Rheumatoid arthritis (RA) is a long-term condition that causes swelling, pain and stiffness in the joints.
Key points
RA can occur at any age, but most often appears between the ages of 25 and 50 years old.
It occurs when your body’s immune system attacks the joints between your bones, usually affecting the hands, feet and wrists.
As well as pain and stiffness in the joints, RA can also make you feel unwell outside the joints, with low energy being common.
RA is the second most common form of arthritis, affecting about 40,000 New Zealanders. It affects women 3 times more often than men; smokers have a higher rate than non-smokers.
Early treatment, which includes medicines and non-medication therapies, can slow the progression of rheumatoid arthritis, minimise joint damage and even lead to complete remission.
What are the symptoms of RA?
Rheumatoid arthritis usually starts quite slowly and you may first notice:
joints of your fingers, wrists or the balls of your feet become uncomfortable or tender
swelling in your joints, which often comes and goes
joints are affected symmetrically – you will notice symptoms in the same joints on both sides of the body.
feeling stiff when you wake up in the morning.
For some people, the disease develops very rapidly and there may be a sudden onset of pain and swelling in a lot of joints.
Flare-ups
Symptoms tend to come and go with no particular pattern. You may have periods of time when your joints become more inflamed and painful (flare-ups). Sometimes these flare-ups have an obvious cause, such as physical injury, illness or emotional stress but usually, there is no obvious cause. This unpredictability is frustrating and can make it difficult to plan ahead.
Other effects
Occasionally inflammation may occur in other organs, such as your eyes (causing dry, irritable, red and painful eyes) and lungs (causing difficulty breathing).
Rheumatoid nodules (fleshy lumps) may sometimes appear, usually just below your elbows, but may also occur on your hands and feet. Anaemia (low red blood cell count) is common. Occasionally this can be a side effect of the drugs used to treat rheumatoid arthritis, but it is more often caused by the disease itself.
Long-term impact
Long-term, rheumatoid arthritis affects people differently:
For some people, it lasts only a year or two and goes away without causing any noticeable damage.
Other people have mild or moderate forms of the disease, with periods of worsening symptoms (flare-ups) and periods in which they feel better (remissions).
For some people, ongoing inflammation can increase their chance of heart disease.
What causes RA?
Rheumatoid arthritis is an autoimmune disease, where your body's defence system (the immune system) is confused and attacks its own cells around the joints. The exact cause is not fully understood.
Genes that you inherit from your parents don’t cause rheumatoid arthritis but may play a role. It can increase your chance of developing it.
Women are affected 3 times more often than men.
Smokers have a higher rate of getting rheumatoid arthritis than non-smokers. Smoking can increase the chances of developing rheumatoid arthritis by 40 times. It may also worsen joint damage and contribute to osteoporosis (thinning of the bones).
Some people find that cold, damp conditions and changes in the weather can affect their symptoms, but there is no evidence that the weather causes rheumatoid arthritis or affects its progression.
What happens in RA?
With continuous swelling and inflammation of your joints, the joint capsule remains stretched and can no longer hold the joint in its proper position. As a result, the joint may become unstable and this can lead to joint damage.
The joints affected and the extent to which this happens varies a great deal from person to person.
RA usually affects the small joints in your hands and feet, but it can affect many joints including your ankles, elbows, wrists, hips, knees, neck and shoulders.
The pain, stiffness, fatigue and whole-body (systemic) symptoms of rheumatoid arthritis can be disabling and can lead to difficulty with daily activities.
Effective treatment by a rheumatologist can prevent joint damage and reduce other symptoms of RA.
How is RA diagnosed?
If you have painful or swollen joints, see your doctor. Early diagnosis is important as treatment does help and reduces long-term damage to your joints.
There is no single test that can make a certain diagnosis of early rheumatoid arthritis.
Doctors have to make a clinical diagnosis, where they put together all the information from listening to you and examining you, alongside with laboratory tests and sometimes x-rays.
Your doctor may suggest any of the following tests and investigations.
This test measures how many of each type of blood cell are in your blood. This may show anaemia as well as abnormalities in white blood cell counts or platelet counts that could be associated with RA.
Levels of rheumatoid factor (RF) and other antibodies (anti-CCP) may be checked. About 80% of people have a positive RF.
