid Arthritis Society: living with rheumatoid arthritis

Complications

Rheumatoid arthritis can increase your risk for other conditions, especially if it’s not well controlled.

These are some of those conditions:

Carpal tunnel syndrome

One common problem for people with rheumatoid arthritis is carpal tunnel syndrome.

It occurs when the nerve responsible for sensation and movement in the hands (the median nervous) becomes compressed, and it can manifest through symptoms including:

aching

numbness

numbness in your thumb, fingers and part of your hand

Timely treatment of carpal tunnel syndrome, which can sometimes include wearing wrist splints or receiving steroid injections, can ease symptoms, although surgery to alleviate pressure on the median nerve may be necessary.

Widespread inflammation

Rheumatoid arthritis is an inflammatory condition that may lead to inflammation in other areas of your body, including:

-lungs — inflammatory response affecting the lungs or lining can cause pleurisy or pulmonary fibrosis, which cause chest pain, a dry cough and shortness of breath.

-heart – irritating the tissue surrounding the heart can cause pericarditis, which leads to chest pain.

-eyes — eye inflammation can be associated with scleritis and Sjögren’s syndrome. Scleritis can cause redness and pain in the eyes, and Sjögren’s syndrome can cause dry eyes.

-blood vessels – vasculitis, or inflammation of the blood vessels, is the thickening, weakening, narrowing and scarring of the blood vessel walls. In more serious cases, it can impair blood flow to your body’s organs and tissues and can be life threatening.

But, rheumatoid arthritis this inflammation end up by less to the body after treatment.

Joint damage

Rheumatoid arthritis can cause serious, permanent damage to the joints if it isn’t treated promptly or properly.

Problems that can affect the joints include:

-injury to adjacent bone and cartilage (a tough, elastic substance covering the joints’ surface)

-damage to adjacent tendons (flexible tissue that connects muscle to bone), which might make them break (rupture)

-joint deformities

These conditions can sometimes require surgical treatment to prevent loss of function to the affected joints.

Cardiovascular disease

If you have rheumatoid arthritis, you are at increased risk for cardiovascular disease (CVD).

CVD is an umbrella term used to describe the diseases and conditions that affect the heart or blood vessels — and it encompasses potentially life-threatening issues, including heart attack and stroke.

It’s not entirely clear why people with rheumatoid arthritis have such an increased risk of these problems. You can lower your risk by making sure your arthritis is well controlled and by:

• stopping smoking
• eat a healthy, balanced diet
• exercising regularly

Cervical myelopathy

If you’ve had rheumatoid arthritis for a while, you’re at risk for having a problem at the top of your spine called cervical myelopathy.

If you’re going to have an operation where you’re given general anaesthetic, you might need a special assessment of your neck.

This condition causes the top of the spine to dislocate, which places excess pressure on the spinal cord. Though rare, it’s a serious condition that can significantly limit your mobility and damage your spinal cord permanently if you aren’t treated quickly, with surgery.

Want to know more?

• National Rheumatoid Arthritis Society: possible complications and related conditions

Research and new developments

Scientists and medical experts are learning more each day about the causes, diagnosis, and treatment of one of our most common forms of autoimmune disease, rheumatoid arthritis (RA). Ongoing research is refining treatment strategies and revealing the origins of the disease.

Major Advances in RA Research

1. Biological Therapies – In the last 20 years, biologic drugs such as TNF inhibitors and JAK inhibitors have revolutionized RA treatment by offering relief to people for whom traditional medications don’t work. Researchers are working on more targeted and effective biologics to avoid as much side effects as possible.
2. Early Diagnosis and Treatment — Research indicates that initiating intensive treatment within 12 weeks of the onset of symptoms provides better long-term outcome. This resulted in better early screening initiatives and faster diagnoses.
3. Genetics and RA Risk – The Centre for Genetics and Genomics is examining the role of genetic factors in mediate the risk for RA. By uncovering significant genes related to RA, researchers aim to develop tailor-made treatments based on an individual’s genetic profile.
4. Tackling the Mechanism of Disease – Researchers at the RA Pathogenesis Centre of Excellence are investigating what causes RA to start and importantly what keeps inflammation going, resulting in improved drug delineation targeting inflammation at the source.
5. Gut and Skin Microbiome Research – New studies suggest that the microorganisms dwelling in our gut and on our skin may play a role in the progression of RA and its response to treatment. Scientists are investigating if changing the gut microbiome with diet or probiotics might improve symptoms of RA.
6. Stem Cell Therapy – Initial studies indicate that stem cell therapy may assist in repairing damaged joints and minimize inflammation, potentially providing a treatment for RA in the future.
7. AI in RA Diagnosis – AI algorithms analyze a bevy of data, including X-rays and blood tests, to detect RA sooner and with higher accuracy, allowing patients to be diagnosed more quickly and increasing the likelihood of successful treatment.
8. Vaccine – Researchers are exploring ways to train the immune system to prevent or slow the development of RA, raising the possibility of a future RA vaccine.

Thanks to persistent innovation, the horizon of treatment for RA is shifting toward more efficacious, safer, and personalized therapies that can potentially change the lives of millions suffering from the disease.

Shimla D Costa Story

When I was 21, my life turned upside down. I had just gained entry into my third year of university, training to become a primary school teacher, looking forward to my future. Then, one morning, everything altered.

I awoke with a peculiar ache in my thumbs. At first it just wasn’t so bad, only uncomfortable. I thought it would go away on its own. But within the next few days, the pain radiated to my elbows, to the point where I had trouble extending my arms. Then my wrists, knees and ankles began to hurt, too.

