Health A to Z
Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The symptoms usually affect the hands, feet and wrists.
There may be periods where symptoms become worse, known as flare-ups or flares.
A flare can be difficult to predict, but with treatment it's possible to decrease the number of flares and minimise or prevent long-term damage to the joints.
Some people with rheumatoid arthritis also experience problems in other parts of the body, or more general symptoms such as tiredness and weight loss.
Read about the symptoms of rheumatoid arthritis.
You should see your GP if you think you have symptoms of rheumatoid arthritis, so they can try to identify the underlying cause.
Diagnosing rheumatoid arthritis quickly is important because early treatment can help stop the condition getting worse and reduce the risk of further problems such as joint damage.
Read about diagnosing rheumatoid arthritis.
Rheumatoid arthritis is an autoimmune disease. This means your immune system – which usually fights infection – attacks the cells that line your joints by mistake, making the joints swollen, stiff and painful.
Over time, this can damage the joint itself, the cartilage and nearby bone.
It's not clear what triggers this problem with the immune system, although you're at an increased risk if:
Read more about the causes of rheumatoid arthritis.
There's no cure for rheumatoid arthritis. However, early diagnosis and appropriate treatment enables many people with rheumatoid arthritis to have periods of months or even years between flares. This can help them to lead full lives and continue regular employment.
The main treatment options include:
Read about treating rheumatoid arthritis.
Depending on how much pain, stiffness and joint damage you have, you may have to adapt the way you carry out simple daily tasks. They can become difficult or take longer to complete.
Read about living with rheumatoid arthritis.
Having rheumatoid arthritis can lead to several other conditions that may cause additional symptoms and can sometimes be life-threatening.
Possible complications include:
Ensuring that rheumatoid arthritis is well controlled helps reduce your risk of complications such as these.
Read about complications of rheumatoid arthritis.
The main symptoms of rheumatoid arthritis are joint pain, swelling and stiffness. It may also cause more general symptoms, and inflammation in other parts of the body.
The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days.
The symptoms vary from person to person. They can come and go, and may change over time. You may occasionally experience flares when your condition deteriorates and your symptoms become more severe.
Rheumatoid arthritis mainly affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.
Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this isn't always the case.
The main symptoms affecting the joints are outlined below.
The joint pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.
Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist.
Like joint pain, the stiffness is often more severe in the morning or after a period of inactivity. Morning stiffness associated with another type of arthritis called osteoarthritis usually wears off within 30 minutes of getting up, but rheumatoid arthritis morning stiffness often lasts longer than this.
The lining of joints affected by rheumatoid arthritis become inflamed, which can cause the joints to swell, and become hot and tender to touch.
In some people, firm swellings called rheumatoid nodules can also develop under the skin around affected joints.
As well as problems affecting the joints, some people with rheumatoid arthritis experience a range of more general symptoms, such as:
The inflammation associated with rheumatoid arthritis can also sometimes cause problems affecting other areas of the body, such as:
Read about the complications of rheumatoid arthritis.
Rheumatoid arthritis is an autoimmune condition, which means it's caused by the immune system attacking healthy body tissue. However, it's not yet known what triggers this.
Your immune system normally makes antibodies that attack bacteria and viruses, helping to fight infection.
If you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.
This causes the thin layer of cells (synovium) covering your joints to become sore and inflamed, releasing chemicals that damage nearby:
If the condition isn't treated, these chemicals gradually cause the joint to lose its shape and alignment. Eventually, it can destroy the joint completely.
Various theories of why the immune system starts to attack the joints have been suggested, such as an infection or virus being a trigger, but none of these theories has been proven.
There are a number of things that may increase your risk of developing rheumatoid arthritis, including:
Rheumatoid arthritis can be difficult to diagnose because many conditions cause joint stiffness and inflammation and there's no definitive test for the condition.
You should see your GP if you have these symptoms so they can try to determine the cause.
Your GP will carry out a physical examination, checking your joints for any swelling and to assess how easily they move. Your GP will also ask you about your symptoms.
It's important to tell your GP about all your symptoms, not just ones you think are important, as this will help them to make the correct diagnosis.
If your GP thinks you have rheumatoid arthritis, they'll refer you to a specialist (rheumatologist).
Your GP may arrange blood tests to help confirm the diagnosis.
No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but a number of tests can show possible indications of the condition.
Some of the main tests used include:
Read more about blood tests.
