Written by Dr Miriam Stoppard OBE
Around 10 million people in the UK have arthritis, or similar conditions that affect the joints. In part two of her guide on the condition, Stannah’s Health and Wellbeing Advisor, Dr Miriam Stoppard, explains what rheumatoid arthritis is and provides advice on living with arthritis.
This form of arthritis stems from chronic inflammation of the connective tissues throughout the body, but particularly around the joints where the main signs are often painful, swollen, stiff joints that may eventually become deformed if not properly cared for.
Rheumatoid arthritis (RA) affects about one in 100 people (400,000 people in the UK) and is classified as one of the autoimmune disorders, in which the body produces antibodies that attack its own tissues. It is most common between the ages of 40 and 60, affecting three times more women than men. It sometimes runs in families, suggesting a genetic factor is at play. RA almost always affects the same joints on both sides of the body.
In rheumatoid arthritis, the joints become stiff and swollen as a result of inflammation of the synovial membrane, which lines each joint. Gradually, the cartilage covering the ends of the bones is eroded, together with the bone underlying the cartilage. The tendons and ligaments, which give the joint support, become worn and slack, and the joints may become deformed.
In most cases rheumatoid arthritis affects several joints. It usually starts first in the small joints of the hands and feet but may develop in any joint. RA tends to be symmetrical, appearing in a similar joint on both sides of the body.
RA runs a chronic course and usually recurs in episodes lasting for several weeks or months with relatively symptom-free periods in between. Without proper treatment joints may become destroyed and distorted but this can be prevented by wearing splints on the hands and wrists at night. For some, the disease can “burn itself out” and become quiescent, like an extinct volcano.
What are the symptoms?
Rheumatoid arthritis usually develops slowly, although very occasionally the onset may be sudden and dramatic. General symptoms include fatigue, pale skin, shortness of breath on exertion and poor appetite. Specific symptoms may include:
- Stiff, painful and swollen joints, often of the hands, and classically affecting the middle joint of the finger so that they become spindle-shaped.
- Classically, the pain and stiffness is worst on waking and improves as the day goes on.
- Painless, small bumps (nodules) on the areas of pressure such as the elbows.
Are there complications?
In time, the bones around the affected joint may become brittle and weak as a result of reduced mobility, becoming increasingly more susceptible to fracture.
- The more general symptoms of RA are partly due to anaemia, caused by a failure of the bone marrow to manufacture enough new red blood cells.
- Bursitis may develop, in which one or more of the fluid-filled sacs around the joints become inflamed.
- Swelling that compresses the median nerve in the wrist may lead to tingling and pain in the fingers. This is called carpal tunnel syndrome.
How’s it diagnosed?
Joint changes in the hands are so classical as to confirm the diagnosis. However, your doctor may arrange for a blood test to check for the presence of an antibody known as rheumatoid factor (RF), which is often associated with RA.
- Blood tests may also be done to measure the severity of the inflammation.
- X -rays of the affected joint may be taken to assess the level of bone and joint damage.
What’s the treatment?
The aim of treatment is twofold: firstly, to relieve your symptoms and, secondly, to reduce further joint damage by arresting inflammation and slowing the progress of the disease. Different drugs are available, and your doctor's recommendation will depend on the severity and progress of your disease, your age and your general health.
- If your symptoms are only mild, your doctor may simply prescribe an NSAID (see below).
- If your symptoms are severe, drugs that slow the disease process (Disease-modifying anti-rheumatic drugs (DMARDs)) may be suggested, such as sulphasalazine, methotrexate and hydroxychloroquine. Such drugs should limit permanent damage to the joints but may have to be taken over a few months before their full benefits are felt.
- If the symptoms persist, your doctor may prescribe stronger drugs, like cyclosporin and penicillamine. Biologic drugs may also be suggested such as monoclonal antibodies, TNF inhibitors and interleukin inhibitors. Compared with traditional DMARDs, biologics are more targeted at treating RA. A traditional DMARD is usually in the form of a pill whereas a biologic is given by injection or intravenously in an infusion. As these drugs can have serious side effects, your condition will be monitored closely by your doctor.
- The anaemia that commonly occurs with RA may be improved by treatment with the hormone erythropoietin.