Initially, the pain and stiffness was limited to the mornings, but over the years, it became constant. Everyday tasks — writing, holding a cup of tea, getting out of bed — seemed to be beyond me. I was always tired, as if I was dragging around a burden I couldn’t set down.

After months of confusion, frustration and countless doctor visits, I finally heard the life-altering words: “You have rheumatoid arthritis.”

Adjusting to My New Reality

The diagnosis hit like a punch to the stomach. I had been so young—how could I have arthritis? I assumed arthritis was a condition only older people developed. I had tons of plans, dreams, aspirations, and all of a sudden everything was wrong.

I ended up pushing my graduation back two years. I saw my friends going on to jobs and lives as I revolved through pain, medication, and doctor visits. It was heartbreaking.

But I was not going to let RA define me. And even if I was never going to be able to walk into a classroom as a teacher, I had a different way to teach. I began volunteering for Versus Arthritis, running self-management courses to support folks with RA. Now, I’m proud to be the Chairperson of my local support group, supporting people who are experiencing the same challenges I used to face on my own.

Finding Joy in Everyday Life

Having RA has meant I’ve had to learn to adapt — but I won’t give up the things I love. Baking is one of my avocations — although some kitchen tools are difficult to work with. I’ve learned how to simplify things and carry on with what I enjoy doing.

The fact that spending time with friends gives me strength mentally, plus the fact that my escape on a tough day is music and books. EXERCISE: The lifesaver. Exercises on a chair to combat stiffness, short walks, swimming in a hydrotherapy pool help keep me moving.

Hope in Treatment and Looking Forward

For five years, I’ve been taking a biological injection called Enbrel. I take it each week by self-injection, and it has changed my life. My flare-ups are more infrequent, and although I do have bad days, I also have good ones, which I never thought would be possible at the time I was diagnosed.

My Advice to Others

If you’ve been recently diagnosed with RA, here’s what I want you to know:

• You are not alone. Get a support group — it’s more helpful than you can imagine.
• Take care of yourself. Get good sleep, rest as needed, listen to your body.
• Learn about your condition. Knowledge is power, and knowing about RA helps you to balance it better.

Living Beyond RA

RA is a part of my life, not the sum of my identity. I still deal with struggles, but I’ve learned how to adjust, expand my mind, and in life, move on. It is experiences like mine that make a person who they are today — stronger, more determined, and more hopeful than ever. RA is only one chapter in my story—not even the whole book.

Mark’s Story

I was diagnosed with rheumatoid arthritis in 2008, although, honestly, I don’t recall the specific moment. It was a slow dawning, not an epiphany.

I was co-running a charity video production company, as I still do, and living in South London with my wife, our dog and a parrot. Life was full. I was doing things, playing badminton, sailing, even attempting to learn how to ski. Arthritis was not in my 60-year plan, but life does not follow a script.

The First Signs

It began with swelling in a single finger — my pinky on my right hand. So it may not sound like much, but it profoundly affected my work. At that time I was using a specific camera that necessitated a firm, steady grip and the result was that even small movements became lifeless nephews.

Looking back, I see there were other signs — episodes of acute joint pain in my hands and wrists, which I attributed to work-related strain. I always had lots to do, always had somewhere to go. It never occurred to me that something more was going on.

How to Live Without Taking Medication

I’m currently not on any long-term medication since my partner and I are trying for our second child. And, well, it’s not easy. I’m suffering from pain, stiffness and debilitating fatigue as a consequence of no treatment.” I depend on NSAIDs and the occasional steroid injection to control things, but I realize this is not a long-term solution.

Nevertheless, I tell myself: this too shall pass.

Finding My Hobbies in Different Forms

I’m sure rheumatoid arthritis has impacted my hobbies. I enjoy sailing, but it’s tougher these days — handling ropes, steering and maintaining my balance in rough seas all require solid grip strength. I’ve had to learn to plan ahead more skilfully, following the weather forecast closely, and allowing more time to undertake tasks.

I love badminton too, but my joints are too sore to play at the moment.” It’s frustrating, but I remind myself that this is a period, not a period down. I might be slower than others my age, and I have to be more careful, but that doesn’t mean I’m quitting.

The Mental Battle

One thing you should know about me: I don’t want to talk about my arthritis.” I’m stubborn, and the idea that I’d be pushed around by something I can’t control irritates me. But I’ve also been burned by ignoring pain and trying to work through it; all of that does is prolong the process.

There have been days when I’ve just plowed through, refusing to let RA slow me down, only to wake the next day completely wiped out and unable to move properly. It’s a delicate balance between remaining robust and knowing when to quit.

My Advice to Others

Newly diagnosed with rheumatoid arthritis, you need to know that …

Your disease does not define you. It’s part of your life, but it doesn’t have to be the whole thing.

There will be trade-offs. Medications are helpful, but they have side effects. There’s no one-size-fits-all solution, so do what works for you and realize that some days will be harder than others.

Don’t allow arthritis to define everything else. Some days it’s front and center, other days; it hums in the background. You’re still you, and there is still so much life to live.

Cracking on With Life

RA is there, but I don’t pretend it’s not, and I’m not going to let it take the joy out of my life.” Yes, I go at a slower pace, I premeditate far more, and I take it one day at a time. But at the end of the day, I am still me, I’m working, I’m sailing and I’m loving life.

Arthritis is only one chapter in my story — not the whole book.

Are you ready to discover more about how Rheumatoid Arthritis treatment? Visit our website UnitPharmacy today to learn about pricing, patient reviews, and more.