The full blood count measures your red cells to rule out anaemia. Anaemia means the blood is unable to carry enough oxygen, because of a lack of blood cells.
Anaemia is common in people with rheumatoid arthritis, although having anaemia doesn't prove you have rheumatoid arthritis.
Specific blood tests can help diagnose rheumatoid arthritis, but aren't accurate in everyone.
About half of all people with rheumatoid arthritis have a positive rheumatoid factor present in their blood when the disease starts, but about one in 20 people without rheumatoid arthritis also tests positive.
An antibody test known as anti-CCP (anti-cyclic citrullinated peptide) is available. People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody found to have rheumatoid arthritis has this antibody.
Those who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe rheumatoid arthritis requiring higher levels of treatment.
A number of different scans may also be carried out to check for joint inflammation and damage. These can help tell the difference between different types of arthritis and can be used to monitor how your condition is progressing over time.
Scans that may be carried out to diagnose and monitor rheumatoid arthritis include:
There are a number of medications available that can be used to help stop rheumatoid arthritis getting worse and reduce your risk of further problems.
These are often divided into two types of medication: disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments.
If you've been diagnosed with rheumatoid arthritis, you'll normally be offered a combination of DMARD tablets as part of your initial treatment. These medications are particularly effective in easing symptoms of the condition and slowing down its progression.
DMARDs work by blocking the effects of the chemicals released when the immune system attacks the joints, which could otherwise cause further damage to nearby bones, tendons, ligaments and cartilage.
There are many different DMARDs that can be used, including:
Methotrexate is normally the first medicine given for rheumatoid arthritis, often alongside another DMARD and a short-course of corticosteroids to relieve any pain (see below). It may also be combined with the biological treatments mentioned below.
Common side effects of methotrexate include:
The medication can also sometimes have an effect on your blood count and your liver, so you'll have regular blood tests to monitor this.
Less commonly, methotrexate can affect the lungs, so you'll usually have a chest X-ray and possibly breathing tests when you start taking methotrexate, to provide a comparison if you develop shortness of breath or a persistent dry cough while taking it. However, most people tolerate methotrexate well.
It can take a few months to notice a DMARD working. It's important to keep taking the medication, even if you don't notice it working at first.
You may have to try two or three types of DMARD before you find the one that's most suitable for you. Once you and your doctor work out the most suitable DMARD, you'll usually have to take the medicine in the long term.
Biological treatments are a newer form of treatment for rheumatoid arthritis.
They're usually taken in combination with methotrexate or another DMARD and are normally only used if these medications alone haven't been effective.
Biological medications are given by injection and they work by stopping particular chemicals in the blood from activating your immune system to attack your joints.
Side effects from biological treatments are usually mild and include:
Some people may also be at risk of getting more serious problems, including the reactivation of infections such as tuberculosis (TB) in people who have had them in the past.
A new type of treatment (Jak inhibitors) is now available on the NHS for people with moderate to severe rheumatoid arthritis.
This medicine is taken as a tablet once or twice a day, and usually in combination with methotrexate.
These medicines include:
These medicines are for adults who have already tried taking DMARDs or biologicals, but these haven't been effective or they can't take them.
These medicines can also be taken on their own in adults who can't take methotrexate.
In addition to the medications used to control the progression of rheumatoid arthritis, you may also need to take medication specifically to relieve pain.
Some of the different medicines that may be used to relieve pain are outlined below.
In some cases, you may be advised to use painkillers such as paracetamol, or a combination of paracetamol and codeine (co-codamol) to relieve the pain associated with rheumatoid arthritis.
These medications don't help treat the underlying inflammation of your joints, but they can sometimes be helpful in relieving pain.
For example, they may be recommended while you're waiting to see a specialist or during periods where your symptoms are particularly bad (flare-ups).
In addition to – or instead of – the painkillers mentioned above, your doctor may prescribe a non-steroidal anti-inflammatory drug (NSAID).
This may be a traditional NSAID (such as ibuprofen, naproxen or diclofenac) or an alternative type called a COX-2 inhibitor (such as celecoxib or etoricoxib).
These medications can help relieve pain while also reducing inflammation in the joints, although they won't stop rheumatoid arthritis getting worse over time.
Your doctor will discuss with you what type of NSAID you should take and the benefits and risks associated with each of them.
Although uncommon, taking an NSAID tablet can increase the risk of serious stomach problems – such as internal bleeding – because the medications can break down the lining that protects the stomach against damage from stomach acids.
