Rheumatoid arthritis

Common symptoms of rheumatoid arthritis include:

• Joint pain, tenderness and swelling
• Redness and warmth around the affected joints
• Joint stiffness, especially in the morning or after sitting for a long time
• Fatigue
• Weakness
• Fever (a temperature above 38C)
• Dry eyes
• Chest pain
• Reduced appetite
• Weight loss
• Sweating

Normally, our immune system protects us from harmful bacteria and viruses that could make us ill. It does this by sending antibodies to destroy the threat. In autoimmune diseases, the immune system malfunctions and sends antibodies to attack the body’s own cells.

In rheumatoid arthritis, antibodies attack the lining of the joints (the synovium) stretching the joint capsule and leading to inflammation and pain. The inflamed synovium produces chemicals that damage bones, cartilage, ligaments, and tendons. As the disease progresses, these chemicals can damage other parts of the body, such as the eyes, heart, lungs, skin, and blood vessels.

It is not clear what causes rheumatoid arthritis, but some things that can increase your risk include:

• Smoking — smokers have a higher risk of developing RA
• Genetics — RA often runs in families
• Hormones — RA is more common in women and may be linked to female hormones like oestrogen
• Obesity — if you are obese, you have a higher risk of developing RA
• Age — RA can develop at any age, but is more common in people aged 40 to 60

Treatment for rheumatoid arthritis aims to reduce joint pain and inflammation and prevent or reduce long-term joint damage. Joint damage normally occurs within the first 2 years of developing RA, so early diagnosis and treatment are important to slow down the progression of the disease and prevent long-term complications. Treatments include non-surgical, meaning you do not need to have an operation, and surgical, where surgery is required. Non-surgical treatments are normally tired first.

Non-surgical treatments for rheumatoid arthritis include:

• Lifestyle changes
• Medication
• Therapies

Lifestyle changes

It’s important to maintain a healthy lifestyle when living with a chronic health condition such as RA. Being as healthy as possible will help to minimise symptoms and can prevent your condition from worsening.

Some lifestyle changes recommended for RA include:

• Lose weight if needed and maintain a healthy weight — this will help to reduce stress on your joints
• Exercise — it’s important to maintain a good level of fitness to improve muscle strength and keep your joints flexible. Gentle exercise like swimming, walking, and aqua aerobics are recommended as they don’t put a lot of pressure on your joints
• Diet — some people feel that their condition flares up when they eat certain foods, though there is no firm evidence for this. If you notice your RA gets worse after eating some types of food, you can try to avoid them for a few weeks to see if your symptoms improve. We recommend eating a healthy balanced diet such as the Mediterranean diet
• Stop smoking — cigarette smoking is associated with the production of antibodies that increase your chances of developing rheumatoid arthritis and can make your symptoms worse. Smoking also makes some RA medications less effective
• Rest — taking regular breaks, especially when your joints are inflamed, will help relieve inflammation and fatigue
• Reduce stress — living with a chronic medical condition is not easy, and long-term pain can lead to depression and anxiety. Reaching out to family and friends, counselling, speaking to other people with RA, or joining a support group can help you deal with the psychological impact of the condition. Techniques to reduce stress include meditation, visualisation and breathing techniques, and massage

Medications

There are a range of medications available to treat rheumatoid arthritis. Your consultant may prescribe a combination of different medications to treat your condition. These may include:

Painkillers

Painkillers help to relieve pain and discomfort caused by RA. Painkillers vary in strength and some are available over the counter, while others require a prescription from your doctor. Painkillers may include paracetamol or co-codamol, a combination of paracetamol and codeine.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs relieve pain and reduce inflammation. Your consultant may prescribe them on their own, or in combination with painkillers. NSAIDs include ibuprofen, naproxen, and diclofenac. NSAIDs can damage your stomach lining when taken for a long period of time, so your doctor may prescribe another medication to help prevent this.

Disease-modifying anti-rheumatic drugs (DMARDs)

DMARDs work by blocking the action of the chemicals released when your immune system attacks your tissues. DMARDs are usually very effective in “switching off” the inflammation caused by RA and slowing or stopping the progression of the disease.

DMARDs commonly prescribed for rheumatoid arthritis include methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine.

DMARDs can take several months to take effect. Keep taking your medication as instructed by your consultant, even if you don’t think it’s working. Talk to your consultant if you have any questions or concerns.

DMARDs can affect your liver, so you will need to have regular blood tests to monitor your liver function while you are taking them.

Steroids

Steroids, or corticosteroids, are a powerful anti-inflammatory medication that can relieve pain, stiffness and swelling and reduce inflammation. They can be given as an oral tablet or liquid, or an injection into the muscle or joint. Steroids may be prescribed to provide short-term pain relief during a flareup of your symptoms. Steroids should not be used long term, as they can cause serious side effects such as weight gain, osteoporosis (brittle bones), thinning of the skin, bruising, and muscle weakness.

