Rheumatoid arthritis: symptoms, diagnosis, treatment and living with it

The NHS says the main symptoms are joint pain, swelling and stiffness. They often develop gradually over several weeks, although some cases progress quickly over a number of days. They vary from person to person and may come and go or change over time, and you may get flares when your symptoms get worse.

It can cause problems in any joint, although the small joints in the hands and feet are often the first to be affected. The NHS says it typically affects joints symmetrically, on both sides of the body, but not always.

• Joint pain, usually a throbbing, aching pain that is often worse in the mornings and after a period of inactivity.

• Stiffness. For example, you may not be able to fully bend your fingers or make a fist.

• Swelling, warmth and redness in the joints, which become tender to touch.

• Rheumatoid nodules, firm swellings under the skin around affected joints, in some people.

• General symptoms: tiredness and a lack of energy, a high temperature, sweating, a poor appetite and weight loss.

• Dry eyes if the eyes are affected, or chest pain if the heart or lungs are affected.

The NHS says rheumatoid arthritis is an autoimmune condition, meaning it is caused by the immune system attacking healthy body tissue. The immune system sends antibodies to the lining of your joints by mistake. This makes the thin layer of cells covering the joints (the synovium) sore and inflamed, releasing chemicals that damage nearby bones, cartilage, tendons and ligaments.

If it is not treated, the NHS says these chemicals gradually cause the joint to lose its shape and alignment and eventually can destroy the joint completely.

This is why rheumatoid arthritis is different from osteoarthritis, which the NHS describes as the more common, wear-related type of arthritis, with morning stiffness that usually wears off within 30 minutes.

The NHS says there is no cure, but early treatment and support, including medicine, lifestyle changes, supportive treatments and surgery, can reduce the risk of joint damage and limit the impact of the condition. Treatment usually involves care from your GP and several different specialists.

NICE says to treat active rheumatoid arthritis with the aim of achieving remission, or low disease activity if remission cannot be achieved (a treat-to-target approach), and to offer first-line treatment with a conventional DMARD such as methotrexate, leflunomide or sulfasalazine as soon as possible and ideally within 3 months of onset of persistent symptoms.

The NHS says rheumatoid arthritis can be difficult to diagnose because many conditions cause joint stiffness and inflammation and there is no definitive test. A GP will examine your joints for swelling and how easily they move and ask about all your symptoms. If the GP thinks you have it, they will refer you to a rheumatologist.

NICE advises referring for specialist opinion any adult with suspected persistent synovitis of undetermined cause, and referring urgently if the small joints of the hands or feet are affected, more than one joint is affected, or there has been a delay of 3 months or longer between onset of symptoms and seeking medical advice.

The NHS says it is not yet known what triggers the immune system to attack the joints. Various theories, such as an infection being a trigger, have been suggested, but none has been proven. It lists several possible risk factors.

• Genes. There is some evidence it can run in families, although the risk of inheriting it is thought to be low as genes play only a small role.

• Hormones. It is more common in women than men, which may be because of the effects of oestrogen, although this link has not been proven.

• Smoking. Some evidence suggests that people who smoke have an increased risk.

On diet, the NHS says that regular exercise and a healthy diet are recommended for everyone, not just people with rheumatoid arthritis, and that exercise can help you lose weight if you are overweight, which can put extra strain on your joints. The NHS does not name a specific rheumatoid arthritis diet.

The NHS says it is important to find a balance between rest and exercise, and usually best to increase the amount of exercise you do gradually. A physiotherapist can advise on suitable types of exercise. It also advises taking medicines as instructed, checking with your care team before taking over-the-counter remedies or supplements, and attending regular reviews.

The NHS says rheumatoid arthritis can lead to other conditions that may cause additional symptoms and can sometimes be life threatening. Possible complications include carpal tunnel syndrome, inflammation of other areas of the body such as the lungs, heart and eyes, and an increased risk of heart attack and stroke. It says keeping rheumatoid arthritis well controlled can help reduce the risk of these complications.

NICE advises offering all adults with rheumatoid arthritis an annual review to assess disease activity and damage, measure functional ability, and check for conditions such as hypertension, ischaemic heart disease, osteoporosis and depression.

The NHS says to let your healthcare team know if you want to start a family or are worried about becoming pregnant while taking medicine for rheumatoid arthritis. Your team will work with you to try to keep it under control while you are trying to get pregnant.

The NHS says to see a GP if you think you have symptoms of rheumatoid arthritis so they can try to identify the underlying cause. It says diagnosing rheumatoid arthritis quickly is important because early treatment can prevent it getting worse and reduce the risk of joint damage.

Persistent joint swelling and morning stiffness that lasts longer than 30 minutes are worth raising soon rather than waiting to see whether they pass. If you already have rheumatoid arthritis, contact your care team if symptoms get suddenly worse or you develop new symptoms between check-ups.

On the NHS, a GP refers you to a rheumatology team, and you will usually have care from your GP and several specialists. NICE sets out a treat-to-target approach with regular monitoring until remission or low disease activity is achieved.

Some people choose to see a private rheumatologist for faster access to assessment, blood tests and scans. Ongoing treatment with DMARDs and biological medicines needs regular monitoring, so make sure your GP and rheumatology team are told about any private prescriptions and results.