X-rays and other imaging techniques
X-rayscan reveal damage caused to the joints by RA.Magnetic resonance imaging (MRI)and ultrasound scanning may also be used. They are more sensitive in picking up changes and are being studied to see how useful they are for diagnosing early disease and for monitoring its progress.
How is RA treated?
Starting treatment as soon as possible after a diagnosis has been made can help prevent permanent joint damage.
Although there is no cure for rheumatoid arthritis as yet, a variety of treatments are available that can slow down the disease and reduce the damage to your joints.
A combination of both medications and non-medication approaches are best. Read more about the medications used to treat RA.
Non-medication approaches
If you are a smoker, stop smoking. There is information that shows that continuing smoking can make it less likely that you will have a good response to medications for RA.
Physiotherapy helps preserve and improve the range of joint motion, increase your muscle strength, and reduce your pain.
Hydrotherapy involves exercising and relaxing in warm water. Being in water reduces the weight on your joints. The warmth relaxes your muscles and helps relieve pain.
Occupational therapy teaches you ways to use your body efficiently to reduce stress on your joints
Self-management skills – arthritis educator clinics, seminars and self-management programmes will equip you with tools and techniques to self-manage your RA.
Surgery is occasionally needed. Operations vary from quite minor ones such as the release of a nerve or a tendon to major surgery such as joint replacement.
Regular medical check-ups: are an important part of managing RA, including checking blood pressure and monitoring cholesterol and other risk factors for heart disease.
Self-care
Lifestyle measures are an important part of self-management.
Take care of your joints. Find the balance between rest and physical activity; rest may make your inflamed joints comfortable but without movement your joints will stiffen and your muscles will weaken.
Exercise is a very important part of a complete treatment plan for RA. It helps reduce your pain and fatigue, increases a range of joint motion and strength, and keeps you feeling better overall. Talk to your physiotherapist about the most appropriate exercise regime for you.
Make your working life easier. You need to find a way to carry out your work tasks that allows you to manage your pain and tiredness and reduce the strain on your joints. The key to success is to do a variety of tasks, in stages, and with rest breaks.
Both heat and cold treatments can relieve pain and reduce inflammation. Some people’s pain responds better to heat and other's to cold.
Relaxation techniques are beneficial for releasing muscle tension, which helps relieve pain.
Live a healthy life. Stay physically active, eat a healthy diet, stop smoking and reduce stress to help your overall health and wellbeing.
Ask your doctor about fish oil; some studies have demonstrated beneficial effects of fish oil supplementation in decreasing pain.
Social events and meeting people with similar problems may help you to deal with day-to-day activities and provide emotional support. Arthritis New Zealand provides a range of services to all New Zealanders affected by arthritis.
Associate Professor Rebecca Grainger is a senior lecturer in the Department of Medicine and Department of Pathology at the University of Otago, Wellington. She is also a consultant rheumatologist at Hutt Valley DHB. Rebecca is a subject matter expert in osteoarthritis and arthritis.
Credits: Health Navigator Editorial Team. Reviewed By: Assoc Professor Rebecca Grainger, Rheumatologist, University of Otago and Hutt Valley DHB
Last reviewed: 21 May 2019
Medicines to treat rheumatoid arthritis
Medicines for RA are used to relieve pain, reduce swelling, slow or stop joint damage.
Each person responds differently to arthritis medicines, which means you will need to work with your rheumatologist (a doctor who specialises in arthritis and related diseases) to identify the treatment that works best for your symptoms and your condition. You may need to try different treatments before finding the one that is right for you.
These medicines alter the underlying disease rather than just treating the symptoms. They slow down the disease and its effects on the joints.
DMARDs are most effective when started early on in the disease.
They start working gradually over a few weeks to months.
While taking DMARDs you will be required to have regular blood and urine tests to look for possible side effects and to assess how well the medication is working for you.
They can be used if other treatments have not worked well but they don’t work for everyone.
Mostly they are used in combination with other DMARDs.
In New Zealand, TNF inhibitors are funded with restrictions (Pharmac subsidy restrictions). To qualify for subsidy, the initial application for treatment must come from a specialist rheumatologist
These medicines reduce inflammation and swelling of the joints. They start working quickly. They relieve pain and swelling but do not reduce damage to the joints.
For most people, taking NSAIDs is safe. However, extra care is needed if you have high blood pressure, high cholesterol, diabetes, stomach ulcers, kidney problems or if you smoke.
