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Rheumatoid arthritis: A guide to symptoms, causes and treatment
Written byLaura Harcourt
Reviewed byProfessor Sanjiv Jari
This guide looks at the symptoms, causes and treatments of rheumatoid arthritis and how lifestyle changes can help prevent flare-ups.
Summary
1What is rheumatoid arthritis?
Rheumatoid arthritis is a type of arthritis. Arthritis is a general term used to describe pain, inflammation, and stiffness in a joint or joints...
2Symptoms of rheumatoid arthritis
RA typically affects the joints of the hands, wrists, and feet, often symmetrically on both sides of the body. In some people it can also affect...
3What is the difference between osteoarthritis and
Unlike rheumatoid arthritis, a condition in which the body’s immune system attacks its own joint tissue, osteoarthritis (OA) occurs when the...
Rheumatoid arthritis (RA) is an autoimmune condition that causes swelling, pain and stiffness of the joints. RA affects around 400,000 adults in the UK and is about two to three times more common in women than men.1
There’s no cure for RA, so treatment is focused on managing symptoms. In this guide to rheumatoid arthritis, we’ll help you understand what RA is, what causes it and how it can be treated. We’ll also look at lifestyle changes some people with rheumatoid arthritis may find benefit from.
What is rheumatoid arthritis?
Rheumatoid arthritis is a type of arthritis. Arthritis is a general term used to describe pain, inflammation, and stiffness in a joint or joints. There are more than 100 types of arthritis, and it affects around 10 million people in the UK.2,3
‘Rheumatism’ isn’t the same as rheumatoid arthritis. Rheumatoid arthritis is a specific autoimmune condition, whereas the term ‘rheumatism’ has been used colloquially to refer to general aches and pains in the joints but it’s no longer used in medical diagnoses.
If you have an autoimmune condition such as RA, your immune system mistakenly thinks your body’s own healthy cells are a foreign threat and so attacks them. In the case of rheumatoid arthritis, your immune system attacks the lining of the joints (synovium), causing painful swelling and stiffness. Longer term this can also lead to damage to the joint and surrounding bone and cartilage.4
Symptoms of rheumatoid arthritis
RA typically affects the joints of the hands, wrists, and feet, often symmetrically on both sides of the body.5 In some people it can also affect the lungs, heart, blood vessels and eyes.4
Symptoms include:4
- joint pain – usually symmetrical on both sides of the body and often throbbing or aching which is worse in the morning or after being inactive such as sitting for a while
- joint stiffness – often worse in the morning for more than 30 minutes or after inactivity
- swollen, hot, tender joints
- joint deformity (misshapenness) if joints are damaged
- more general symptoms – such as fatigue, fever, sweating, loss of appetite and weight loss
- dry eyes or chest pain
Symptoms are different for each person and some people experience periods when symptoms become worse – called a flare or flare-up. A flare-up can happen at any time, but it can occur after times of stress or an infection.1 Depending on someone’s symptoms, daily tasks can become harder to do, and there may need to be adjustments made to the way these are carried out.
If you’re experiencing any of these symptoms, please see your GP.
What is the difference between osteoarthritis and rheumatoid arthritis?
Unlike rheumatoid arthritis, a condition in which the body’s immune system attacks its own joint tissue, osteoarthritis (OA) occurs when the cartilage protecting the joint wears out, causing pain and stiffness.6
Osteoarthritis is the most common type of arthritis. It can affect anyone of any age, but it’s more common if you’re:6,7
- in your 40s or older – as risk increases with age
- are a woman (particularly after the menopause)
- have a family history of the condition
- have experienced a past joint injury or joint overuse
- are overweight
Osteoarthritis can affect any joint, but the knees, hips and spine are most often affected because they bear the weight of the body. You’re also more likely to experience OA in your hands since you use them so much in everyday life.8,9
When a joint is affected by OA, the cartilage protecting the end of bones is worn away, and the bare bones rub together, making joints stiff, painful and creaky. Some people may also experience swelling. This can make movement painful and can feel worse at the end of the day.6,9
While there’s also joint pain and stiffness in rheumatoid arthritis, the symptoms are slightly different. Here are some of the key differences between the two:4,6
| Symptoms | Rheumatoid arthritis | Osteoarthritis |
|---|---|---|
| Joint pain and stiffness | Yes – often worse in the morning or after inactivity | Yes – often worse at end of the day or after inactivity |
| Number of joints affected | Multiple, usually symmetrical | One or more |
| Morning stiffness | Yes – usually longer than 30 minutes | Yes – usually less than 30 minutes |
| Swollen joints | Yes | Sometimes |
| Red, warm joints | Yes | No |
| Fatigue | Sometimes | Sometimes |
| Fever, weight loss | Sometimes | No |
If you have RA, you’re more likely to develop osteoarthritis as well, because the inflammation in the joint can start to destroy the joint’s lining. As the cause is different between OA and RA, the treatment options also differ between the two.
