Rheumatoid arthritis is a condition that causes pain, swelling and inflammation in the joints. Initially, the joints of the hands and feet are affected, but any joint may later become affected.
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Rheumatoid arthritis can make your joints feel stiff and can leave you feeling generally unwell and tired.
The condition affects approximately 350,000 people in the UK and occurs more frequently in women than men. It is most common after the age of 40, but it can affect people of any age.
Rheumatoid arthritis is an autoimmune disease. Your immune system, which usually fights infection, attacks the lining of your joints, causing them to become inflamed. Over time your joints may become permanently damaged and stop working properly.
The symptoms of rheumatoid arthritis usually come and go. Sometimes symptoms only cause mild discomfort, but other times they can be very painful, making it difficult to move around and do everyday tasks. When symptoms become worse, this is known as a flare-up. A flare-up is impossible to predict, making rheumatoid arthritis difficult to live with.
At present there is no known cure for rheumatoid arthritis. However, with early diagnosis and treatment symptoms can be eased and the progression of the condition can be slowed down.
The symptoms of rheumatoid arthritis tend to develop gradually, with the first symptoms often being felt in small joints, such as your fingers and toes.
The symptoms of rheumatoid arthritis often tend to come and go and you will experience what are known as ‘flare ups’. This means that from time to time, your condition will worsen and your symptoms will be more intense and severe. You can experience a flare-up at any time of the day or night. However, it is likely that your symptoms will be more painful in the morning, when you first wake up. Usually, your symptoms will begin to ease as the day progresses, as you start using and flexing your joints.
Once rheumatoid arthritis progresses, it can spread to other joints, such as your shoulders, elbows, hips and jaw. The condition tends to affect several joints at the same time, usually on both sides of your body. For example, it often affects both knees or both hands.
The symptoms of rheumatoid arthritis are outlined below.
- Joint pain and swelling - this is usually worst in the morning and tends to improve as you move around.
- Joint stiffness - again, this often improves once you start moving around.
- Warmth and redness - the lining of the affected joint becomes inflamed, leaving the skin over the joint warm, red and swollen.
- Loss of appetite.
- Generally feeling unwell.
- Skin nodules - one in four people with rheumatoid arthritis develop lumps under their skin, known as rheumatoid nodules. These commonly occur on the skin over the elbows and forearms, and are usually painless.
- Anaemia - this is a condition where the blood is unable to carry enough oxygen, due to a low number of red blood cells. It often leaves you feeling tired and lethargic. Eight out of ten people with rheumatoid arthritis are anaemic.
Unlike osteoarthritis, which only affects the bones and joints, rheumatoid arthritis can cause inflammation in other parts of your body. The condition can also cause inflammation of your tear glands, salivary glands, the lining of your heart and lungs, and your blood vessels.
The exact cause of rheumatoid arthritis is unknown. We know how the condition attacks the joints, but it is not yet known what triggers the initial attack. Some theories have suggested that an infection or a virus may trigger rheumatoid arthritis, but none of these theories have been proven.
Rheumatoid arthritis is an autoimmune condition. This type of condition causes the body to attack its own tissues. Normally, your immune system makes antibodies that attack bacteria and viruses, helping to protect your body against infection. If you have rheumatoid arthritis, your immune system sends antibodies to the lining of your joints, where instead of attacking harmful bacteria, they attack the tissue surrounding the joint.
The synovium is a membrane (thin layer of cells) that covers each of your joints. When antibodies attack the synovium, they leave it sore and inflamed. This inflammation causes chemicals to be released, which over a several months will cause the 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 can eventually destroy the joint completely.
There is some evidence that rheumatoid arthritis can run in families. Your genes may therefore be one factor in the cause of the condition. However, having a family member with rheumatoid arthritis does not necessarily mean that you will inherit the condition. Even an identical twin of someone with rheumatoid arthritis would only have a one in five chance of developing the condition.
Rheumatoid arthritis is twice as common in women than in men. This may be due to the effects of oestrogen (a female hormone). Research has suggested that oestrogen may be involved in the development and progression of the condition. However, this has not been conclusively proven.
