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Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an inflammatory condition that normally affects the small joints of the hands and feet, but can also affect other joints in the spine and knees.

  1. Causes pain, heat and swelling in the joints
  2. Autoimmune condition
  3. Early treatment can reduce effects on joints

People experiencing pain in the joints or who want to speak to a doctor online about rheumatoid arthritis can do so through our secure video consultation service. You can book a slot at a suitable time for you. 

Rheumatoid Arthritis
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Description

Rheumatoid arthritis is an inflammatory joint condition. It causes pain and stiffness in the affected joints, which are commonly the wrists, hands and feet. Some people may develop the condition in their spine or knees. Rheumatoid arthritis is chronic, and needs treatment early in order to stop it from progressing, and to reduce the risk of complications.

The condition is thought to affect around 400,000 people in the UK. It mostly occurs in those over the age of 50, but can develop at a younger age in some. The condition is three times more prevalent in women than it is in men. 

Research into what triggers the condition is ongoing. While the exact cause of rheumatoid arthritis is unclear, it’s understood to be an autoimmune condition. This is where the immune system attacks a specific part of the body and causes inflammation; in RA, it attacks the joints.

Because it’s a systemic disease, it can sometimes cause other manifestations outside of the joints. Common secondary symptoms of the condition include rheumatoid nodules (which can occur in the eyes, lung and heart), neurological problems (particularly relating to nerve entrapment), and issues with the respiratory system (for example, pulmonary fibrosis). Rarer symptoms include issues with the cardiovascular system, kidneys and liver.

Self care measures are an important part of living with RA. Exercising and eating well can help to reduce the risk of osteoporosis (bone loss) which can complicate rheumatoid arthritis. 

Usually a doctor will refer someone with rheumatoid arthritis to both a physiotherapist and occupational therapist. They can help to assess the progression of the disease, which should also be looked at in an annual review. This review will examine whether medication needs to be adjusted, and whether surgery might be necessary if symptoms are worsening.

RA can have an adverse effect on a person’s work and social life, as mobility may be restricted, making everyday activities more difficult. It is thought that around a third people with RA stop working within two years of developing the condition. It’s therefore important to get treatment for the condition early, to prevent it from progressing.

If you would like to speak to a doctor online about rheumatoid arthritis, our video consultation service can put you in touch with a GMC-registered clinician. They can provide advice on symptoms and issue prescription renewals where appropriate.

Page last reviewed:  09/03/2020
Diagnosis and treatment

What are the causes of rheumatoid arthritis?

It’s not known why some people develop rheumatoid arthritis and others don’t. Genetic disposition is however thought to be a factor, so a family history of RA can increase someone’s risk. Research has also pointed towards a relationship between rheumatoid arthritis and smoking, but this isn’t definitive. 

In people with RA, the immune system attacks the tissue around the joint in error, which inflames the synovium (a layer of cells in between the joints). This causes chemicals to be released which damage bones, cartilage, tendons and ligaments.

How is rheumatoid arthritis diagnosed?

When assessing symptoms, a doctor will look to establish if the pain and swelling in either the hands or feet has lasted over 6 weeks, and if morning stiffness has accompanied this.

If rheumatoid arthritis is suspected, a clinician may refer the patient for an imaging scan, such as an x-ray, and for blood testing. X-rays can provide a doctor with more clarity on the state of a joint, whereas a blood test can determine the presence of antibodies, which tend to be elevated in those with RA. 

How is rheumatoid arthritis managed?

It's important to start treating rheumatoid arthritis early (within the first 2-3 years of symptoms) to help prevent the condition from becoming worse. The treatment for RA most commonly uses disease-modifying antirheumatic drugs (DMARDs).

The most common DMARD is leflunomide, followed by hydroxychloroquine, although this is thought to be less effective. There are various other DMARDs that can be used in combination, such as methotrexate and sulfasalazine, but further analysis is needed to determine whether leflunomide should be replaced as the first line treatment.

Page last reviewed:  09/03/2020
Questions and Answers

How is rheumatoid arthritis treated?

Primarily, RA is treated with one or a combination of disease-modifying anti-rheumatic drugs, or DMARDs. They can help to lessen the effect of the immune system on the joints, reducing inflammation and slowing down the progression of the disease. 

Aside from DMARDs, immunosuppressant drugs, such as corticosteroids and biological therapies, are also available. Corticosteroids will only tend to be used for a short time, whereas biological therapies may be used over a longer period.

How long will it take for me to recover?

RA is a lifelong condition. However, if it is treated early, many people will be able to control the symptoms. Left untreated, it can lead to an increased chance of disability within 10 years of being diagnosed. 

The condition tends to flare up periodically, where symptoms develop and become worse, but getting the right treatment can extend remission periods and slow the progression of the disease down.

Can I consult a doctor about rheumatoid arthritis online?

People who want to speak to a doctor about rheumatoid arthritis, or who think they may have symptoms of the condition, can get expert advice online from our GMC-registered doctors.  They can discuss managing the condition, and refer you to specialist therapists where required. Book an appointment at a convenient time for you.

Page last reviewed:  09/03/2020

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