What is rheumatoid arthritis?

Rheumatoid arthritis is a disease in which there is chronic inflammation of the lining of several joints, usually the small joints of the hands and feet, although the wrists, knees, ankles, shoulders, and neck can also be affected. Often the inflammation is in a symmetrical pattern, for example, the same joints on each hand can be affected.

What causes rheumatoid arthritis?
The actual cause is uncertain, but it is believed that the body’s immune (defence) system attacks the joints, hence it is often referred to as an auto-immune disease. It is possible that this is triggered by an infection, or that heredity plays a part.

Who gets rheumatoid arthritis?
Any age group – even children – can develop rheumatoid arthritis, although it most commonly develops between the ages of 30 and 50. Childhood rheumatoid arthritis is referred to as Still’s disease. Women are three times as likely as men to be affected.

What are the symptoms?
Initial symptoms are often vague, including tiredness, morning stiffness, and intermittent pain and swelling in a few joints. In about one in five people, the disease develops rapidly, within sudden onset of severe pain in a number of joints.

How is rheumatoid arthritis diagnosed?
The initial diagnosis may be made on the basis of the symptoms. Certain blood tests may help to make the diagnosis, these include: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and rheumatoid factor. X-rays may also help.

How is rheumatoid arthritis treated?
Drugs are the mainstay of rheumatoid arthritis treatment. Four main types of drug are used: painkillers, non-steroidal anti-inflammatories (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and corticosteroids. In addition, there is a new class of drugs, known as TNF inhibitors, that has recently been developed for the treatment of severe rheumatoid arthritis. Drug regimes are individually tailored, and a drug combination that works for one person may not work for another.

Exercise and physiotherapy are also important in relieving many of the symptoms of rheumatoid arthritis.

Surgery is occasionally needed, either to replace damaged joints or to release trapped nerves or tendons.

The course of rheumatoid arthritis is very unpredictable, and differs from person to person. Because of this, it is only possible to generalise about the treatments available.

Is there anything I can do to help myself?
It is important to take care of your joints. Ways you can do this include:
* Maintain a healthy weight.
* Strike a balance between rest and exercise. While exercise is generally beneficial, it is best to avoid contact sports and violent exercise such as squash. Swimming and walking are ideal.
* Wear shoes with shock-absorbing soles, such as trainers.
* If you find some activities difficult, ask your occupational therapist for advice on simple aids or adaptations that may help.
* If you find that a particular activity causes your joints to ‘flare up’, avoid that activity.
* Keep warm in the winter.

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