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In this section you can find out more information regarding Rheumatoid Arthritis (RA)

Arthritis means ‘inflammation of the joint’. Rheumatoid arthritis (RA) is a chronic inflammatory, autoimmune condition – the immune system, which is normally there to protects us, attacks the healthy lining of the joints. (RA is different to osteoarthritis which is caused by wear and tear on the joints rather than a disease).

RA causes pain, swelling and stiffness in the joints, usually affecting the hands and feet first. As the condition progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders.

In the UK, RA affects more than 400,000 people. The condition often starts between the ages of 40 and 50 – however, it can also affect younger people. Women are 3 times more likely to be affected than men.

References
1. Mayo clinic. Rheumatioid arthritis. Available at https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648 Accessed October 2022
2. Medscape. Rhumatoid arthritis Q&A. Available at https://www.medscape.com/answers/331715-5335/what-is-the-global-prevalence-of-rheumatoid-arthritis-ra-among-different-agegroups-and-ethnicities Accessed October 2022
3. NHS. Arthritis - Overview. Available at https://www.nhs.uk/conditions/arthritis/ Accessed October 2022

Causes

The exact cause of RA is not fully understood – an unknown event triggers the immune system to mistakenly attack healthy body tissue. Some studies have shown that RA starts after a period of stress, physical or mental trauma, following an illness or giving birth - however, it is unclear why or how these events trigger RA. Once triggered, antibodies are sent to the lining of the joints (synovium), where they attack the tissue.

The lining of the joints becomes sore and inflamed, and chemicals are released that damage nearby:

  • Bones
  • Cartilage (stretchy connective tissue between bones)
  • Tendons (tissue that connects bone to muscle)
  • Ligaments (tissue that connects bone and cartilage)

If RA goes untreated, the joint gradually loses its shape and alignment, and is eventually destroyed.

Risk Factors

Factors that may increase the risk of RA include:

Genetics

There is some evidence that RA can run in families. However, the risk of inheriting it is thought to be low as genes are only thought to play a small role in the condition.

Smoking

Some evidence suggests that people who smoke have an increased risk of developing RA.

Smoking has also been shown to make symptoms worse. It can also have an impact on the response to RA medication.

Weight

Being overweight has been associated with a worsening of RA symptoms and has been looked at as a potential risk factor in developing RA.

Hormones

Hormones are thought to play an important role in the development of RA. RA is more common in women than men, which may be because of the effects of oestrogen, although this link has not been proven.

References
1. NHS. Rheumatoid Arthritis - Causes. Available at https://www.nhs.uk/conditions/rheumatoid-arthritis/causes/ Accessed October 2022
2. National Rheumatoid Arthritis Society (NRAS). Possible causes and risk factors. Available at https://nras.org.uk/resource/possible-causes-and-risk-factors/ Accessed October 2022

The main symptoms of RA are joint pain, swelling and stiffness. It can also cause more general symptoms and inflammation in other parts of the body.

Joints - RA 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. Both sides of the body are usually affected at the same time, in the same way, but this doesn’t always happen.

Pain - The joint pain associated with RA is usually a throbbing and aching pain. It is often worse in the morning or after a period of inactivity.

Stiffness - Joints affected by RA can feel stiff. Just like joint pain, the stiffness is often worse in the morning or after a period of inactivity.

Swelling, warmth and redness - The lining of joints affected by RA become inflamed, which can cause the joints to swell and become hot and tender to touch.

Additional symptoms - As well as problems affecting the joints, other symptoms can include:

  • Tiredness and a lack of energy (fatigue)
  • A high temperature or a fever
  • Sweating
  • Poor appetite
  • Weight loss
  • Dry eyes – as a result of inflammation
  • Chest pain – as a result of inflammation
  • Rheumatoid nodules — small lumps under the skin around affected joints

What are the symptoms of RA? 1

What are the symptoms of RA? 2

References
1. NHS. Rheumatoid Arthritis – Living with Rheumatoid Arthritis. Available at https://www.nhs.uk/conditions/rheumatoid-arthritis/living-with/ Accessed October 2022
2. Verses Arthritis. Rheumatoid Arthritis. Available at https://www.versusarthritis.org/about-arthritis/conditions/rheumatoid-arthritis/ Accessed October 2022

RA can be difficult to diagnose because there is no definitive test for the condition. There are also quite a few conditions that have the same symptoms.

A diagnosis of RA is made by a doctor assessing symptoms experienced, an examination of the joints and the results of x-rays, scans and blood tests. If RA is suspected, a referral to a specialist (rheumatologist) is made.

Blood Tests

No blood test can definitively prove or rule out a diagnosis of RA. However, several tests can show possible signs of the condition.

