What is Rheumatoid Arthritis?
Rheumatoid arthritis is an autoimmune disease in which the immune system attacks the lining of the joints. It typically affects the small joints of the hands, wrists and feet on both sides of the body, causing swelling and morning stiffness that lasts more than thirty minutes. Treatment started early prevents joint damage that cannot later be reversed.
Also called: RA
Who gets Rheumatoid Arthritis?
Rheumatoid arthritis affects roughly one person in a hundred worldwide. It is two to three times more common in women, and most often begins between the ages of 30 and 60 — though it can start at any age. A family history raises the risk, and smoking is the strongest modifiable risk factor known: it both increases the chance of developing RA and makes treatment less effective.
What are the symptoms of Rheumatoid Arthritis?
Not everyone has every symptom below, and having one does not confirm the diagnosis. These are the features that most often lead to assessment:
- Pain, swelling and warmth in the small joints of the hands, wrists and feet, usually on both sides
- Morning stiffness lasting longer than thirty minutes, and stiffness returning after sitting still
- Difficulty making a fist, gripping, opening jars or turning taps, worst first thing in the morning
- Fatigue that is out of proportion to activity, sometimes months before joint symptoms
- Low-grade fever, weight loss or a general sense of being unwell
- Firm nodules under the skin near the elbows or fingers in some patients
- Dry eyes and dry mouth, or breathlessness, where other systems are involved
How is Rheumatoid Arthritis diagnosed?
There is no single test. Diagnosis rests on the pattern — which joints, how many, how long, and how symmetrical — supported by investigations.
Blood tests look for rheumatoid factor and anti-CCP antibodies, and for raised inflammatory markers (ESR and CRP). Anti-CCP is the more specific of the two antibodies and often appears years before symptoms. Around a fifth of patients are negative for both, which is called seronegative RA and is treated in the same way.
Ultrasound and MRI detect inflammation of the joint lining and early erosions long before they appear on X-ray, which is why imaging is used to confirm the diagnosis rather than to wait for damage to become visible.
How is Rheumatoid Arthritis treated?
Treatment aims at remission, and the earlier it starts the better the long-term outcome. The first few months after symptoms begin are a window in which damage can be prevented rather than merely slowed.
Methotrexate is the usual first medicine, taken once a week with folic acid, often combined with hydroxychloroquine or sulfasalazine. A short course of corticosteroids bridges the gap while it takes effect.
If the target is not reached within three to six months, treatment escalates to a biologic or a JAK inhibitor — agents that block a specific step in the inflammatory pathway. Disease activity is scored at each visit and the plan changed if the target is not met.
Physiotherapy maintains grip and range of movement, and stopping smoking measurably improves how well the medicines work.
Living with Rheumatoid Arthritis
Most people with rheumatoid arthritis diagnosed and treated early today live full working lives, and the severe deformities associated with the disease in older textbooks are now uncommon. Regular blood monitoring continues for as long as treatment does. Cardiovascular risk is higher in RA than in the general population, so blood pressure, cholesterol and smoking are managed actively alongside the joints.
When should you see a rheumatologist?
Joint swelling lasting more than six weeks, morning stiffness beyond thirty minutes, or pain in the small joints of both hands should be assessed without waiting to see whether it settles.
Common questions about Rheumatoid Arthritis
Is rheumatoid arthritis curable?
It is not curable, but it is very controllable. With treatment started early, most patients reach remission or low disease activity — minimal symptoms and no ongoing joint damage. Sustained remission sometimes allows medication to be carefully reduced under supervision.
What is the difference between rheumatoid arthritis and osteoarthritis?
Rheumatoid arthritis is autoimmune inflammation: it affects both sides of the body, causes swelling and warmth, and is worst after rest. Osteoarthritis is cartilage wear: it is usually asymmetrical, worsens with activity through the day, and causes brief stiffness rather than prolonged morning stiffness.
Can I have rheumatoid arthritis with a negative RA factor?
Yes. About one in five patients is negative for both rheumatoid factor and anti-CCP. This is called seronegative rheumatoid arthritis, and it is diagnosed on the clinical pattern and imaging, and treated the same way.
Does rheumatoid arthritis affect organs other than joints?
It can. The lungs, eyes, blood vessels and heart may be involved, and cardiovascular risk is raised. This is one reason treatment aims to switch off inflammation completely rather than just to relieve joint pain.
How quickly does methotrexate work?
Six to twelve weeks for the full effect. Corticosteroids are often given for the first few weeks as a bridge so that symptoms improve while methotrexate takes hold.
This page is general information to support a consultation. It is not a diagnosis, and it does not replace an assessment by a doctor who has examined you.