Rheumatoid arthritis is a long-term autoimmune disease that makes joints painful, swollen and stiff. Early diagnosis matters, because joint damage usually cannot be reversed and timely treatment can prevent it.

What is this disease?

The immune system’s job is to fight infection. In rheumatoid arthritis it attacks the cells that line the joints by mistake. The joint swells and becomes stiff and painful, and over time the cartilage and nearby bone can be damaged.

The exact cause of this mistake is not clear. Being a woman, a family history and smoking all raise the risk.

What are the signs?

Pain, swelling and stiffness in the joints, mostly the hands, feet and wrists
Morning stiffness that lasts
Tiredness and sometimes weight loss
Periods when the disease gets worse, called flares

The disease does not stay in the joints. The lungs, heart and eyes can become inflamed, and the risk of heart attack and stroke rises. Good control of the disease lowers these risks.

Why does seeing a doctor early matter?

Joint damage can begin within the first year or two, and once it has happened it usually cannot be reversed. If your joints have been swollen and stiff for several weeks, do not wait.

How is it checked?

There is no single test for this disease. Your doctor puts these together:

History: when and how the symptoms began, what has become hard to do, and what medicines you take.
Examination: the joints, the skin, and listening to the lungs.
Blood tests: RF and anti-CCP, a blood count, and ESR and CRP, which show inflammation.
Imaging: X-ray, ultrasound or MRI.

What does treatment generally look like?

There is no definite cure, but with early diagnosis and suitable treatment many people go months or years between flares and keep working. The aims are to ease pain and inflammation, slow or stop damage to joints and organs, and keep up everyday activities.

Disease-modifying medicines (DMARDs): slow or change the course of the disease. They take several weeks to months to work.
Biologics and JAK inhibitors: used when first treatment is not enough.
Anti-inflammatory medicines and steroids: for faster relief of pain and swelling, at the lowest amount needed.
Physiotherapy and occupational therapy: to keep strength and movement and make daily tasks easier.
Surgery: for some joints with permanent damage.

Your doctor chooses your medicine, and it may change over time. Most of these medicines need regular blood tests.

What can you do yourself?

Rest more when the disease is active and exercise more when it is quiet. Short rests work better than long periods in bed.
Stop smoking.
Ask whether you need calcium and vitamin D or a bone density check, especially if you take steroids.
Go through your vaccines with your doctor.

When should you get help urgently?

A joint that suddenly becomes very painful, hot and swollen, especially with a fever or shivering, may be infected. People with rheumatoid arthritis are more at risk of joint infection, and this needs checking the same day. See the full list of warning signs.

Rheumatoid arthritis