If you're prescribed an NSAID tablet, you'll often have to take another medicine, such as a proton pump inhibitor (PPI), as well. Taking a PPI reduces the amount of acid in your stomach, which greatly reduces the risk of damage to your stomach lining.
Corticosteroids are powerful medications that can help reduce pain, stiffness and inflammation.
They can be used as:
They're usually used to provide short-term pain relief – for example, while you're waiting for DMARD medication to take effect or during a flare-up.
Corticosteroids are normally only used in this way because long-term use of corticosteroids can have serious side effects, such as
Your doctor may also refer you to other services that might be able to help you with your rheumatoid arthritis symptoms.
A physiotherapist may help you improve your fitness and muscle strength, and make your joints more flexible.
They may also be able to help with pain relief using heat or ice packs, or transcutaneous electrical nerve stimulation (TENS).
A TENS machine applies a small pulse of electricity to the affected joint, which numbs the nerve endings and can help ease the pain of rheumatoid arthritis.
If rheumatoid arthritis causes you problems with everyday tasks, occupational therapy may help.
An occupational therapist can provide training and advice that will help you to protect your joints, both while you're at home and at work.
Some type of support for your joints, such as a splint, may also be recommended, or devices that can help open jars or turn on taps.
If you have problems with your feet, a podiatrist may be able to help. You may also be offered some type of support for your joints or shoe insoles that can ease pain.
Sometimes, despite medication, damage to your joints may occur. In such cases, you may need surgery to help restore your ability to use your joint.
Surgery may also be recommended to reduce pain or correct deformities.
There are different types of surgery to correct joint problems in the hand. Examples include:
Arthroscopy is a procedure to remove inflamed joint tissue.
During the operation, a thin tube with a light source and camera (arthroscope) is inserted into the joint through a small cut in the skin so the surgeon can see the affected joint.
Special surgical instruments are inserted through other small cuts in the skin to remove the damaged tissue. You usually don't have to stay overnight in hospital for this kind of surgery, but the joint will need to be rested at home for several days.
Some people with rheumatoid arthritis need surgery to replace part or all of a joint, such as the hip, knee or shoulder joint. This is known as a joint replacement or arthroplasty.
Replacement of these joints is a major operation that involves several days in hospital followed by months of rehabilitation.
The latest joints have a limited lifespan of 10 to 20 years. They're not perfect and some function may not be restored after the damaged joint is replaced by a new one.
Many people with rheumatoid arthritis try complementary therapies, such as:
In most cases, there's little or no evidence these are effective in the long-term, although some people may experience a short-term benefit from them.
There's no strong evidence to suggest that specific dietary changes can help improve rheumatoid arthritis, although some people with rheumatoid arthritis feel their symptoms get worse after they've eaten certain foods.
If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve. But it's important to ensure your overall diet is still healthy and balanced.
There's also little evidence supporting the use of supplements in rheumatoid arthritis, although some can be useful in preventing side effects of medications you may be taking.
There's some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis.
Taking control of rheumatoid arthritis will help you cope with its impact on your lifestyle.
Arthritis Care offers self-management training courses to teach techniques for living positively with arthritis. Techniques include:
A self-management programme specifically for people with rheumatoid arthritis has been developed by the National Rheumatoid Arthritis Society (NRAS). The course helps people learn more about their condition and provides practical tips on how to manage everyday life.
Many people find it helpful to talk to others in a similar position. You may find support from an individual or group of people with rheumatoid arthritis.
Patient organisations have local support groups where you can meet others diagnosed with the same condition.
Call the NRAS helpline free on 0800 298 7650 to speak to a trained rheumatoid arthritis adviser. NRAS also has a team of medical advisers.
You can also call Arthritis Care's free, confidential helpline on 0808 800 4050 (Monday-Friday, 10am-4pm).
It can be hard to deal with the unpredictable nature of rheumatoid arthritis. Some days, the pain and stiffness will be much worse than others, and there's no way of knowing when a flare-up will occur.
The difficult nature of rheumatoid arthritis can mean some people develop depression or feelings of stress and anxiety. Sometimes, these feelings can be related to poorly controlled pain or fatigue.
Living with any long-term condition makes you more likely to have a range of emotions such as frustration, fear, pain, anger and resentment.
Speak to your healthcare team if you're struggling to deal with your condition emotionally. They may be able to offer medication or psychological interventions to help.