Discuss with your doctor whether taking NSAIDs is suitable for you.
NSAIDs should be used until an effective DMARD is found and then dose reduced or stopped if possible. Read more about the safe use of NSAIDs.
Corticosteroids (also called steroids)
These are used at the start of treatment, to reduce the pain and swelling of your joints, while waiting for other medication to take effect.
They may also be used to treat sudden flare-ups but are not usually needed after the flare-up has settled.
These may be given as tablets, such as prednisone, or as injections directly into the joint itself or into the muscle or vein. Read more about prednisone and cortisone injections (into joints).
Learn more
The following links provide further information about managing your pain arthritis. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
The following links provide further information about medicines for arthritis. Be aware that websites from other countries may have information that differs from New Zealand recommendations
Understanding that you are the centre of your own RA management is key to living well with rheumatoid arthritis.
This does not mean that you manage your condition on your own, without support from your health care provider. Rather, it means that you work in partnership together with your health care provider to manage your condition and improve your health and enjoy a better quality of life.
Here are some ways that can help you live well with RA.
Adjust your routine
Joint swelling and pain can make it difficult to complete daily tasks – things you used to do with ease, may be more challenging.
Understanding your limitations and making small adjustments to your daily routines may make things easier. This may include doing your tasks in stages with rest breaks and re-organising your environments such as your kitchen or work space so that items you use frequently are easy to reach.
Understand your medication
Get the most out of your medication by taking it regularly, as prescribed.
Also, get to know your medicines – their side effects and what to do if they occur, anything you can do to lessen them, and any tests or monitoring that may be required.
By having a better understanding of your medicines, you have a greater chance of taking them properly and safely.
Arthritis medicines may interact with over-the-counter medicines or herbal supplements, so check with your rheumatologist pharmacist before using these.
Make healthy lifestyle choices
Maintaining a healthy lifestyle will help your physical and mental well being.
Doing gentle, regular exercises can help keep your joints flexible, strengthen your bones, help you maintain a healthy weight, relieve emotional stress and create a feeling of general well being.
Eat a well-balanced diet with a high intake of whole grains, vegetables, fruits, legumes, nuts, fish and olive oil. There is no specific diet for people with RA and no specific foods to avoid.
Have a support network
Adjusting to life with RA can be challenging and frustrating.
It can be hard to deal with the unpredictable nature of the condition. Some days, the pain and stiffness will be much worse than others, and there's no way of knowing when a flare-up will occur.
You may feel angry, anxious, sad, discouraged and depressed. This is normal.
Many people find it helpful to talk to others in a similar position. You may find support from an individual or group of people with rheumatoid arthritis.
Speak to your healthcare team if you're struggling to deal with your condition emotionally and your low mood is affecting your daily activities.
Plan for setbacks
Many people with RA find that they can achieve remission with either a total absence of symptoms or having only an occasional flare of joint symptoms or morning stiffness. But flares may occur and it's not unusual to alternate between periods of flares (relapse) and being free of symptoms.
These periods of relapse can be difficult to deal with. Symptoms you once had under control, can return.
Understanding why relapses occur and planning for setbacks can help you manage them better.
Talk to your doctor about how to manage flare-ups. Plan for how you'll manage tasks at home and work during a flare-up.
Have your say – shared decision making
Talk to your healthcare provider about any aspect of your care that you are not satisfied with. Together you can find solutions or the support you need.
While your doctor may have expert knowledge in the diagnosis and treatment of your condition, remember you have the best understanding of how you're feeling, what your expectations are, and what things are important to you. Therefore, together you and your doctor can find the best choices for you.
Here are some examples of questions to ask your rheumatologist:
How will I know if the medication is working, and how long does this take?
What are the possible side effects and how often will they occur?
What should I do to minimise the chance of side effects?
Who do I contact if I have concerns about the medication?
Are there medications I should stop now that I am beginning this new treatment?
How can I keep track of the blood test results used to monitor my RA?
Learn more
The following links provide further information on living well with rheumatoid arthritis. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.
Note: Some of these resources are from overseas so some details may be different. In New Zealand, ring 111 for emergencies, or freephone Healthline on 0800 611 116.
This section will be of most interest to clinicians (eg, nurses, doctors, pharmacists and specialists).
Regional HealthPathways NZ
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
