Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune condition, meaning the immune system, which normally defends the body, mistakenly attacks the thin lining of the joints. This drives the inflammation that causes pain, swelling and, over time, joint damage. It is not caused by wear and tear, and it is not something you brought on yourself.

Why it develops is not fully understood. It seems to arise when a genetic tendency meets a trigger in the environment, rather than from any single cause.

Some factors are more commonly associated with it:

• A family history of rheumatoid arthritis or other autoimmune conditions
• Smoking, which raises the risk and can make the disease harder to control
• Being a woman: rheumatoid arthritis is around two to three times more common in women than in men, and onset often falls between the ages of 40 and 60

Rheumatoid arthritis often begins gradually, and the pattern can be a clue in itself. Typical features include:

• Pain and swelling in several joints, often the small joints of the hands and feet, and frequently affecting both sides of the body
• Joint stiffness in the morning that lasts more than half an hour before easing
• Joints that feel warm, tender or swollen
• Tiredness and a general sense of being unwell

Symptoms can come and go, and may be mistaken for everyday aches, which is part of why a specialist assessment helps establish what is really going on.

Diagnosis brings together your history, an examination, and the right investigations. Blood tests can show markers of inflammation and certain antibodies, though no single test confirms the diagnosis on its own.

Ultrasound is particularly valuable here. It can detect inflammation in the joint lining and tendons that may not be obvious on examination, sometimes before joints look visibly swollen. Because Dr Borukhson performs point-of-care ultrasound during the consultation, this assessment can often happen in the same visit, helping reach an accurate picture sooner. You can read more on the ultrasound clinic page.

The aim of treatment is to bring the inflammation under control, ease symptoms and protect the joints from damage. Treatment is tailored to the individual and is discussed fully with you, but the general principle is that starting effective treatment early gives the best long-term outcome.

Treatment is built around disease-modifying anti-rheumatic drugs (DMARDs), medicines that calm the overactive immune response and protect the joints rather than simply easing pain. Methotrexate is usually the first choice, with sulfasalazine, hydroxychloroquine and leflunomide among the alternatives, and biologic or targeted therapies where the response is incomplete. Each option is discussed fully with you and used under specialist supervision: most DMARDs need regular blood tests, methotrexate is planned carefully around pregnancy, and biologic medicines need screening beforehand because they can raise the risk of infection. A short course of a corticosteroid, such as prednisolone, can settle a flare while a slower-acting medicine takes effect, and the approach is kept under review so it can be adjusted over time. Where a particular joint remains troublesome, an ultrasound-guided injection may help settle it. The specifics of any treatment plan are always agreed with you.

Rheumatoid arthritis is a long-term condition, but with treatment that keeps the inflammation controlled, many people stay active and well, and periods of low or no disease activity (remission) are a realistic goal.

A few measures genuinely help alongside your medication:

• Keep moving. Regular, joint-friendly activity protects strength and movement; our guide to arthritis and exercise covers this in more detail.
• Stop smoking, which improves how well treatment works and benefits your heart and lungs.
• Eat well and stay a healthy weight, as covered in diet and arthritis.
• Pace yourself during flares and rest when fatigue is high.

Keeping up with blood tests and review appointments lets the plan be fine-tuned as things change.

Most symptoms can be managed at routine appointments, but some warrant prompt contact with your rheumatology team or GP:

• A flare with several hot, swollen, painful joints that is not settling
• A single very hot, swollen joint, which needs same-day assessment to rule out infection
• Signs of infection while on a DMARD or biologic, such as fever, a persistent sore throat or feeling generally unwell, as these medicines can mask or worsen infection

New eye pain or redness, or fresh tingling or numbness, also deserves a timely review.

Seek urgent or emergency care for chest pain, breathlessness, a new severe headache, or sudden weakness, numbness or unsteadiness. If you are planning a pregnancy, raise it early; see arthritis, autoimmune conditions and pregnancy.

The earlier rheumatoid arthritis is recognised and treated, the better the chance of protecting the joints and preserving function. If you have persistent joint pain, swelling or prolonged morning stiffness, a timely specialist review is worthwhile, even if the symptoms seem mild.

How quickly should I see a specialist if rheumatoid arthritis is suspected?

An early review is worthwhile, even if the symptoms seem mild or come and go. Treating the inflammation early offers the best protection for the joints over the long term. Persistent joint pain, swelling or morning stiffness lasting more than half an hour deserves a timely assessment rather than a wait-and-see approach.

What happens at the first appointment?

The consultation brings together your history, a careful examination of the joints, and blood tests looking at inflammation markers and antibodies. Dr Borukhson also performs point-of-care ultrasound during the visit, which can pick up inflammation in the joint lining and tendons before it is obvious from the outside. This helps build an accurate picture from the first appointment.

Can a blood test confirm rheumatoid arthritis on its own?

No. Blood tests can show inflammation markers and certain antibodies, but no single test settles the diagnosis by itself, so the results are always weighed alongside your history and examination. Ultrasound adds another layer, as it can reveal inflammation in the joint lining before joints look visibly swollen.

What monitoring will I need on treatment?

Most disease-modifying anti-rheumatic drugs, including methotrexate, need regular blood tests, and biologic medicines need screening before they start because they can raise the risk of infection. Where pregnancy is a consideration, treatment is planned carefully around it. Follow-up appointments allow the plan to be adjusted as your condition changes.

Will I be on medication for life?

Rheumatoid arthritis is a long-term condition, and treatment usually continues long term to keep the inflammation under control and protect the joints. The plan is not fixed, though: it is reviewed regularly and can be adjusted as your condition and circumstances change. How long any individual medicine continues is always a decision made with you.