Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic condition that results from a malfunctioning immune system.

Your immune system is designed to identify foreign bodies (such as bacteria and viruses) and attack them to keep you healthy. However, in the case of rheumatoid arthritis, your immune system mistakenly attacks healthy tissue in and around your joints, causing ongoing inflammation and pain.

Your joints and rheumatoid arthritis

Joints are places where bones meet. Bones, muscles, ligaments and tendons all work together so that you can bend, twist, stretch and move about.

The ends of your bones are covered in a thin layer of cartilage. It acts like a slippery cushion absorbing shock and helping your joint move smoothly.

The joint is wrapped inside a tough capsule filled with synovial fluid. This fluid lubricates and nourishes the cartilage and other structures in the joint.

When you have rheumatoid arthritis:

• your immune system attacks your joints, which causes:
  • a build-up of synovial fluid
  • inflammation of the tissues that line the joint (synovial membrane)
  • pain, heat and swelling
• cartilage becomes brittle and breaks down; because the cartilage no longer has a smooth surface, the joint becomes stiff and painful to move
• ligaments, tendons and muscles surrounding the joint can also be affected, causing joints to become unstable.

What are the symptoms of rheumatoid arthritis?

The most common symptoms of rheumatoid arthritis include:

• swelling, pain and heat in the joints, usually starting in the smaller joints of the hands or feet
• stiffness in the joints, especially in the morning
• persistent mental and physical tiredness (fatigue)
• the same joints on both sides of the body being affected

Less common symptoms may include weight loss, inflammation of other body parts (such as the lungs or eyes) or rheumatoid nodules (fleshy lumps below the elbows or on hands or feet).

Rheumatoid arthritis can occur at any age, but usually appears between the ages of 30 and 60. It affects women more often than men.

The course and severity of rheumatoid arthritis varies from person to person. Symptoms may change from day to day.

At times your symptoms (such as pain, fatigue and inflammation) may become more intense. This is a flare. Flares are unpredictable and can seem to come out of nowhere.

What causes rheumatoid arthritis?

We don’t know what causes the immune system to malfunction and attack the joints, but it appears that your genes may play a role. Other factors such as hormones, infection (by an unknown bacteria or virus), emotional distress or environmental triggers (such as cigarette smoke or pollutants) may be involved.

What do I do if I think I have rheumatoid arthritis?

If you’re experiencing joint pain and inflammation, it’s important that you discuss your symptoms with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly. Early treatment will help you to control the inflammation, manage pain more effectively and minimise the risk of long-term joint damage and disability.

If you’re diagnosed with rheumatoid arthritis or suspected of having the condition, you may be referred to a medical specialist known as a rheumatologist for further investigations and medical treatment.

What is the treatment for rheumatoid arthritis?

While there’s no cure for rheumatoid arthritis, there are many strategies to help manage the condition and its symptoms so you can continue to lead a healthy and active life. It’s helpful to understand the nature of your condition and build good relationships with your doctor, rheumatologist and healthcare professionals.

Medication for rheumatoid arthritis

Some of the medications you may take include:

• pain relievers (or analgesics), such as paracetamol, for temporary pain relief
• non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, to control inflammation and provide pain relief
• corticosteroids, such as prednisolone, to quickly control or reduce inflammation
• disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, to control your overactive immune system
• biological and biosimilar medicines (bDMARDs), such as infliximab – these are biological disease-modifying drugs that work to control your immune system, but in a much more targeted way.

Depending on your particular symptoms, and how much pain and inflammation you have, you may take one medication or a combination of different medications.

How do I self-manage rheumatoid arthritis?

There are other things you can do to manage your rheumatoid arthritis:

• learn about rheumatoid arthritis – knowing as much as possible about your condition means that you can make informed decisions about your healthcare and play an active role in the management of your condition
• exercise – this will help you maintain muscle strength and joint flexibility, build up stamina and help you manage your pain. Appropriate low-impact aerobic activities include exercising in warm water, cycling and walking. Activities like strength training and tai chi are also beneficial. Seek advice from a physiotherapist or an accredited exercise physiologist before you begin an exercise program to make sure it is safe and suits your abilities
• see a physio – a physiotherapist can provide advice on ways you can modify your activities to minimise joint pain, show you pain relief techniques and design an individual exercise program for you
• talk to an OT – an occupational therapist can give advice on pacing yourself and managing fatigue, and modifying daily activities at both home and work to reduce strain and pain on affected joints
• try relaxation techniques – muscle relaxation, distraction, guided imagery and other techniques can help you manage pain and difficult emotions such as anxiety, and can help you get to sleep
• grab a gadget – supports such as walking aids and specialised cooking utensils, ergonomic computer equipment and long-handled shoe horns can reduce joint strain and can help you to manage pain and fatigue. An occupational therapist can give you advice on aids and equipment to suit you
• rest – can help you to manage fatigue and is particularly important when your joints are swollen
• stay at work – it’s good for your health and wellbeing. Talk to your doctor or allied healthcare professional about ways to help you stay at work or get back to work
• eat well – while there’s no specific diet for people with rheumatoid arthritis, it’s important to have a healthy, balanced diet to maintain general health and prevent weight gain and other medical problems, such as diabetes and heart disease
• complementary therapies – treatments such as massage or acupuncture may be helpful. Talk with your doctor or rheumatologist before starting any treatment. Fish oil supplements may also be helpful as they contain omega-3 fats. Research suggests omega-3 fats can help reduce rheumatoid arthritis inflammation.

Joint surgery for rheumatoid arthritis

Surgery may be necessary in some cases when joint deterioration and pain are severe or there’s a risk of losing overall function.

Where to get help

• Your GP (doctor)
• Rheumatologist
• Musculoskeletal Health Australia Tel. (03) 8531 8000 or 1800 263 265
• Australian Physiotherapy Association
• Exercise and Sports Science Australia
• Occupational Therapy Australia
• Independent Living Centres Australia
• Medicines Line – for information on prescription, over-the-counter and complementary medicines Tel. 1300 MEDICINE (1300 633 424)