Rheumatoid arthritis

Also called RA

The immune system attacking the joints. Not a wear and tear condition, and the first twelve weeks matter enormously.

What it is

Rheumatoid arthritis is regularly confused with osteoarthritis, and they are completely different problems. Osteoarthritis is a joint wearing. Rheumatoid arthritis is the immune system attacking the joint lining, and it is a whole-body inflammatory disease.

Around 450,000 people in the UK have it. It affects around three times as many women as men, and it usually begins between 40 and 60.

There is a window. Starting disease-modifying treatment within about twelve weeks of symptoms starting substantially improves long-term outcomes and prevents joint damage that cannot be undone. That is why persistent joint swelling is an urgent referral, not a wait-and-see.

Signs you might notice

Pain, swelling and stiffness in the small joints of the hands and feet, usually symmetrical: both hands, both feet.

Morning stiffness lasting more than an hour. This is the feature that separates it from osteoarthritis.

Fatigue and feeling generally unwell, which often precedes the joint symptoms.

Firm nodules under the skin near joints.

Dry eyes and mouth, breathlessness, and other whole-body effects, because this is not only a joint disease.

How it can affect day-to-day life

Fatigue is rated by patients as one of the worst symptoms and is consistently under-addressed in clinics focused on joint counts.

Flares are unpredictable, which makes work and plans difficult in a way steady disability does not.

Cardiovascular risk is raised by the inflammation itself, so blood pressure, cholesterol and smoking matter more here than in the general population.

Methotrexate and biologic drugs suppress the immune system, so infection needs treating promptly and live vaccines need checking.

Supporting someone well

Get seen fast. Persistent swelling of small joints with morning stiffness needs a rheumatology referral now, not after a trial of painkillers.

Take the disease-modifying drug consistently, including when things feel fine. It is treating the disease, not the symptoms.

Methotrexate is taken weekly, not daily. Weekly dosing errors have killed people, so it deserves its own place on the chart and its own check.

Take the folic acid alongside it as prescribed, because it reduces side effects considerably.

Keep moving between flares, and rest a genuinely inflamed joint during one.

Get the flu and pneumococcal vaccinations, and check before any live vaccine.

Ask for a flare plan and a helpline number for the rheumatology team.

In a service, Fiducia Together flags weekly medicines distinctly from daily ones on the medication round, which is exactly the error this condition punishes most.

Where to get help

Ask a GP for an urgent rheumatology referral, and use the phrase persistent swelling of small joints.

The National Rheumatoid Arthritis Society and Arthritis UK both run helplines.

Fever or feeling very unwell on immune-suppressing treatment needs same-day assessment.