If you're taking medicines for rheumatoid arthritis, let your healthcare team know if you want to start a family or if you're worried about becoming pregnant while on medication.
Some medications, such as methotrexate, leflunomide and biological treatments, shouldn't be taken by men or women while they're trying for a baby. The doctors and nurses will work with you to ensure your rheumatoid arthritis is controlled while you're trying to get pregnant.
Babies and young children are physically and mentally demanding for any parent, but particularly so if you have rheumatoid arthritis. If you're struggling to cope, it may help to talk to other people in the same situation as you.
You may also be able to get additional support from your health visitor or occupational therapist to help you manage your young family.
Pain, discomfort and changes in the way you feel can affect your sex life. Your self-esteem or thoughts about how you look may affect your confidence.
Although many people find it difficult to talk about such private issues, there are resources that might help you.
Talking to your partner or GP about the impact of rheumatoid arthritis on your sexuality and sexual relationships may help.
If you have to stop work or work part time because of your rheumatoid arthritis, you may find it hard to cope financially.
You may be entitled to one or more of the following types of financial support:
You may also be eligible for other benefits if you have children living at home or if you have a low household income.
If you have rheumatoid arthritis, you're likely to need repeat prescriptions of medication to keep your condition under control.
Rheumatoid arthritis isn't listed as a medical condition that entitles a person to free prescriptions in England, although you may be able to get your medication for free if your condition falls under the category of "a continuing physical disability which means the person can't go out without the help of another person".
You're also entitled to free prescriptions if you're 60 or over, or if you receive either:
If you aren't entitled to free prescriptions, you may find it cheaper to buy a prescription prepayment certificate (PPC). This is effectively a prescription "season ticket" that covers all your prescriptions over a three or 12 month period.
Read more about help with prescription costs to see if you're entitled to free prescriptions.
Rheumatoid arthritis can put you at a higher risk of developing other conditions, particularly if it's not well controlled.
Some of these conditions are described below.
Carpal tunnel syndrome is a common condition in people with rheumatoid arthritis.
It's the result of compression of the nerve that controls sensation and movement in the hands (median nerve) and can cause symptoms such as:
Symptoms of carpal tunnel syndrome can sometimes be controlled with wrist splints or corticosteroid injections, although surgery to release the pressure on the median nerve may be needed in severe cases.
Read about treating carpal tunnel syndrome.
Rheumatoid arthritis is an inflammatory condition which can cause inflammation to develop in other parts of your body, such as the:
However, thanks to early treatment, inflammation due to rheumatoid arthritis affecting other parts of the body is becoming less common.
If rheumatoid arthritis isn't treated early or isn't well controlled, the inflammation in your joints could lead to significant and permanent damage.
Problems that can affect the joints include:
These problems sometimes need to be treated with surgery to prevent loss of function in the affected joints.
If you have rheumatoid arthritis, you're at a higher risk of developing cardiovascular disease (CVD) than the population at large.
It's not clear exactly why people with rheumatoid arthritis are at an increased risk of these problems. You can reduce your risk by ensuring your arthritis is well controlled and by reducing the impact of other factors that contribute to CVD, such as:
Read about preventing CVD.
If you've had rheumatoid arthritis for some time, you're at increased risk of developing cervical myelopathy and you may need a special assessment of your neck before any operation where you're put to sleep.
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's a serious condition that can greatly affect your mobility and can lead to permanent spinal cord damage if not treated promptly with surgery.
Paul Casimir has been living with arthritis for half his life, but he doesn't let it stop him doing the things he enjoys.
Paul Casimir was diagnosed with rheumatoid arthritis at 20. He was a fast runner throughout his teens, but at 19 his body started to stiffen up.
"I had been feeling a little bit strange for about a year before I was diagnosed with arthritis," says Paul. "I just seemed to move at the pace of a distracted goat. I didn't really know what was going on. I was at drama school at the time and I kept getting cast as old people."
One day, after finishing a play, he collapsed into bed completely exhausted. When he woke up, his knees had swollen and he had to stay in bed for four days. His doctor was puzzled.
"It then went away for a while, but returned with a vengeance a couple of months later," says Paul. "I was referred to a rheumatologist, who diagnosed rheumatoid arthritis. It was something I'd never heard of and I didn't know why it was happening to me. I felt tears in my eyes when she told me."
