Many of us have at least a rudimentary knowledge of arthritis and the symptoms it causes. But fewer of us may be aware that there are several different types of arthritis.

The most common type is osteoarthritis (OA), which occurs as a result of general wear and tear. It is a condition often associated with age (it tends to be more common in over-60s), and accounts for around 8 in 10 of arthritis cases.

Rheumatoid arthritis (RA) is less common, and perhaps not as well known. This type of arthritis can occur at any age from 16 years onwards. (Arthritis which occurs before the age of 16 is referred to as juvenile arthritis.)

This week, we decided to look at rheumatoid arthritis in a little more depth, so we got in touch with the National Rheumatoid Arthritis Society (NRAS), the only UK charity dedicated to the condition. Ailsa Bosworth, the CEO and founder or NRAS, kindly took some time to answer our questions.

Osteoarthritis and rheumatoid arthritis: what’s the difference?

OA and RA do bear some symptomatic similarities. Both conditions result in severe joint pain, swelling and stiffness. However the causes of these conditions are very different.

‘RA is an inflammatory autoimmune disease that affects the joints.’ Ailsa explains. ‘The immune system goes wrong and attacks you instead of protecting you. It is very different to osteoarthritis. It’s a systemic disease, and can affect other organs such as the eyes, lungs and heart. Having another autoimmune condition is relatively common and RA can occur with anemia, IBS, Crohn’s and colitis, Sjögren's syndrome, secondary Sjögren's syndrome or uveitis.’

So who is more likely to be diagnosed with rheumatoid arthritis?

‘Whereas osteoarthritis is a wear and tear condition and generally affects many older people (over the age of 60); rheumatoid arthritis can affect anyone over the age of 16 at any point in their lives. RA is most commonly diagnosed between the ages of 40 and 60 years. Females are at a higher risk of being diagnosed. It is not fully understood why, but the disease affects about three times as many women as it does men.’

Symptoms

The severity of symptoms experienced by those living with RA can vary greatly. The condition often presents itself through swollen, red and hot joints that are stiff, painful to move and tender to touch.

As Ailsa elaborates:

‘Pain and fatigue are the two most dominant symptoms of RA. The fatigue that RA patients experience doesn’t compare to regular tiredness. It goes far beyond and can be very overwhelming. Flu-like symptoms are also common, especially in the early stages of RA, before the disease is under control.’

RA symptoms can affect any joint in the body, but the condition is frequently first noticed in the hands and feet. In some cases symptoms may develop symmetrically. RA symptoms can go through changes over time, with periods of intense flare ups.

Other symptoms which might occur as a result of rheumatoid arthritis include:

  • a lack of energy
  • fever
  • weight loss
  • sweating
  • loss of appetite

RA can also affect the heart, lungs and eyes. In these instances patients may notice chest pain or dry eyes.

Invisible illness

RA is sometimes described as an ‘invisible illness’ which means that the condition may not be outwardly obvious to onlookers. This can make it difficult for people to understand the gravity of the condition and how those diagnosed are affected on a daily basis.

‘RA affects every aspect of daily life,’ Ailsa tells us, ‘from physical to emotional wellbeing. It is an incredibly painful condition that makes everyday activities difficult; such as making a cup of tea, taking a shower or preparing breakfast for your child.’

Pain and frustration related to RA might be present throughout the day, but Ailsa explains that mornings can be particularly difficult.

‘People with RA especially suffer in the morning, as joint stiffness is more severe at this time. It can often take about 30 to 60 minutes until they’re able to get going, making it hard to get to work or take children to school.’

How is rheumatoid arthritis treated?

There is no cure for rheumatoid arthritis, but there are treatments available that can help to manage symptoms. One study found that early treatment can offer a better outlook for patients diagnosed with RA.

‘Drug treatments are crucial for people living with rheumatoid arthritis’ Ailsa says, ‘although lifestyle changes, such as eating a healthy and balanced diet, taking regular exercise and keeping to a healthy weight do help in the process of managing the disease.’

‘However, there is no alternative to medication in terms of controlling inflammation. The most commonly used drug is Methotrexate: a cancer drug that is used in rheumatology in much smaller doses (than in cancer) to dampen down the immune response of the body. Steroids can also be used at certain times in RA.’