- Your doctor may recommend that you use a splint or brace, particularly at night, to support a particularly painful joint and slow the development or deformities.
- Physiotherapy may be given to improve joint mobility and help increase muscle strength.
- Hydrotherapy and heat or ice treatments may help relieve pain.
- If a joint is intensely painful, it may need an injection of corticosteroid.
- If the joint becomes severely damaged, your doctor may suggest that you have surgery to replace the damaged joint with an artificial one.
Living with arthritis
If you have long term arthritis, in many instances you may be able to manage your symptoms so that you can keep up an active lifestyle. Consult your doctor about pain relief and keeping joints mobile. Organisations concerned with arthritis can also provide valuable information (https://www.versusarthritis.org/; https://www.arthritisaction.org.uk/; www.nras.org.uk).
Things you can do for yourself
- If you’re overweight, probably the most important single thing you can do is lose weight to take the strain off your joints.
- In addition, keeping up simple exercises to increase muscle power will help stabilise the affected joints and control your symptoms.
- Swimming is an excellent way to strengthen muscles and maintain joint mobility. As the water supports your body, muscles can be exercised without straining your joints. If you have a heated pool nearby, do use it at least once a week as it increases muscle power without putting undue strain on joints.
- Gentle exercises in warm water are particularly good for rheumatoid arthritis.
Gentle, regular exercise helps relieve stiffness and improve mobility. Physical activity also helps strengthen the muscles that support the joints. However, if exercise causes swelling or pain, stop the activity and consult your doctor. You can be shown which exercises are most suitable for you by a physiotherapist arranged by your doctor.
Severe joint pain can be improved by applying heat or cold to the area. Heat increases blood flow; cold helps reduce swelling. Both decrease sensitivity to pain.
Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of non-addictive drugs used to relieve pain and inflammation, particularly in muscles, ligaments and joints.
They work by limiting the release of prostaglandins, chemicals produced by the body that cause pain and trigger inflammation. One of the best known NSAIDs is ibuprofen, which is available over the counter.
NSAIDs can cause side effects. One of the most common is irritation of the stomach lining, which may lead to peptic ulcers if NSAIDs are taken for a long period of time. If you’re prescribed NSAIDs for a chronic condition, you’ll probably be prescribed an anti-ulcer drug as well to counter this effect.
Another side effect of NSAIDs is allergic reaction, which may appear as a rash or swelling. People with asthma or kidney problems shouldn’t take NSAIDs because they can make these conditions worse.
Your doctor or a physiotherapist may be able to suggest specially adapted pieces of equipment to help you with household tasks. The equipment may have particular features, such as handles that are easy to grip or extending arms to help you reach objects without bending down.
- If arthritis restricts the movement in your hands, use cutlery with thick handles and glasses with wide stems that will be easier to grip. A plate with a rim may keep the food from spilling, and a non-slip mat will help hold your plate still during a meal.
- Tongs enable you to pick up objects that are out of your reach without bending or stretching. Some types of tongs have a trigger mechanism that operates pincers at the end of the arm.
- A fixed seat in the shower allows you to sit down while you wash. Handrails and a non-slip floor surface reduce the risk of falls.
- A person with arthritis can be given a new lease of life if painful negotiations of stairs can be avoided with a stairlift. Their world opens up, their confidence rises and their mental wellbeing improves.
What's the outlook?
Many people with rheumatoid arthritis are able to lead a normal life, although lifelong drug treatment may be necessary to control the symptoms. About one in 10 people have some degree of disability, as repeated attacks gradually destroy the joints.
There are many household items that will help you to lead a normal life so ask your doctor about them.
Regular blood tests will be needed to monitor the progress of the disease and your response to the treatment. In some cases, the attacks gradually stop, and the disease is said to have burned itself out. After the age of 50, RA quite frequently does so. However, some permanent disability may remain.
In the long-term, the priority is to prevent destruction and deformity of joints and two main weapons are used: drugs including DMARDs and biologics to arrest the disease. As well as a combination of physical therapy to keep joints moving, and rest, by wearing splints at night to preserve the position of optimum function.
If you missed Part One of Miriam's guide where she discusses Osteoarthritis you can click here to learn more.