Rheumatoid arthritis (RA) attacks the whole body rather than just the joints as in osteoarthritis. Here, Professor David Scott, medical adviser to the National Rheumatoid Arthritis Society, explains the importance of early diagnosis and treatment.
Rheumatoid arthritis is a progressive auto-immune disease where the body’s immune system attacks the joints, causing pain and inflammation.
“If left untreated and allowed to progress, it can severely damage and ‘eat away’ at the joints,” explains Professor Scott, who is also honorary consultant rheumatologist at Norfolk and Norwich University Hospital.
“The key to preventing damage is early diagnosis and beginning treatment as early as possible – at least within the first three months.
“The good news is that treatments have advanced considerably in the last 10 years.”
“Symptoms usually start in the small joints of the hands and feet – particularly the main knuckle joints in the hand and usually affect at least two joints, which become painful, red and inflamed, and may start to swell.
“Symptoms usually progress rapidly within days and weeks,” says Professor Scott. “The pain is severe, persistent and doesn’t go away.”
Other symptoms of RA can include:
- Morning joint stiffness (lasting more than half an hour)
- Sleep problems
- Extreme tiredness
- Loss of appetite and weight loss
- Flu-like illness
If you have some of these symptoms, see your GP.
Distinguishing rheumatoid arthritis from osteoarthritis
“RA is a systemic disease, which means that it affects the whole body, including sometimes the heart, eyes, skin, lungs and blood,” explains Professor Scott.
“It’s an auto-immune condition – which means the body’s own immune system begins to attack the body.
“Although osteoarthritis can also cause joint pain – including morning stiffness – this usually disappears after half an hour, but in RA it often lasts for many hours,” he explains.
“Patients with RA can wake up in the middle of the night with joint pain and stiffness, often experiencing fatigue and weight loss – which doesn’t happen with osteoarthritis.”
How common is it?
Around 680,000 people in the UK are estimated to have RA – around 1 per cent of the population. It is much less common than osteoarthritis which affects around 10 million people.
It most commonly begins in the 40 to 50 age group and is three times more common in women than men, although it can start at any age and affect men too.
What causes it?
Doctors aren’t certain what causes it, but some experts believe it could be triggered by a virus, infection or an injury. Although family history plays a role, it doesn't necessarily follow that you will develop RA if a close relative has the condition.
“Because many more women have RA than men, it's possible that hormones may have a role. Prolonged use of the oral contraceptive pill may have a protective role, reducing the risk of developing RA, but it may just delay the onset rather than prevent it developing,” says Professor Scott.
How is it diagnosed?
Various blood tests can identify RA, including the rheumatoid factor test and the anti citrullinated protein antibody test. Ultrasound and magnetic resonance imaging can also reveal early signs of joint inflammation.
- Non-steroidal anti-inflammatory drugs: These are given to ease pain and reduce inflammation and include ibuprofen and naproxen, but do not slow down the RA process.
- Disease modifying therapy (DMARDs): These slow down the progression of the disease and can be used alone or in combination therapies.
- Biologics: These are newer types of DMARDS which target several different proteins responsible for inflammation. “They are only prescribed when at least two standard DMARDs have been tried (one of which must be methotrexate) and the patient’s disease is not well-controlled, and are given by injection,” explains Professor Scott.
Physiotherapy, occupational therapy, pain management techniques, injections and surgery, including joint replacement, are other treatment options.
RA and heart disease
RA increases the risk of a heart attack or stroke. It’s important to see your GP to prescribe preventative treatments to control your blood pressure and cholesterol levels. Following a healthy diet, exercising and stopping smoking will also reduce your risks.
- Exercise: “Although a very inflamed joint needs to be rested, as soon it improves you should try to be active and take exercise, to keep the joint mobile and strengthen the muscles and tendons that move the joint,” says Professor Scott.
- Losing weight: If you’re overweight, losing weight can relieve pressure on weight-bearing joints.
- Keep a food diary: “There’s no special diet that has proven to help in RA,” says Professor Scott. “But some patients notice symptoms flare up after eating certain foods. I advise keeping a food diary to see if any foods trigger their symptoms and try avoiding them.”
- Stop smoking: ‘By stopping smoking, your symptoms will improve and you’ll also be at a lower risk of heart attack or stroke,” advises Professor Scott.
- Get informed: Contact the National Rheumatoid Arthritis Society http://www.nras.org.uk or call Free phone 0800 298 7650
For more information on Rheumatoid and other forms of arthritis, visit our dedicated Musculoskeletal Centre. Or if you have a specific question, ask one of our experts who will be able to help you with a concern that you may have.
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