Paul managed his condition with painkillers and anti-inflammatory medication for the next few years. It was difficult for him to move properly. "Dancing was what got me through the roughest times," he says."Even when I could barely move, I could still dance. Standing still was excruciating, but transferring my weight from one leg to the other was bearable."
One day, he decided to see how he would get on without medication. He has never looked back.
"I didn't really notice much of a difference with the medication," he said. "People diagnosed now would be offered different kinds of medication, such as disease modifying medication, but that wasn't around when I was diagnosed.
"After a while it became really important to me to start challenging the condition, to take back control of my life."
He started swimming and going out dancing, and stopped worrying about what other people thought. It's been five years since the last big flare-up.
"I just learned to get on with life," he says. "It's easy to dwell on the pain and misfortune and think, 'Why me?' But, in the end, that's just futile. What's important is to focus on all the things you enjoy. I swim regularly and enjoy a ramble in the woods, whereas 20 years ago I'd have thought going for a walk was the most ridiculous suggestion someone could make. The richer your experiences are in life, the more you're distracted from the pain.
"And I still look good on the dance floor, dancing like a robot from 1984!"
Jonathan Gledhill was diagnosed with rheumatoid arthritis when he was 27. He explains how arthritis affects his life.
"I have sero-negative rheumatoid arthritis, which doesn't show up in blood tests for arthritis. I have it in several joints but mainly in both knees, my right wrist, hands, feet, elbow and it may be affecting my spine a little now. I have pain and swelling in the joints, and muscle stiffness, especially in the morning.
"It started in my right knee when I damaged the cartilage in a car accident in 2001. The knee was sore, swollen and stiff, and never recovered. During the next four years I developed pain in my wrists, thumb, feet and ankles, but blood tests for arthritis were negative. My GP prescribed anti-inflammatory painkillers for me.
"I was eventually diagnosed via X-rays in 2006. There's a theory that a traumatic accident can start arthritis in the damaged area of the body, but the doctors couldn't say for sure whether the accident started the arthritis or whether it was a coincidence. My grandma has arthritis, so I might have inherited it from her.
"I started taking an anti-rheumatic drug to slow the progression of the arthritis. For about 18 months I didn't have to take so many painkillers, but now the drug has become less effective. I go to the rheumatology clinic every six months to check my progress, and I have monthly blood tests to make sure the drug isn't affecting my liver.
"I'm lucky that I'm still quite mobile. I live with my girlfriend but can do everything for myself. I can walk unaided, though I've developed a limp. After 15 or 20 minutes of walking I get quite sore. I had an embarrassing incident in the cinema recently. I nearly fell over when I tried to stand up. My knee had locked and I couldn't straighten it. My friends had to help me out and take me to A&E, but as soon as we arrived my knee relaxed and I could use it again.
"I can still work in my job in IT, and my boss is understanding. He lets me work later hours so that I don't have to rush in the morning when my pain and stiffness is at its worst. After a little while it starts to loosen up a bit.
"Something I find frustrating is that people can look at you and not realise there's anything wrong. I'm not unwell enough to need a disabled badge, but the walk up the hill from the car park can make me sore. People often assume arthritis happens only to older people.
"The pain in my feet feels as if I'm wearing shoes that are too tight and won't let me bend my toes. And because my hands are affected I sometimes have trouble opening cans and turning taps, but I've bought a tin opener with a ratchet handle instead of a twisting one, and that's a lot easier to use. I've had to give up rugby and hillwalking but I can still drive and cycle. I took up exercise biking, which helps, and I lift light weights to strengthen my muscles.
"The main thing is to get plenty of rest. If I get enough sleep and don't overdo things, it's reasonably manageable.
"Sometimes pain in my elbow wakes me up in the night, but generally I sleep well. Overdoing an activity, even DIY, can make me suffer the next day, so I make sure I have lots of breaks. Warm water helps too, having a nice hot bath or going swimming. I went on holiday to Florida and the warm weather there made me feel a lot better.
"My condition will probably progress slowly to the stage where I'll need surgery, but hopefully that won't be for a long time.
"When I was diagnosed, I felt relieved to be able to identify my symptoms, but also quite angry. There were things I still wanted to do, such as taking up running. I had to accept I wouldn't be able to do them. It took me about a year to come to terms with my diagnosis and be more positive.
"My family, friends and people with arthritis on the Arthritis Care forum helped me realise it's not the worst thing you can have. Although arthritis has an impact on your life it won't stop you doing a lot of the things you like to do."