Rheumatoid Arthritis

Definition/diagnostic criteria Rheumatoid arthritis (RA) is a common form of arthritis characterised by inflammation of joints. It is an autoimmune disease where the immune system mistakenly attacks the body’s tissues, particularly the synovium around joints. This results in inflammation (synovitis) and can lead to joint damage over time​​.

Epidemiology RA affects about 1 in 100 people at some stage in their lives, most commonly starting between the ages of 30 and 50. It’s three times more common in women than in men and doesn’t usually run in families​​.

Diagnosis
Clinical features: The primary symptoms include joint pain, swelling and stiffness, particularly worse in the morning or after resting. The most commonly affected joints are the small joints of the fingers, thumbs, wrists, feet, and ankles. RA is often symmetrical, affecting the same joints on both sides of the body​​.

Investigations: Diagnosis is based on symptoms, blood tests (rheumatoid factor and anti-CCP antibodies), and X-rays of hands or feet showing typical damage. No single test confirms early RA with absolute certainty​​.

Treatment The main aims are to decrease disease activity, prevent joint damage, reduce pain and stiffness, minimize disability, and treat any other symptoms. GPs should refer suspected cases urgently to rheumatology. Treatments include:

  • Disease-modifying antirheumatic drugs (DMARDs) like methotrexate and sulfasalazine,
  • Non-steroidal anti-inflammatory drugs (NSAIDs),
  • Painkillers like paracetamol and codeine.
  • Regular exercise, physiotherapy, and possibly surgery for joint deformities are also part of the treatment approach​​​​​​.

Prognosis With improved treatments, particularly early use of DMARDs and biological medicines, the outlook for joint damage in RA has become much better. However, RA can increase the risk of developing other diseases like cardiovascular disease, osteoporosis and infections, slightly reducing life expectancy compared with the general population​​.

Further reading

Published: 31st July 2022 Updated: 16th February 2024

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Nursing in Practice Reference is based on the best-selling book Symptom Sorter. The experts behind Nursing in Practice Reference are Marilyn Eveleigh who is Nursing in Practice’s editorial advisor and a primary care nurse in East Sussex, Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse.