Rheumatoid arthritis

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Key facts

Rheumatoid arthritis is a chronic (long-term) disease that can cause pain and swelling in your joints.
People who have rheumatoid arthritis often experience times when their joints are particularly painful.
It is important not to delay speaking to your doctor if you think you may have rheumatoid arthritis.
Starting treatment as soon as possible helps avoid serious symptoms.
You can slow down further damage to your joints and manage pain with medicines, exercise and lifestyle changes.

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic (long-term) disease that can cause pain and swelling in your joints. Rheumatoid arthritis is an autoimmune disease where your immune system doesn’t recognise the tissue lining your joints to be part of your body and attacks it. When this happens, some joints become swollen and painful.

Rheumatoid arthritis usually affects smaller joints, such as the joints in your hands and feet, but can also affect large joints like your knees and hips.

Rheumatoid arthritis affects almost 1 in every 50 people in Australia and is more common in women than in men. Rheumatoid arthritis is different from osteoarthritis because it occurs when your immune system attacks your joints, while osteoarthritis is when the cartilage that protects your joints breaks down.

What are the symptoms of rheumatoid arthritis?

The symptoms of rheumatoid arthritis are pain and stiffness in at least 3 joints. People with rheumatoid arthritis may experience these symptoms in different ways, which can include:

pain or swelling in the joints of both hands or both feet
stiffness in your joints for longer than 30 minutes after you wake up
symmetry with the same joints on both sides of the body being affected
a flu-like feeling, when your entire body aches

Not everyone who experiences these symptoms has rheumatoid arthritis. The symptoms of rheumatoid arthritis are like other types of arthritis so your doctor may recommend further tests and refer you to a joint specialist, a rheumatologist, for diagnosis.

People with rheumatoid arthritis often have different experiences. Some people have flare ups — times when their joints feel particularly sore — followed by months, or even years, with few symptoms. Other people may have symptoms that slowly get worse over time.

Rheumatoid arthritis can affect other parts of your body, such as your lungs, heart or eyes, especially if the disease is not properly treated.

What causes rheumatoid arthritis?

Doctors do not know the cause of rheumatoid arthritis. But you are more likely to have rheumatoid arthritis if someone in your close family has the disease. Smoking also increases your risk of developing rheumatoid arthritis.

Can I prevent rheumatoid arthritis?

You cannot prevent rheumatoid arthritis because the cause of the disease is not known.

Quitting smoking, or never smoking, will reduce your risk of developing rheumatoid arthritis. You are more likely to develop rheumatoid arthritis if someone in your close family has it, but unfortunately there is no way to reduce this risk.

People who have rheumatoid arthritis often experience flare ups, which are times when their joints are particularly sore. Learning what triggers your flare ups can help reduce or prevent them.

For some people, stress can trigger a flare up, so can being run down or pushing yourself beyond your limits. Having an infection, missing a dose of your medicine or changing your treatment plan can also cause a flare up.

Keeping a food and activity diary may help work out your personal triggers but keep in mind that sometimes flare ups happen without any obvious cause.

When should I see my doctor?

If you notice symptoms of rheumatoid arthritis, or you are concerned that you may have rheumatoid arthritis, you should see your doctor as soon as possible. Your doctor may refer you to a rheumatologist who is a doctor that specialises in joints. It is important to act quickly. The sooner you start treatment, the less likely you are to experience permanent joint damage and deformity.

How is rheumatoid arthritis diagnosed?

Your doctor will diagnose rheumatoid arthritis after asking questions about your symptoms and looking at your painful or swollen joints. It is likely your doctor will recommend blood tests, including checking your blood levels of antibodies called rheumatoid factor (RhF) and anti-cyclic citrullinated peptide (anti-CCP), as well as some markers of inflammation called erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). A high result in any of these blood tests may suggest that you have rheumatoid arthritis.

Your doctor may also recommend x-rays or other scans to help make a diagnosis.

If your doctor thinks that you may have rheumatoid arthritis, they will refer you to a rheumatologist, who is a doctor that specialises in joints.

Starting treatment for rheumatoid arthritis as soon as possible is important as it reduces the chance that you will have serious symptoms later.

How is rheumatoid arthritis treated?

There is no cure for rheumatoid arthritis. But there are treatment options your doctor can prescribe to help manage your pain and stop further damage to your joints. Your doctor may recommend a combination of medicines, including:

Pain relief medicines, such as paracetamol.
Omega-3 supplements. This is a type of fat naturally found in foods such as certain fish that you can take as a food supplement to help with pain and stiffness.
Non-steroidal anti-inflammatory drugs (NSAIDs) or cyclo-oxygenase-2 selective (COX-2) inhibitors. These are pain relief medicines that your doctor might prescribe when paracetamol and supplements do not relieve your pain and stiffness.
Disease modifying antirheumatic drugs (DMARDs), such as methotrexate. These are a group of medicines that reduce your symptoms and the damage to your joints, including medicines known as biologic DMARDS (bDMARDs).
Corticosteroids, such as prednisolone. These are medicines that can help manage your pain and stiffness during flare ups. Corticosteroids are available as tablets, or it might be injected by your doctor into a joint to reduce pain.

Other complementary treatments such as massage, acupuncture or transcutaneous electrical nerve stimulation (TENS) can help reduce your pain. But they will not reduce the damage to your joints and should not replace your prescribed medications.

Tripterygium wilfordii (“thunder god vine extract”) is a Chinese herb that is not recommended to treat rheumatoid arthritis as it can have dangerous side effects.

How is rheumatoid arthritis managed?

You can manage rheumatoid arthritis by taking medicines as prescribed to treat pain and joint inflammation. You can also help reduce symptoms by exercising and maintaining a healthy weight. Aim to do 30 minutes of moderate exercise most days of the week. This can be at one time or broken up into shorter sessions.

You may also need to make changes at home to help you manage daily tasks like cleaning or gardening. An occupational therapist can help you make adjustments if pain or joint stiffness makes certain tasks hard to complete. They can recommend tools to reduce strain on your joints, such as long-handled dustpans so you don’t need to bend over, or book holders to reduce the strain on your hands and wrists.

You might find that rheumatoid arthritis makes you frustrated and upset. Rheumatoid arthritis can cause poor sleep, which can also make you feel down. Discus your feelings with friends and family and explain to them what they can do to support you. This may help you feel better and reassured that help is available, if needed. If you are struggling with a low mood or not managing to sleep, your doctor will be able to support you and work with you to build a plan to help.

Preventing falls

Rheumatoid arthritis can make your joints stiffer and less flexible, increasing your risk of falling. Some examples of how to reduce your risk of falling at home include: