Rheumatoid arthritis

Rheumatoid arthritis is the second most common type of arthritis in the UK. It is characterised by a painful swelling of the joints and affects more than 300,000 people in the UK. It usually develops in middle aged people although it can develop at any age.

It tends to affect the fingers, wrists, shoulders, knees, ankles and the balls of the feet.

Rheumatoid arthritis is discussed as follows in this section of the guide:

• How does rheumatoid arthritis occur?
• Why is rheumatoid arthritis so painful?
• Causes of rheumatoid arthritis
• Symptoms of rheumatoid arthritis
• Rheumatoid arthritis progression
• Diagnosis of rheumatoid arthritis
• Tests for rheumatoid arthritis
• Treatment for rheumatoid arthritis
• Managing rheumatoid arthritis

How does rheumatoid arthritis occur?

This form of arthritis occurs as a result of inflammation in the joints.

But how does this happen?

Inflammation is the body’s normal response to illness, infection or injury. The vascular tissues in your body cause an inflammation as a form of protection against bacteria or viruses which are responsible for an infection.

This inflammatory response is a vital function of the body as it heals wounds, infections or diseases which could otherwise be serious even fatal. It forms part of the immune system which acts as the first line of defence against germs such as bacteria and viruses.

This normal form of inflammation eases after a period of time before disappearing without any trace.

But this inflammation can trigger rheumatoid arthritis. If a fault occurs in the immune system it causes it to turn on the body and attack the tissues of the joints. White cells and antibodies which normally fight off an infection are able to access the joints and once there, they cause an inflammation.

This inflammation means that the joints become warm, sore to touch and swollen.

Why is rheumatoid arthritis so painful?

This pain is a result of swelling and excess fluid around the joint with inflamed tendons as well. The cartilage within your joints starts to erode and as it does so it causes the bones to grind against each other. The bones become thicker and misshapen due to this friction which then forces them out of their natural alignment.

The pain you experience is caused by this friction, inflamed tendon sheaths and the synovial membrane - a thin membrane which acts as a lining within the cavity of the joint.

Causes of rheumatoid arthritis

Experts are still undecided about the precise causes of rheumatoid arthritis. They cannot pinpoint an exact cause of rheumatoid arthritis but they have several theories which are:

• Family history
• Female hormones
• Autoimmune disease
• Problem with the synovium
• Lifestyle factors

Family history

There is evidence to suggest that rheumatoid arthritis may be an inherited disease. So there may be an ‘arthritis gene’ although more research is needed to support or refute this.

There are cases of rheumatoid arthritis which run in families but this does not mean that you will definitely inherit this condition. If your parents or a close relative have rheumatoid arthritis then you have an increased risk of doing so but there are other factors to take into account.

Female hormones

Gender is certainly an issue with rheumatoid arthritis and in fact, several other forms of this condition. Three times as many women get rheumatoid arthritis compared to men which may be attributed to the female hormone oestrogen.

Fluctuating levels of this can trigger this condition as well as affect its progression. Pregnancy appears to ease the symptoms of rheumatoid arthritis although these tend to return after childbirth.

Autoimmune disease

Rheumatoid arthritis is classed as an ‘autoimmune disease’which means that the immune system is responsible for attacking tissues within the body. There are more than 80 autoimmune diseases which include several types of arthritis, for example rheumatoid arthritis.

Problem with the synovium

The synovium membrane covers the joints but this can become inflamed if attacked by protein antibodies. It releases a series of chemicals which thicken the synovium: these are also harmful to the cartilage, bones and tendons of the joints.

Lifestyle factors

There are a few lifestyle factors which increase the risk of rheumatoid arthritis such as smoking and obesity.

Symptoms of rheumatoid arthritis

This disease often starts slowly although some people find that it develops rapidly and painfully. The first sign that you may have rheumatoid arthritis is a swelling and uncomfortable feeling in your joints. You may find that your joints feel stiff and sore when you get up in the mornings.

These early indicators develop in the wrists, fingers and knuckles. But they can also appear in your shoulders and knees. Areas of the body less commonly affected include the elbows, neck and hips.

These symptoms are known as ‘flare ups’. The periods of time when you do not have any symptoms are called ‘remission’.

The joints become hot and sore to touch which is caused by an inflamed synovium. This inflammation can spread to other joints which cause small lumps to appear on the skin under the elbows, hands and feet.

If the hands are affected then you will find it difficult to grip anything or to curl your hand into a fist.

Apart from the typical arthritis symptoms you may develop a feeling of extreme tiredness or chronic fatigue, fever and dry eyes. Weight loss is another sign of this disease as is anaemia.

Pleurisy and vasculitis occur in a few rare cases.

Rheumatoid arthritis progression

You may experience small, regular flare ups which last from a few days to several months. But it is impossible to predict when these will occur and for how long.

Diagnosis of rheumatoid arthritis

Rheumatoid arthritis is a difficult condition to diagnose as there are many conditions which cause symptoms similar to it. But it is important that you visit your GP sooner rather than later even if you only have a few mild symptoms.

As with any condition it is better to seek treatment at an early stage as this often means a greater chance of success. Whilst rheumatoid arthritis cannot be cured, nevertheless, it is in your own interest to consult your doctor as soon as possible.

The reason for this is that it enables him/her to put you on a course of treatment which can prevent this form of arthritis from spreading throughout your body.

Do this especially if you have suffered from rheumatoid arthritis symptoms for the last three months. The aim is to limit the damage this disease can do to your joints so please see your GP as soon as possible.

Your GP will ask you about your symptoms and your medical /family history. He/she will examine you before referring you for tests.

Tests for rheumatoid arthritis

These tests include blood tests, X-rays and MRI/ultrasound scans.

Blood test

A blood test will show whether there is any inflammation in your joints by means of three indicators. These are:

• C-reactive protein (CRP)
• Plasma viscosity (PV)
• Erythrocyte sedimentation rate (ESR)

These measure the amount of inflammation in your blood. The higher these measures the greater the likelihood you have rheumatoid arthritis.

A blood test is also performed to detect the presence of anaemia which is often a feature of people with rheumatoid arthritis. But, if you are diagnosed with anaemia it does not automatically mean that you have rheumatoid arthritis.

Your GP or rheumatoid specialist will also be looking for an antibody called ‘rheumatoid factor’ which is present in the bloodstream of 8 out 10 rheumatoid arthritis sufferers. But around 1 in 20 people that have this antibody do not have rheumatoid arthritis so other tests are needed to confirm or reject a diagnosis of rheumatoid arthritis.

X-rays

X-rays are useful at showing any damage to the joints caused by an inflammation such as this. This is most noticeable in the feet so you will undergo an x-ray of your feet before any other area of your body.

Ultrasound/MRI scans

Ultrasound scanning and MRI scans are also useful at detecting the presence, extent and severity of any inflammation. This includes rheumatoid arthritis.

There is no single test which will confirm a diagnosis of rheumatoid arthritis. A diagnosis is only made following a combination of methods such as a physical examination, discussion of your symptoms and tests.

Several of these tests, such as blood tests are often repeated at set periods of time to enable your GP to monitor the progression of your arthritis. This means charting the speed and extent of the progression and whether this means a change to your medication.

Treatment for rheumatoid arthritis

Rheumatoid arthritis cannot be cured but there are ways and means of relieving the symptoms. These include medication such as painkillers (e.g. paracetamol), stronger painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), food supplements, diet and exercise and physiotherapy.

Surgery is only performed in severe cases. This includes joint replacement, e.g. knee or removal of inflamed tendons.

For more information about these and other forms of self-help visit our treatment for arthritis section. Many of these treatments apply to most forms of arthritis.

Managing rheumatoid arthritis

It is not an easy thing to be diagnosed with rheumatoid arthritis. It is a stressful and distressing condition to deal with and has a dramatic effect on your life.

It very often means a change in the way you lead your life such as making a few adaptations at home or at work. But people with this disease often cope in unexpected ways.

Your GP can advise you about this plus there are organisations specially trained to advise sufferers about this. Find out more in our living with arthritis section.