Therapies

Physiotherapy

Physiotherapy can improve your overall fitness, increase strength, and help to keep your joints flexible. Your physiotherapist may also use other therapies such as heat and cold packs, and transcutaneous nerve stimulation (TENS) to help manage your pain. Our expert team of physiotherapists are skilled in assessing your individual needs and creating a tailor-made treatment plan to suit you.

Occupational therapy

Occupational therapy focuses on helping you to perform day-to-day tasks at home, school, or work. Occupational therapists can teach you techniques that protect your joints, and provide devices that make some tasks, such as opening jars or turning on taps, easier. Occupational therapy can improve your self-confidence, increase your independence, and allow you to stay in, or return to, work.

Surgical treatments

If your joints become damaged due to rheumatoid arthritis, your consultant may recommend surgery. The aim of surgery is to reduce pain, repair the joint, and correct any deformities. The type of surgery you require depends on the type of joint damage you have.

Surgery for rheumatoid arthritis may include:

Foot surgery

Foot surgery for RA may include:

• Removal of the small joints in the ball of the foot
• Straightening of the toes
• Fixation of the joints
• Removal of inflamed tissue from around the joints

Finger, hand, and wrist surgery

Finger, hand, and wrist surgery for RA may include:

• Carpal tunnel surgery
• Tendon release surgery
• Removal of inflamed tissue from around the joints

Arthroscopy

An arthroscopy is an operation to remove damaged joint tissue. During an arthroscopy, a tube with a light and camera is inserted through a small incision (cut) in the skin. This allows your consultant to examine your joint and look for areas of damage. Specially designed instruments are then inserted through further small incisions, and the diseased tissue is removed. Arthroscopy is normally performed as a day case, meaning you’ll be able to go home later the same day. You will need to rest your joint at home for a few days following your arthroscopy.

Joint replacement surgery

If your joint damage is severe, your consultant may recommend joint replacement surgery. During this surgery, all or part of your diseased joint is removed and replaced with an artificial (prosthetic) one. Joint replacement surgery is major surgery, and you will need to stay in hospital for several days after your operation. You will also need to have rehabilitation for several months. Common joint replacement surgeries include knee replacement, hip replacement and shoulder replacement.

At your first consultation with Circle Health Group, you will be seen by a consultant rheumatologist, a doctor specialising in musculoskeletal disease and systemic autoimmune diseases such as RA.

Your consultant will ask you about your symptoms, medical history, and general health. They will perform a physical examination.

Will they need tests or scans?

Your consultant will need various tests and scans to confirm a diagnosis of rheumatoid arthritis. These include blood tests and imaging scans.

Blood tests may include:

• Erythrocyte sedimentation rate (ESR) — this measures inflammation in the body
• C-reactive protein (CRP) — another marker for inflammation
• Rheumatoid factor (RF) — RF is a protein that the immune system produces when it attacks healthy tissue. Around 80% of people with RA test positive for RF. People without RA can also have a positive result
• Anti-cyclic citrullinated peptide (anti-CCP) — Anti CCPs are antibodies produced by the immune system. A positive anti-CCP result means you are very likely to develop RA, but not everyone with RA tests positive
• Full blood count — a full blood count is a blood test to assess your general health and rule out other diseases that may be causing your symptoms. It also checks for anaemia, a condition common in people with RA

Your consultant may order scans of your affected joint to confirm your diagnosis, assess the level of damage, and monitor your joints for signs of worsening damage over time.

Scans may include:

• X-ray — an X-ray uses small amounts of radiation to take pictures of your bones. They allow your consultant to check for bone injuries or deformities
• MRI — Magnetic Resonance Imaging (MRI) scans use large magnets and radio waves to transmit detailed images of your bones and soft tissues to a computer screen. They give your consultant a clearer, more detailed picture of your bones and soft tissues

How is a diagnosis made?

Your consultant will make a diagnosis based on your symptoms, physical examination and the results of any tests and scans.

Why is this first consultation so important?

Your first consultation at Circle Health Group is important because it’s where we get to meet you, discuss your symptoms, and learn about your expectations for treatment.

At your first consultation, your consultant will provide a diagnosis based on your symptoms, physical examination, and the results of any tests or scans. They will then discuss the best treatment plan for you based on your diagnosis.

At Circle Health group, it’s very important to us that you are as comfortable and well-informed as possible throughout your treatment. Please feel free to ask any questions or discuss any concerns you may have with your consultant at any time.

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care, including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about rheumatoid arthritis treatment, book your appointment online today, or call a member of our team directly.

Content reviewed by Circle in-house team in January 2023. Next review due January 2027.

• Rheumatoid Arthritis (RA) Versus Arthritis
• Rheumatoid Arthritis: Causes, Symptoms, Treatments and More Arthritis Foundation
• Overview. Rheumatoid arthritis NHS