Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a long-term autoimmune disease: the body’s immune system attacks its own joint lining (the synovium).

How it develops

• The immune system wrongly targets the synovium.
• The synovium becomes thick and inflamed.
• This inflamed tissue slowly eats into the cartilage and bone.
• Without treatment, joints become damaged and deformed.
• RA can also affect the lungs, eyes, heart and blood vessels.

Risk factors

• Female sex — about 2 to 3 times more common
• Age 30 to 60
• Family history

Symptoms and signs

• Pain and swelling in many small joints
• Both sides of the body are affected equally (symmetrical)
• Common in the small joints — knuckles, finger joints, wrists
• Morning stiffness lasting more than 1 hour
• Tiredness, low-grade fever, weight loss
• Firm lumps under the skin near the elbow (rheumatoid nodules)
• Late stage: bent fingers, and fingers drifting towards the little-finger side (ulnar drift)

Management plan

• Early referral to a rheumatologist. The first 3 months are the best window to prevent damage.
• Disease-modifying drugs (DMARDs), with methotrexate as the first choice.
• Biologic injections if DMARDs do not work.
• Short course of steroids for flare-ups.
• Anti-inflammatory tablets for pain.
• Physiotherapy and occupational therapy to keep joints moving and functioning.