What is Rheumatoid Arthritis?
Rheumatoid Arthritis (RA) is an autoimmune disease - meaning that the body’s immune system, which is designed to attack germs or viruses, is mistakenly activated. In the case of RA it attacks the healthy tissue around the joints. If left untreated, it can cause extensive joint damage and that damage is irreversible. Doctors don’t yet know what triggers the condition - and research continues - but virus, injury, smoking and stress are all being investigated as possible causes. For someone with RA it is not unusual for several joints to become inflamed and painful, making carrying out everyday tasks extremely difficult.
The key to treating rheumatoid arthritis is early diagnosis. With the correct treatment some people suffer very little joint damage and only a few - around 1 in 20 - have severe joint damage. The progression of the disease varies from one person to another.
Early diagnosis of RA is the key to avoiding extensive damage to the joints.
- Constant or recurring pain or tenderness in the joints
- Stiffness and or swelling of the joints and difficulty in moving the affected joint normally
- Hands and feet are particularly susceptible, but the larger joints can be affected too
- In some cases the lungs and eyes can be affected
- Prolonged stiffness of the joints on waking up in the morning - lasting for longer than 30 minutes
- Extreme fatigue and feeling feverish
For most people the symptoms generally appear between the ages of 40 and 60 - but not exclusively. Some people might not even have aching joints at first - they might feel depressed or have unusually low energy levels, or perhaps have the symptoms of flu. The important thing to remember is that there is no obvious pattern in the symptoms - most people experience flares, where the symptoms are suddenly severe, but as the name implies these can disappear just as quickly.
Rheumatoid Arthritis is different for everyone, and the symptoms can differ too.
As with any visit to the GP, the starting point is going to be your symptoms: before your appointment try to think about what times of day you feel pain, for how long and which joints are affected. Tell the doctor as much as you can, because this will be key to the diagnosis. For example, is there a family history of RA?
There is no single conclusive method of determining whether or not someone has RA, and your doctor might ask for a blood test (to check for antibodies) or for an X-ray or MRI scan (to check for joint damage).
Normally you will be referred to a consultant rheumatologist, who will conduct further tests to decide what course your treatment should take. Given that the progression of RA is different for everyone, the consultant will want to find out as much as possible about your experience and symptoms before establishing what treatment you should have. Once this is decided, you will have regular appointments at the clinic to monitor how effective your treatment is, with regular blood tests and examinations of your joints.
There has been great progress in the treatment of RA and research continues into the causes the disease. At the moment there is no cure for RA, so the focus of treatment is to slow down its progression - something which can be done very successfully, especially with an early diagnosis.
Drug treatment:The drugs which can slow the progression of RA are disease-modifying anti-rheumatic drugs (DMARDs) and these are usually prescribed after diagnosis. You will be closely monitored to see how effective they are - and whether there are any side-effects - and it might take a little while to settle on the right drug for you and to establish what the dose should be. Don’t worry if this takes months rather than weeks - remember that RA is an unpredictable disease and just as its symptoms are different for everyone, so are the responses to individual drugs. The main thing is that once the right medication has been identified, it really can make a huge positive difference and keep the progression of the condition in check.
In addition to DMARDs you might also be prescribed medicine to alleviate the symptoms. These could be simple painkillers such as paracetamol, or anti-inflammatory drugs to reduce swelling in the affected joints. In some cases you might be given a corticosteroid (‘steroid’) Injection in a particular joint to relieve the pain and swelling.
Some people don’t respond to the standard treatment offered by DMARDs. In these cases, a newer generation of drugs - biological (also sometimes known as biologic) drugs - will be prescribed. These target particular chemicals or cells in the body’s immune system response. Under current NHS guidelines, these drugs are only prescribed where the typical DMARD treatment hasn’t worked, and for this reason it’s extremely rare for them to be prescribed for a newly-diagnosed person.
Read more about the development of drug treatment for RA here.
Surgery: Joint replacement surgery is sometimes undertaken where there has been severe joint damage, or where other treatments have failed to reduce pain or inflammation. Hand surgery, both to improve the function of the hands and to protect the other joints and tendons in the hand from damage, is more commonly undertaken than in cases of osteoarthritis. Hip and knee surgeries follow the same procedures as for osteoarthritis.
Exercise : You will usually be able to see a physiotherapist through the arthritis clinic, and he or she will be able to show you exercises which will strengthen the muscles around your joints and improve your mobility. Exercise also helps reduce stress - which could be a trigger of the symptoms - and also helps if you’ve been feeling low. There is plenty of exercise you can do without needing a specific programme: walking, for example, which is excellent for building strength and stamina. Equally many people find that swimming helps, and alleviates some of the joint pain.
Yoga and tai chi can also be beneficial - these activities which involve gentle stretching can improve muscle strength and balance, and help overall mobility.
Always discuss what exercise would be beneficial for you with your nurse or doctor and avoid doing anything which puts extra strain on the joints - jogging, for example.
Diet & Lifestyle A healthy diet is a good thing in itself, and something we should all be aiming for at any stage of life and whatever the state of our health is. Eating healthily is especially important for people with RA as it can help reduce the pressure of excess weight on joints. A good start is to eat plenty of vegetables, fruit and wholegrains, and to avoid processed foods wherever possible, as they contain more salt, sugar and fat. Broadly speaking, it is recommended we all follow the Mediterranean Diet, which means plenty of fruit, vegetables, pulses and oily fish.
Every extra pound of body weight increases the pressure on the knee joint by 3 - 4 pounds.
If you are given a diagnosis of RA, it’s important to stop smoking as this will improve your general health and may reduce the risk of flare-ups. Talk to your doctor or nurse if you need help giving up.
There is currently no conclusive evidence that dietary supplements can alleviate the symptoms of RA, although some people feel better as a result of taking them. The most commonly used supplements are fish oils, Omega-3 and vitamins, and some people find they feel better when taking them.
Always talk to your healthcare team before taking supplements. Apart from anything else, it could save you from wasting money.
Assistive devices Assistive devices (e.g. walking sticks, wall-mounted jar openers) have two basic aims: to alleviate pain and inflammation, and to improve mobility. Any device which reduces the stress on a joint can achieve this. In addition, your healthcare team can arrange a visit from an occupational therapist who can recommend ways to improve your mobility and help you carry out everyday tasks. As many people with RA can experience pain or swelling in their hands, there is a wide range of gadgets to make life easier.
Complementary therapies As with other forms of arthritis, there are a number of complementary therapies which people try. There’s generally no reason not to go ahead with a complementary therapy if it makes you fell better - but do discuss it with your rheumatologist or someone in the team first. As a rule, the NHS does not pay for these treatments but what is provided varies locally, so it’s worth asking before you pay yourself. The following link to the charity Arthritis Care UK’s website contains lots of useful information: www.arthritisresearch.org
Talking You might not always feel like it, but talking about your diagnosis and treatment with someone else can make a huge difference to your attitude and mood. It’s especially helpful to share your thoughts and feelings with someone else living with RA, and the National Rheumatoid Arthritis Society (NRAS) has trained volunteers you can talk to and also has information about groups you can attend. Visit www.nras.org.uk/speak-to-someone-else-with-ra and www.nras.org.uk/groups for more information. Alternatively, give them a ring on their freephone helpline number: 0800 298 7650.
Other useful sources of information about RA:
If you’d like to know more about living with or caring for someone with RA, there’s lots of information available. You might find the following websites useful: