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RA or Rheumatoid Arthritis: Understanding and Managing a Complex Condition

Click here to download our patient leaflet on RA

Click here to download  our patient leaflet on living with RA

What is it?

Rheumatoid Arthritis or RA is the commonest type of inflammatory arthritis. It can affect up to 1% of the population at some time in their lives.

It is a chronic autoimmune condition in which the immune system mistakenly attacks the lining of the joints, causing inflammation, pain, and joint damage. Unlike osteoarthritis, RA is not caused by wear and tear but by immune system overactivity.

RA can begin at any age but typically starts between 30 and 50 years old and is about three times more common in women than in men.

What are the symptoms?

 

RA usually starts gradually, often with:

  • Persistent joint pain and swelling
  • Morning stiffness (intense) lasting much longer than 30 minutes
  • Symmetrical joint involvement (e.g., both wrists or knees)
  • Severe fatigue and general feeling of being unwell

The most commonly affected joints are:

  • Fingers and toes
  • Wrists and ankles
  • Elbows, knees, and shoulders

 

Inflammation is the cause of the severe pain, stiffness (always much worse first thing in the morning) and exhaustion most people experience. 

Many people find it very difficult to move at all first thing and it can take about 2 hours for this intense pain and stiffness to ease. Having a hot shower and exercising usually helps to improve things and it usually gets a little easier as the day goes on.

How is it diagnosed?

Rheumatologists are the doctors who diagnose and treat RA and all of the other types of inflammatory arthritis.

The key to the diagnosis is in a combination of:

  • the symptoms you experience,
  • what is found when your joints are examined,
  • blood tests (inc. Rheumatoid Factor, anti-CCP antibodies, CRP for inflammation)
  • XRs (hands and feet)
  • often an ultrasound of the inflamed joints
  • sometimes an MRI scan

How is it treated?

The good news is that as soon as RA has been diagnosed the acute treatment can be started on the same day. Early treatment is critical.

Most people try a reducing course of Prednisolone (steroid), starting on the day their RA is diagnosed and this usually settles everything down quite quickly.

However, as the dose of Prednisolone is reduced or stopped then, in some cases, the symptoms start to return so the Prednisolone dose is adjusted and a DMARD such as Methotrexate or Hydroxychloroquine is added.

When definite RA has been diagnosed, NICE guidelines recommend starting DMARDs (Disease-Modifying Anti-Rheumatic Drugs) within 6 weeks of symptom onset to reduce inflammation, protect joints, and achieve remission or low disease activity.

What are DMARDs?

A DMARD is a disease modifying therapy and it is called this because it gradually ‘modifies the disease’ by regulating the immune system back to ‘normality’.

However, as it takes quite a few months to do this Prednisolone (steroid) is used is low doses to ‘bridge the gap’ until the DMARD(s) have started to work.

There are four main DMARDS used to treat RA and they are:

  • Methotrexate
  • Hydroxychloroquine
  • Sulphasalazine
  • Leflunomide

Sometimes two DMARDs are given together if the RA is severe, and this can be very successful.

 

How do I know if my RA is severe?

Severe RA may involve:

  • Many painful, swollen joints (often more than 20)
  • Profound fatigue
  • High CRP levels, anaemia, or presence of erosions on imaging
  • Positive Rheumatoid Factor or anti-CCP antibodies
  • Lots of inflammation on ultrasound of their joints

 

These patients require intensive, early treatment to get the inflammation under control. If conventional DMARDs are not effective enough, biologic or targeted synthetic DMARDs (e.g., TNF inhibitors, JAK inhibitors) may be introduced.

 

Monitoring and Goals

RA is monitored using tools like DAS28, which assess disease activity. The goal is ‘tight control’—adjusting treatment until remission or low disease activity is achieved. Regular blood tests and reviews are part of the care plan.

 

Living with RA

RA can affect more than joints. It may impact mood, energy levels, and quality of life. But with the right treatment, many people live active, fulfilling lives. Supportive measures include:

  • Exercise and physiotherapy
  • Occupational therapy
  • Joint protection strategies
  • Mental health and wellbeing support

 

Did You Know?

  • RA can affect the lungs, heart, and eyes in some cases (usually if inflammation is not well controlled).
  • Early diagnosis and treatment reduce the risk of long-term disability.
  • Many patients achieve remission with the right combination of therapies.

 

Final Thoughts

RA is serious, but manageable. With prompt diagnosis and a personalised treatment plan, most people with RA can take control of their condition and live well.

 

Sources: NICE NG100 (2020), BMJ Best Practice, Versus Arthritis, EULAR Guidelines.