Patient information from BMJ

Rheumatoid arthritis

Last published:Jun 23, 2020

Rheumatoid arthritis makes your joints swollen and stiff. It can be very painful and can lead to lasting joint damage. But there are treatments that can reduce pain, help protect your joints from damage, and let you lead an active life.

You can use our information to talk to your doctor and decide which treatments are best for you.

What is rheumatoid arthritis?

If you have rheumatoid arthritis some of your joints are painful and swollen. This happens because of a problem with your immune system.

Your immune system protects you against illnesses by attacking germs in your body.

But if you have rheumatoid arthritis your immune system also attacks the lining of your joints, causing a painful swelling. This can eventually lead to permanent damage to your bones and joints.

What are the symptoms?

The symptoms of rheumatoid arthritis usually develop slowly over time, often when people are in their 50s. When symptoms first start you might notice that your joints feel a little stiff, especially in the mornings. The small joints of your hands or feet are usually affected first.

Eventually your affected joints may become stiff, painful, and sore to the touch. The pain and stiffness are often worse just after you've been sleeping or sitting still, and they get better as you get moving.

You might get swelling in some joints. Some people also get swellings or lumps under their skin. These can happen on the back of your elbows or finger joints.

What treatments work?

Many medicines can help with rheumatoid arthritis. Your doctor might recommend taking a combination of treatments. If one approach doesn't help (or doesn't help enough), you can try another.

Treatment won't cure your arthritis but it can help with your symptoms and protect your joints from damage.

Medicines for rheumatoid arthritis work best if you start taking them as soon as you start having symptoms. You might need to keep taking treatment for the rest of your life. You might also need to take extra medicines when you have a flare-up of symptoms.

Drugs to slow down the damage to your joints

Medicines that help protect your joints from damage are called disease-modifying anti-rheumatic drugs or DMARDs for short. They also help with the symptoms of rheumatoid arthritis, such as pain, but they might take a few months to start working.

Methotrexate is usually the first DMARD people are prescribed but there are others. These usually come as tablets. But methotrexate can also be given as an injection.

If your rheumatoid arthritis is fairly mild you might need to take only one of these drugs. If this doesn't help enough, your doctor might recommend taking two or three of these medicines together. Your treatment might vary over time depending on your symptoms.

For more severe rheumatoid arthritis your doctor might recommend taking methotrexate as well as a newer type of disease-modifying drug called a biologic drug. These drugs are given as an injection or directly into a vein through an intravenous infusion (also known as an IV or a drip). 

All of these treatments can have side effects. Your doctor should explain these to you. You will have regular check-ups to make sure your treatment is working and to keep an eye out for side effects. If you do get problems your doctor will help you switch to a different drug or combination of drugs.

Corticosteroids

Your doctor might also recommend taking drugs called corticosteroids to help reduce the pain and swelling of rheumatoid arthritis.

These medicines are often called steroids for short, but they aren't the same as the steroids used by some athletes and bodybuilders. They're similar to chemicals your body makes naturally to reduce inflammation.

Doctors usually prescribe low doses of corticosteroids, but you might take higher doses for a short time to help with a flare-up of symptoms.

Most people take corticosteroids as tablets but these medicines can also be given as injections, sometimes into a joint, to improve symptoms more quickly.

Steroids can cause side effects, including weakened bones, if you take them for a long time. Your doctor will discuss side effects with you.

If you take corticosteroid tablets regularly your doctor will probably recommend taking calcium and vitamin D supplements to help protect your bones. You will also have regular tests to check on your bones (called bone density tests).

Pain medicines

Disease-modifying drugs and corticosteroids can help with rheumatoid arthritis pain. But you might also need to take pain medicine sometimes.

Drugs called non-steroidal anti-inflammatory drugs (NSAIDs) help with pain and inflammation. Some examples are ibuprofen and naproxen.

You can buy low doses of ibuprofen without a prescription. You can also get higher doses or stronger NSAIDs with a prescription from your doctor. If one NSAID doesn't work for you, another might.

NSAIDs can upset your stomach. They can also sometimes cause more serious problems, such as stomach ulcers. Doctors usually recommend taking them with food to reduce the chance of problems. Your doctor might also suggest you take a drug to protect your stomach.

You should not take an NSAID called diclofenac if you have heart problems.

Things you can do to help yourself

You might want to try other ways of coping with rheumatoid arthritis pain, as well as taking medicines.

Some people find that a warm bath or shower helps. Wrapping an ice pack (or a bag of frozen vegetables) in a towel and putting it on the painful joint might also help.

Exercise can help with pain and stiffness, as long as you do something that doesn't stress your joints. Swimming can be good. A physiotherapist can help you find exercises that suit you.

Pregnancy and rheumatoid arthritis

Most drugs for treating rheumatoid arthritis are not safe to take while pregnant.

But most women find that their symptoms are much better during pregnancy. If you have questions about treatment during pregnancy, talk with your doctor.

What will happen to me?

If your rheumatoid arthritis is treated early with disease-modifying drugs, this should improve your symptoms and help stop the disease getting worse.

But if you don't have treatment, or if you stop treatment, your disease will probably progress and damage your joints, which can make everyday tasks difficult.

If your rheumatoid arthritis becomes very advanced it can cause problems with other parts of your body, such as your heart, lungs, and eyes.

You might find having rheumatoid arthritis a daunting prospect. But treatments can help you live a full, active life. If you have a flare-up of symptoms there are extra treatments that can help.

It's also important to get support if you need it. Your family and friends might be able to help you. And your doctor will be able to tell you what kinds of help and support are available in your area.