Receiving treatment for RA is important as it can prevent or reduce the extent of permanent joint damage. When trying to manage a chronic condition like RA, it can take some time to establish the best medication options.

Ailsa goes on to explain: ‘Since the turn of the century, biologic treatments have also been used to treat RA patients who don’t respond to disease modifying drugs, such as Methotrexate.’

Examples of biologic drugs include infliximab and etanercept. These are given via an injection.

Once you have received diagnosed with RA it is likely that that you will work with your doctor and rheumatology specialist to achieve the best possible drug treatment for your individual condition.

‘RA is a heterogeneous disease,’ Ailsa explains, ‘it manifests itself differently in different people. This can make it difficult to pinpoint what treatment works best for each individual so further research into the area is currently being done.’

What does the future hold for RA treatments?

According to the World Health Organisation it is estimated that RA affects up to one percent of the world’s population and is therefore a significant contributor to global disability. Continued research into the disease means that there is hope for potential new treatments in the future.

The global drug and treatment market for RA is a very busy one and we can expect lots of exciting changes in the future.’ Ailsa says. ‘A big area of research at the moment is focused on identifying biomarkers. Biological markers are found in blood and tissue and can help clinicians be more precise when tailoring a drug to an individual, which is a huge problem when dealing with a diverse disease like RA. Biosimilars, replacing the original biologics as they come off patent, are starting to enter the market, and we will be seeing an increase of these in the next few years.’

‘Another massive step forward in RA treatment is the introduction of JAK inhibitors. These oral drugs are much more accessible than infusions or self-injections.’

Can exercise help rheumatoid arthritis?

As with any chronic illness, sticking to the treatment plan outlined by your doctor or specialist is vital.

However, Ailsa goes on to illustrate that there are certain lifestyle measures, in particular exercise, that can benefit those living with RA and help them to remain as healthy as possible.

‘RA patients have an increased risk of cardiovascular disease, and exercise plays a huge role in minimising this. There is an extensive body of research which has shown that cardiovascular exercises that increase the heart rate, such as walking, swimming and cycling, are the best form of exercise for people with RA, whilst minimising impact on joints.’

‘Strengthening exercises are also important to keep the muscles around the joints strong. However, it can be difficult to educate people in this respect, as the idea of exercising when you are in pain can seem counterproductive at first.’

In order to highlight the importance of exercising to stay healthy, the NRAS have been working on a new awareness campaign.

This autumn NRAS will be launching an interactive video programme called Love Your Heart to help people calculate their risk of cardiovascular disease. It will educate them on how to minimise this risk and provide goal setting resources to support them in self-managing RA and its effects.’

Coping with a rheumatoid arthritis diagnosis

Being diagnosed with a chronic condition is often a testing experience, to say the least. So what can those receiving an RA diagnosis, and those around them do to make living with the condition easier?

‘Learning to cope with a life-long, chronic illness such as RA is down to support and understanding. The more you know about the disease, the better you’re able to understand and manage your symptoms. Where possible this should also extend to your family, friends and colleagues. If you can help them understand your condition, it increases your support network, which can in turn help make life easier for you.’

It may feel tricky to broach the subject with friends and colleagues, but sharing your experience and knowledge can help to make situations in your social life and at work much easier.

‘Support from other people is such an important factor for people with RA. However, we know that many people don’t disclose an RA diagnosis, especially in the workplace, as they fear it might impact their career.’

‘RA is an invisible illness, as it is not possible to see pain and fatigue. This can make people reluctant to admit when they’re suffering as they don’t want to come across as ‘being moany’. The most important thing is that family, friends and colleagues gain an understanding of the disease so they know how to provide the best support for the affected person.’

How does the NRAS help?

Turning to a charity such as the NRAS can offer a wealth of support and information for people who are affected by rheumatoid arthritis.

‘NRAS provides a great variety of self-management resources for patients as well as a peer-to-peer support system (a free helpline, support groups and an online forum) to help people remain positive and in control.’ Ailsa tells us.

‘NRAS is dedicated to increasing the quality of life for those with RA and the help and support our network offers can be life changing. We want to be there for individuals from the start of their journey with RA;  which is why we continue to provide the resources that allow them to access help whenever they need it.’

You can find more information on the services NRAS offers, and on rheumatoid arthritis, on the NRAS website.