What causes rheumatoid arthritis?
The exact cause of rheumatoid arthritis is unknown. It’s thought to be triggered in some people by environmental factors, such as tobacco use or in those who have genes that make it more likely for them to develop RA.10,11
Certain risk factors for developing rheumatoid arthritis include:1,4,11
- sex – women are two to three times more likely than men to get RA
- age – RA can affect you at any age, but you’re more likely to be diagnosed between the ages of 40‒60
- genetics – there’s some evidence that if you have a relative with the condition, you’re more likely to develop it too
- weight – being overweight increases the risk of developing RA
- smoking – there’s some evidence smoking is associated with an increased risk of developing RA for some individuals
How to treat rheumatoid arthritis
Unfortunately, there’s no cure for rheumatoid arthritis, so treatment is focused on managing your pain, inflammation and other symptoms. It’s important to get early treatment to prevent or limit joint damage and reduce the number of flare-ups so you can remain as active as possible.
Treatments include prescribed medications to help manage pain and tackle the inflammation that causes rheumatoid arthritis symptoms. Other options are supportive treatments and surgery. Complementary treatments include physiotherapy, occupational therapy, and using heat or ice packs.23
In addition to these treatments, you may find benefit from making lifestyle changes to reduce inflammation and decrease your chances of experiencing a flare-up.
Although the research is currently limited in terms of diet and RA, it’s recommended to follow a balanced, Mediterranean-style diet as part of a healthy lifestyle. This is a diet rich in fruit, vegetables, legumes, fish, nuts, grains, cereals, beans, and unsaturated fats such as in olive oil. This can reduce the risk of obesity, and may have a lower inflammatory effect than other diets.12,13
Some studies recommend to include oily fish twice a week as part of this diet and/or omega-3 polyunsaturated fatty acid supplements of 2g/day.14,15 However, further research is needed to establish whether there’s a definite benefit to those with RA. Other sources of omega-3 include walnuts and flaxseeds.
A healthy, balanced diet will also ensure you get all the vitamins and minerals you need.16
Staying physically active can be challenging during a flare-up, but finding the right exercise can improve your rheumatoid arthritis symptoms and quality of life. Regular, moderate exercise can help maintain a healthy weight and strengthen muscles, helping to support joints and protect your joints from further damage.
If you find high-impact activities (such as contact sports like football, or running) consistently trigger a flare-up, you can try low-impact exercise instead.
Low-impact activities such as swimming, gentle cycling, aqua aerobics tai chi or yoga are excellent choices if you’re looking to stay fit without putting undue pressure on your joints.1 You can speak to the instructor of any classes before signing up if you have RA to check if they’re suitable.
Stress can set off your body’s inflammatory response, which can sometimes trigger RA flare-up.17 Living with a long-term condition such as RA can also increase stress levels.
If you have RA, finding the right self-care routine and ways to cope with life’s stressors can help. Common techniques for managing stress include talking therapies or speaking to friends or family, exercise, doing enjoyable activities, massage, aromatherapy, yoga and meditation.
There are also local support services available if you’d like additional help.
Some studies suggest that vitamin D supplements may be beneficial, although sample sizes were small and more research is needed to know for sure.18,19,20
Vitamin D and calcium supplements may help to prevent osteoporosis if you have RA, especially if you’re taking steroids as part of your treatment.4 We can all benefit from taking vitamin D supplements from October to March in the UK, as we don’t get enough vitamin D from sunlight during the winter months. Some people will benefit from taking vitamin D for the whole year.21 Dietary vitamin D contributes to normal immune system function and a healthy inflammatory response.22
Some people with rheumatoid arthritis may find benefit from using natural remedies alongside their medical treatment. Read our rheumatoid arthritis natural remedies guide for more information. Always speak to a healthcare professional before taking any new supplements or products.
When to consult your GP
If you’ve been experiencing symptoms of rheumatoid arthritis such as symmetrical joint pain, swelling or stiffness please speak to your GP. If rheumatoid arthritis is suspected, you’ll be referred to a rheumatology specialist for further investigation.
Early diagnosis and treatment are essential in limiting joint damage and maintaining quality of life.4
The final say
Rheumatoid arthritis is a chronic, autoimmune condition, which can have a profound effect on life.
Although there’s no cure for rheumatoid arthritis, finding the right treatment can help relieve symptoms and prevent further joint damage. In addition, eating a healthy, balanced diet, exercising regularly, finding ways to manage stress and having a good support system can also contribute to living well with rheumatoid arthritis.
The advice in this article is for information only and should not replace medical care. Please check with your GP or healthcare professional before trying any supplements,
treatments or remedies. Food supplements must not be used as a substitute for a
varied and balanced diet and a healthy lifestyle.