Main blood tests used include:

  • Erythrocyte sedimentation rate (ESR) – measures inflammation levels
  • C-reactive protein (CRP) – measures inflammation levels
  • Full blood count – to check for anaemia (a lack of red blood cells making the blood unable to carry enough oxygen). Anaemia is common in people with RA although having anaemia does not confirm RA

Other blood tests include:

Rheumatoid factor

Rheumatoid factor blood test - measures levels of rheumatoid factors in the blood. Rheumatoid factors are proteins that the immune system produces when it attacks health tissue.

About 50% of people with RA have high levels of rheumatoid factors in their blood when the disease starts, but about 1 in 20 people without rheumatoid arthritis also test positive.

Anti-CCP

Anti-cyclic citrullinated peptide (anti-CCP) test - anti-CCPs are antibodies also produced by the immune system. People who test positive for anti-CCP are very likely to develop RA, but not everybody with rheumatoid arthritis has this antibody.

Those who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe RA requiring higher levels of treatment.

Joint Scans

Scans may be used to diagnose and monitor joint inflammation and damage. They include:

  • X-rays – create images of the inside of the body, and are used to look for injury or damage to the bones or joints.
  • Ultrasound scans – use sound waves to build up pictures of the inside of the body.
  • Magnetic Resonance Imaging (MRI) scans – use magnets to look at what is happening inside the body. A scan can show soft-tissue damage - in the muscles, ligaments or nerves - as well as any problems with the bones.
  • Computerised Tomography (CT) scans – use x-rays and a computer to create detailed images of the inside the body (sometimes called a CAT scan).

References
1. NHS. Rheumatoid Arthritis – Living with Rheumatoid Arthritis. Available at https://www.nhs.uk/conditions/rheumatoid-arthritis/living-with/ Accessed October 2022
2. Verses Arthritis. Rheumatoid Arthritis. Available at https://www.versusarthritis.org/about-arthritis/conditions/rheumatoid-arthritis/ Accessed October 2022

There are a variety of treatments available for RA which can help reduce inflammation in the joints, relieve pain, prevent or slow down joint damage and reduce disability. The earlier that treatment is started, the more likely it is to work.

There are three main ways to treat rheumatoid arthritis:

  1. Medications
  2. Physical therapies
  3. Surgery

Medications

There are four main groups of medications that are used to treat RA:

  1. Painkillers – e.g., paracetamol, can help to relieve the pain (should not be the only treatment used).

  2. Non-steroidal anti-inflammatory medications (NSAIDs) - e.g., Ibuprofen, can be used to help control symptoms of pain, swelling or stiffness. They can be used in combination with painkillers.

  3. Disease-modifying anti-rheumatic medications (DMARDs) - Can slow the progression of RA and save the joints from permanent damage. Biologics are a subset of DMARDs that target specific parts of the immune system causing joint damage. A biologic can slow, modify or stop the disease.

  4. Steroids (corticosteroids) - help reduce the pain, stiffness and inflammation.

Physical therapies

Physical therapies such as physiotherapy, hydrotherapy and occupational therapy can all help to improve symptoms and mobility.

Surgery

Despite taking medicines, joints may still become damaged. Surgery is sometimes needed to reduce pain, correct joint shape or restore the ability to use a joint. Surgery may involve removal of inflamed tissue or joint replacement.

References
1. NHS. Rheumatoid Arthritis – Living with Rheumatoid Arthritis. Available at https://www.nhs.uk/conditions/rheumatoid-arthritis/living-with/ Accessed October 2022
2. Verses Arthritis. Rheumatoid Arthritis. Available at https://www.versusarthritis.org/about-arthritis/conditions/rheumatoid-arthritis/ Accessed October 2022

Rheumatoid arthritis can be life changing. Depending on pain, stiffness and joint damage, simple daily tasks may become difficult or take longer to do.

Lifestyle changes can help with managing RA and include:

Exercise - lack of exercise may stiffen joints and weaken muscles. It is important to keep a good balance between rest and exercise. Low-impact activities that put less strain on joints, such as swimming, cycling, walking and aqua aerobics are best.

Healthy eating - there is no specific diet for patients with RA, however a balanced, nutritious diet will help to maintain a healthy weight.

Keeping well - keeping up to date with vaccinations and resting during a flare up.

Medication - it is important to take medication as prescribed, even if symptoms reduce. Medication can help prevent flare-ups and reduce the risk of joint damage.

References
1. NHS. Rheumatoid Arthritis – Living with Rheumatoid Arthritis. Available at https://www.nhs.uk/conditions/rheumatoid-arthritis/living-with/ Accessed October 2022
2. Verses Arthritis. Rheumatoid Arthritis. Available at https://www.versusarthritis.org/about-arthritis/conditions/rheumatoid-arthritis/ Accessed October 2022

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