Rheumatoid arthritis (RA) occurs when the immune system causes inflammation of the lining of joints and surrounding structures. It can start at any age and affects around 400,000 Australians.
About rheumatoid arthritis
Arthritis means inflammation of the joints. Rheumatoid arthritis (RA) is an autoimmune disease where the white cells and antibody proteins in your blood that usually fight infections attack your joints instead. This causes inflammation where you may experience heat, swelling and tenderness in the affected joints.
Eventually, this inflammation may lead to thinning of the cartilage that covers the ends of your bones, and may cause the bone to be worn away. RA may also cause inflammation of the sheaths around your tendons. RA can affect other parts of your body, such as your lungs, but this is rare.
Symptoms of rheumatoid arthritis
Initially you may notice discomfort in a few joints such as your fingers, knuckles, wrists or the balls of your feet. Typically, RA is a 'symmetrical' arthritis – this means it affects both wrists or both hands in the same way. For most people, RA develops quite slowly at first. Other people find the condition comes on quickly and painfully, making it difficult to carry out daily activities. Symptoms include:
- pain and swelling around the joint, making it tender and warm
- stiffness in the morning, or if you sit for a long time
- poor grip strength
- tiredness, which can make you feel irritable and depressed
- flu-like symptoms such as fever
- weight loss
- rheumatoid nodules – fleshy lumps that usually appear on your hands, feet and elbows.
RA affects everyone differently. You may find that your symptoms come and go with little pain, swelling or inflammation. Flare-ups can last for a few days to a couple of months. You probably won't be able to predict when they’ll occur.
Causes of rheumatoid arthritis
The exact reasons why you may develop RA aren't fully understood. There are a number of things that seem to be involved. Women are nearly three times more likely to get RA than men. Symptoms tend to improve during pregnancy, suggesting that hormones and the immune system may be involved. It's possible that RA is triggered by an infection or virus, but there isn't any evidence to prove this.
Having certain genes makes it more likely that you’ll get RA, and the disease runs in some families. Lifestyle factors such as smoking and obesity may also increase your risk.
Diagnosis of rheumatoid arthritis
If you think you may have RA, even if your symptoms are mild, see your GP. It's important to be referred to a specialist to start treatment as early as possible, especially if you’ve had symptoms for more than three months. Treatment focuses on reducing inflammation to limit the damage to your joints. If left untreated, RA may lead to serious disability.
Your GP will ask about your symptoms and examine you. They may also ask you about your medical history. There's no single test that can diagnose RA but your GP may refer you for one or more of the following:
- a blood test for a marker called rheumatoid factor, present in 80 percent of people with RA
- anti-CCP antibody testing
- blood tests for anaemia (a condition when you have too few red blood cells or not enough haemoglobin in your blood) – 80 percent of people with RA have anaemia
- X-ray, ultrasound or magnetic resonance imaging (MRI) to look for changes in your joints.
Treatment of rheumatoid arthritis
Self-help
There are things you can do to help ease the symptoms of RA.
- Find a balance between exercise and rest. It's important to exercise to stop your joints from becoming weak and stiff but don't do too much. Swimming is excellent because it strengthens your muscles and joints without putting any strain on them. A physiotherapist can tailor a program to suit you.
- Losing excess weight will reduce the pressure on your joints.
- An occupational therapist can suggest ways of making everyday tasks easier and may be able to provide you with specialist equipment.
- Eat a healthy, balanced diet and cut down on saturated fats.
- Use a splint on the affected joint and rest it during a flare-up.
There’s limited evidence that taking certain food supplements can help RA. These include the following:
- Omega-3 fatty acids – found in oily fish such as mackerel, salmon and sardines, and some plant seed oils and nuts
- Borage seed oil
- Evening primrose oil.
Speak to your GP if you're thinking of taking any supplements.
Medicines
No medicine can cure RA, but there are many that can help symptoms.
- Painkillers such as paracetamol may help to relieve pain and stiffness.
- Non-steroidal anti-inflammatory drugs (NSAIDs) reduce symptoms of inflammation, relieving pain and swelling.
- Disease-modifying anti-rheumatic drugs (DMARDs) slow down the progression of RA and ease its symptoms. They can take several months to work so it's important to continue taking them. You may need to try more than one.
- Biological medicines made from animal or human proteins block the progress of RA in your immune system. You may be eligible to try these if other medicines haven't helped your symptoms.
Always ask your doctor for advice and read the accompanying consumer medicine information leaflet. If you have any questions about your medicines ask your GP or pharmacist for advice.
Non-surgical treatments
NSAIDs are available as creams or gels that you can rub onto painful areas. They aren't usually sufficient for treating inflamed joints.
If you have a bad flare-up, you may be offered a corticosteroid injection into a specific joint to reduce inflammation.
Surgery
As medical treatments have improved, surgery has become less common in the treatment of RA. However, if you have severely damaged joints and medicines haven't helped, your doctor may recommend one of the following operations to reduce pain and discomfort:
- a hip or knee replacement
- synovectomy to remove the lining of an inflamed joint
- removal or repair of severely inflamed tendons
- surgery to fuse a joint to make it more stable
- osteotomy to cut and reposition bone to better align a joint or to reduce the pressure on it.
Complementary therapies
Complementary therapies such as acupuncture and aromatherapy may relieve pain and make you feel more relaxed. However, they don’t affect how fast the disease progresses. Speak to your doctor before trying any complementary therapy as it may affect conventional medicines.
Living with rheumatoid arthritis
At times you may find RA upsetting and frustrating. It's important to tell your doctor how it's affecting your life so you get the most suitable treatment. You may need to make changes to your daily life but there are people who can help make this easier.
There’s some evidence to suggest that if you have an inflammatory condition such as rheumatoid arthritis, you may be at a greater risk of heart disease. Therefore, it's important to take steps to minimise your risk of developing this, for example by reducing the amount of saturated fat in your diet and taking regular exercise. Your GP can give you more advice and information.
Further information
Arthritis Australia
1800 011 041
www.arthritisaustralia.com.au
Australian Rheumatology Association
www.rheumatology.org.au
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Last published: 30 July 2011