While we strive for accuracy and balance, please be aware that this article may
discuss products available for purchase through Holland & Barrett. Consult a
healthcare professional before making any health-related decisions.
- Versus Arthritis. Rheumatoid arthritis (RA) [Internet]. [cited 2024 March 14]. Available from: https://versusarthritis.org/about-arthritis/conditions/rheumatoid-arthritis/
- Versus Arthritis. Arthritis [Internet]. [cited 2024 March 14]. Available from: https://versusarthritis.org/about-arthritis/conditions/arthritis/
- Arthritis types [Internet]. Centers for Disease Control and Prevention; 2023 [cited 2024 Apr 11]. Available from: https://www.cdc.gov/arthritis/types/index.html
- NHS. Rheumatoid Arthritis [Internet]. 2023 [cited 2024 March 14]. Available from: https://www.nhs.uk/conditions/rheumatoid-arthritis/
- NHS Choices. Symptoms - Rheumatoid arthritis [Internet]. 2024 [cited 2024 Jun 26]. Available from: https://www.nhs.uk/conditions/rheumatoid-arthritis/symptoms/
- NHS. Osteoarthritis [Internet]. 2023 [cited 2024 March 14]. Available from: https://www.nhs.uk/conditions/osteoarthritis/
- CDC. Osteoarthritis [Internet]. 2021 [cited 2024 March 14]. Available from: https://www.cdc.gov/arthritis/types/osteoarthritis.htm
- Osteoarthritis [Internet]. World Health Organization; [cited 2024 Apr 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/osteoarthritis
- Versus Arthritis. Osteoarthritis (OA) [Internet]. [cited 2024 March 14]. Available from: https://versusarthritis.org/about-arthritis/conditions/osteoarthritis/
- Arthritis Foundation. Rheumatoid Arthritis [Internet]. 2021 [cited 2024 March 14]. Available from: https://www.arthritis.org/diseases/rheumatoid-arthritis
- Chauhan K, Jandu JS, Al-Dhahir MA. Rheumatoid arthritis [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/
- Scheiber A, Mank V. Anti-Inflammatory Diets [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK597377/
- Stromsnes K, G. Correas A, Lehmann J, Gambini J, Olaso-Gonzalez G. Anti-Inflammatory Properties of Diet: Role in Healthy Aging. Biomedicines. 2021 Jul 30;9(8):922. Available from: https://www.mdpi.com/2227-9059/9/8/922
- Kostoglou-Athanassiou I, Athanassiou L, Athanassiou P. The Effect of Omega-3 Fatty Acids on Rheumatoid Arthritis. Mediterranean Journal of Rheumatology [Internet]. 2020 Jun 30;31(2):190–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362115/
- Nikiphorou E, Philippou E. Nutrition and its role in prevention and management of rheumatoid arthritis. Autoimmunity Reviews. 2023 Jul;22(7):103333. doi:10.1016/j.autrev.2023.103333
- Office of dietary supplements - omega-3 fatty acids [Internet]. U.S. Department of Health and Human Services; [cited 2024 Apr 11]. Available from: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/
- Arthritis Foundation. How Stress Affects Arthritis [Internet] [cited 2024 March 14]. Available from: https://www.arthritis.org/health-wellness/healthy-living/emotional-well-being/stress-management/how-stress-affects-arthritis
- Singh Chawla S, Meena N, Garg R, Batta A, Kaur S. Assessment of Vitamin D in rheumatoid arthritis and its correlation with disease activity. Journal of Natural Science, Biology and Medicine [Internet]. 2018;9(1):54. Available from: https://pubmed.ncbi.nlm.nih.gov/29456394/
- Guan Y, Hao Y, Guan Y, Bu H, Wang H. The Effect of Vitamin D Supplementation on Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis. Frontiers in Medicine. 2020 Oct 30;7. Available from: https://www.frontiersin.org/articles/10.3389/fmed.2020.596007/
- Tv P, Kumar B, Chidambaram Y, Thangavelu S. Correlation of rheumatoid arthritis disease severity with serum vitamin D Levels. Clinical Nutrition ESPEN. 2023 Oct;57:697–702. doi:10.1016/j.clnesp.2023.08.025
- Vitamin D [Internet]. NHS; [cited 2024 Apr 11]. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
- Scientific opinion on the substantiation of health claims related to vitamin D and normal function of the immune system and inflammatory response (ID 154, 159), maintenance of normal muscle function (ID 155) and maintenance of normal cardiovascular function (ID 159) pursuant to Article 13(1) of regulation (EC) no 1924/2006. EFSA Journal. 2010 Feb;8(2). doi:10.2903/j.efsa.2010.1468
- NHS Choices. Treatment - Rheumatoid arthritis [Internet]. 2024 [cited 2024 Jun 26]. Available from: https://www.nhs.uk/conditions/rheumatoid-arthritis/treatment/
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