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.
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:
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.
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.
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 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).
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.
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.