Doctor
Rheumatoid arthritis is an autoimmune disease. It happens when your immune system, which is meant to protect you from infection, turns on your body. It attacks the synovium, the membrane that lines your joints, causing inflammation. (Arthritis actually means inflammation of the joints.) If left untreated, your joints can be damaged permanently.
Rheumatoid arthritis doesn’t only affect your joints. It can also affect other parts of your body, causing inflammation in the lining of your heart and lungs, your blood vessels and even in your tear glands. It’s recently been discovered that people with rheumatoid arthritis may be more prone to heart attack and stroke. The Arthritis Research Council (arc) is funding research to find out more about this risk.
Around 370,000 people in the UK have rheumatoid arthritis. It’s more common in women than men, and is most likely to start between the ages of 40 and 50, but anyone can have it, from children (12,000 in the UK have rheumatoid arthritis) to their great grandparents.
How is it different from osteoarthritis?
With osteoarthritis, the problem is more one of wear and tear, although other factors are probably involved too, such as obesity, genetics and previous injuries. It develops gradually over time, and happens when the cartilage in your joints (the tissue that protects the surface of the bones in the joint), degenerates, becoming pitted, brittle and rough. As a result, the bone beneath it becomes thicker, and develops knobbly growths and the joint becomes stiff and painful.
While you may well have some inflammation with osteoarthritis, this is not the main source of the problem, as it is with rheumatoid arthritis.
Symptoms
Usually symptoms appear gradually, with pain, swelling and stiffness in your joints – hands and feet to start with, then spreading to other joints in your body, including hips, shoulders, elbow and jaw. Mornings are usually the most painful. Symptoms often ease throughout the day, as you use the affected joints. Other symptoms to watch out for are heat and redness around your joints, feeling unwell, a lack of appetite, anaemia, which can contribute to another symptom, extreme tiredness, and skin nodules. You’ll usually find these lumps – known as rheumatoid nodules – under your skin on your lower arms and around your elbows.
These symptoms, and their severity, can vary from person to person. And they tend to come and go, with periods when the symptoms become much worse. These are known as ‘flare ups’, and can happen at any time, day or night. Flare-ups usually follow a pattern, and you can go for months or even years between these painful episodes. However this condition will still be causing some damage to your joints in the months or years in-between flare-ups.
Around 20 percent of people with rheumatoid arthritis have a mild version, which rarely causes too much discomfort. A small percentage of those with rheumatoid arthritis - around five percent - find that it quite quickly becomes progressively worse. These people are also those more likely to find that the condition causes inflammation in other parts of their body too (for instance, the blood vessels).
What causes it?
No-one knows what triggers our body’s defence system to turn on itself and damage our joints. There are some possible risk factors, for instance smoking. And there may be a genetic element, as the condition does seem to run in some families.
There is no cure for rheumatoid arthritis. However, over recent years there have been developments in treatment, which mean that there are now more, and better, ways of keeping this condition under control. It’s really important to see your GP as soon as you can, if you think you may have the symptoms of rheumatoid arthritis. Quick treatment is vital to prevent lasting damage to your joints.
‘You have a three month window before your joints really start to become affected,’ says Jane Tadman of the Arthritis Research Campaign. ‘ The research shows that a lot of people who have rheumatoid arthritis don’t recognise the symptoms, and this is a barrier to getting properly treated,’ she explains. ‘It really is important to see your GP quickly. Early diagnosis and treatment is the mantra for experts now. Anyone with rheumatoid arthritis should get referred to a specialist, so they can treat it quickly.’ In fact, rheumatology departments often have ‘Early Arthritis Clinics’, whose function is to see newly diagnosed patients quickly.
Diagnosis
Your GP will consider your symptoms as a first step, so it’s worth making a list of these – pain, heat, redness etc. and when they’re at their worst. If you want to check further on symptoms, take a look at the Arthritis Care, Arthritis Research Campaign and NHS Choices websites, (see link below).
Your GP will check your joints for swelling and ease of movement, and will ask about your symptoms. He or she may then send you for blood tests and for X-rays and magnetic resonance imaging (MRI) scans. The blood tests can give your doctor some signs that can indicate that you may have rheumatoid arthritis. The X-rays and scans can help show how far the disease has progressed, and any damage that has already been caused to your joints.