Rheumatoid arthritis: key facts to know
What is it?
Rheumatoid arthritis (RA) is a form of inflammation of the joints. It has a different cause from the most common cause of arthritis, osteoarthritis. This is sometimes known as 'wear and tear' arthritis because it most commonly affects your big, weight-bearing joints (hips, knees and spine) and gets more common as you get older or if you're overweight. RA, like underactive thyroid, is an autoimmune disease. Your immune system normally 'attacks' bacteria, viruses etc, helping you fight off infection. In RA, it recognises the tissue that surrounds your own joints as an enemy and attacks it. This causes inflammation and pain and, over time, can damage the joint and the bones on either side.
Who gets it?
Symptoms can start any time from childhood but most commonly in your 40s. Women are almost three times more likely to be affected than men and about 700,000 adults in the UK suffer from RA.
What are the symptoms?
Other conditions, like viral infections, can cause joint inflammation, so your doctor shouldn't make a diagnosis of RA until you've had symptoms for at least six weeks. They include:
- Swelling of three or more joints, on both sides of the body
- Pain and swelling of your finger joints, knuckles, wrists, toes or other foot joints
- Morning stiffness, lasting for over half an hour every day
- Nodules under the skin.
- When you're first affected, you may get other symptoms including tiredness, weight loss and flu-like symptoms. The joints most commonly affected are the small joints of the hands and feet, and they can get hot, red and swollen.
Sometimes RA affects more than your joints, because your immune system attacks other parts of your body including your eyes, arteries and lungs.
What tests will my doctor do?
Blood tests will often (but not always) tell if you have RA. Your doctor may also order X-rays of the joints causing you pain.
What are the treatments?
There are many treatments available for RA. You'll be referred to a hospital specialist clinic when you're diagnosed. The team here includes not just doctors but physiotherapists, who can help with keeping you moving; and occupational therapists, who can provide adaptations to help you cope with day-to-day tasks.
The aims of treatment are to relieve your pain; reduce inflammation of the joints; slow down damage to your joints; keep any disability you suffer to a minimum; and provide support to keep you as active as possible.
Medicines used to relieve pain and swelling include painkilling tablets like paracetamol or codeine and non-steroidal anti-inflammatory medicines, like ibuprofen. Steroid tablets can help with pain, inflammation and stiffness but tend to be given in short courses for flare-ups because they can cause side effects like type 2 diabetes,high blood pressure and osteoporosis (thinning of the bones) at high doses.
Slowing it down by getting in early
When I was a young doctor, people with very severe RA symptoms were given 'disease-modifying anti-rheumatic drugs', or DMARDs. The aim of these drugs was to slow down the progress of the disease. However, the medicines used - including medicines based on gold, and sulfasalazine - all act on your immune system. That means one of the side effects is a higher risk of infections, so they need careful monitoring with blood tests. These days, doctors have discovered that giving these medicines at an early stage can reduce complications in the longer term.
Biologics up our sleeve
In some people, the DMARDs don't slow down the disease progression much. Until recent years, there wasn't much else to offer. But the last few years have seen exciting results with a new group of drugs called the 'biologics'. They're designed to target specific molecules in the immune system that attack the lining of your joints. They're given by injection, need regular blood tests and aren't for everyone, but they have offered real hope to some sufferers.
With thanks to 'My Weekly' magazine where this article was originally published.