Rheumatoid arthritis can be difficult to diagnose because there are many conditions that cause joint stiffness and inflammation. Your GP will conduct a physical examination, checking your joints to see if they are swollen and to find out how easily they move. Your GP will also ask you about your symptoms. It is very important that you tell your GP about all of your symptoms, not just the ones you think are important. This will help your GP to make the correct diagnosis.
After conducting a physical examination and consulting your medical history, your GP may refer you for a series of tests to help confirm the diagnosis. Tests that you may have are outlined below.
There is no definitive blood test that can diagnose rheumatoid arthritis. However, there are a number of tests that can indicate to your GP that you may have developed the condition, but they will not necessarily prove or completely confirm a diagnosis.
Erythrocyte sedimentation rate (ESR)
In an ESR test, a sample of your red blood cells are placed into a test tube of liquid. They are then timed to see how fast they fall to the bottom of the tube, in millimetres per hour. If they are sinking faster than usual, this could mean that you have an inflammatory condition such as rheumatoid arthritis.
C-reactive protein (CRP)
CRP is another type of test that can indicate inflammation in the blood stream. It checks to see how much CRP is present in your blood. CRP is produced by the liver. If there is more CRP than usual, there is inflammation in your body.
Anaemia is a condition where the blood is unable to carry enough oxygen, due to a lack of blood cells. Eight out of ten people with rheumatoid arthritis have anaemia. However, anaemia can be the result of many factors, such as a lack of iron in your diet, cancer or pregnancy. Therefore, having anaemia does not prove that you have rheumatoid arthritis.
This blood test checks to see if a specific antibody, known as the rheumatoid factor, is present in your blood. This abnormal antibody is present in eight out of ten people with rheumatoid arthritis. However, this antibody cannot always be detected in the early stages of the condition. The antibody is also found in one out of 20 people without rheumatoid arthritis, so again, this test cannot confirm rheumatoid arthritis.
X-rays and magnetic resonance imaging (MRI) scans
X-rays of your joints can help your doctor differentiate between different types of arthritis. A series of X-rays can also help show how your condition is progressing. Magnetic resonance imaging (MRI) scans can help show what damage has been done to a joint. MRI scans use magnetic and radio waves to create images of your body.
Rheumatoid arthritis can be a difficult condition to live with. The stiffness, pain and fatigue that the condition causes can make everyday tasks very difficult. As the condition affects your mobility, walking can be difficult or impossible.
It can also be hard to deal with the unpredictable nature of the condition. Some days the pain and stiffness will be much worse than others, and there is no way of knowing when a flare-up will occur. The unpredictable and difficult nature of rheumatoid arthritis can mean that some people develop depression, or feelings of stress and anxiety.
Having rheumatoid arthritis can put you at a higher risk of developing other conditions, such as those outlined below.
- Carpel tunnel syndrome - this is a common condition in people with rheumatoid arthritis. Carpel tunnel syndrome is 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 - because rheumatoid arthritis is an inflammatory condition, it 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. Rheumatoid arthritis 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 - if you have had rheumatoid arthritis for some time, you are at increased risk of developing 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.
- Vasculitis - this is a condition that 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.
People with rheumatoid arthritis are more at risk of getting infections, such as colds, flu and pneumonia, particularly if they are taking powerful anti-rheumatic medicines that suppress the immune system.
You can prevent flu by having a flu jab. Anyone over 65 is entitled to a free annual flu jab. You are also entitled to a free flu jab if you have a serious health condition, such as kidney disease or diabetes, or if you have a lowered immunity due to cancer treatment or steroid medication.
You may also be entitled to a pneumococcal vaccine, which protects you against pneumonia. This is a one-off injection, which is free to anyone over 75 and those on immunosuppressive medicines. Ask your GP for advice.
At present, rheumatoid arthritis is not a condition that can be prevented. This is largely because the exact trigger of the condition is unknown. Although viruses and bacteria may be involved, research is not yet conclusive. However, with prompt diagnosis and treatment, the progression of rheumatoid arthritis can be significantly slowed down and further serious joint damage prevented.