When someone tells me their joints hurt, one of the first things they often say is:
“I suppose it’s just arthritis. I’m getting older.”
Sometimes it is.
But rheumatoid arthritis is something quite different.
It isn’t simply the result of getting older or wearing your joints out.
It is an autoimmune disease, and recognising it early can make a very big difference.
So what is rheumatoid arthritis?
Rheumatoid arthritis, or RA, occurs when the immune system mistakenly attacks the lining of the joints.
This causes inflammation.
The inflamed joint becomes painful, swollen and stiff.
If the inflammation continues unchecked, it can eventually damage cartilage, bone and the surrounding structures.
And RA isn’t restricted to the joints.
Because it is a systemic inflammatory disease, it can affect other parts of the body too.
What does it feel like?
One of the classic symptoms is morning stiffness.
You wake up and your hands feel stiff, swollen and difficult to move.
It can take a considerable amount of time before they loosen up.
The hands, wrists and feet are commonly affected, but RA can involve many joints.
Another clue is that it often affects joints on both sides of the body.
Both hands.
Both wrists.
Both feet.
That isn’t an absolute rule, but it is a useful clue.
The joints may feel warm and swollen rather than simply painful.
Some people also experience profound tiredness.
And I mean tiredness.
Not simply “I had a bad night’s sleep.”
Inflammation itself can make someone feel completely drained.
How is it different from osteoarthritis?
This distinction is important.
Osteoarthritis is often described as wear and tear, although the biology is more complicated than that.
It commonly affects weight-bearing joints such as the knees and hips and can cause pain that is worse with activity.
Rheumatoid arthritis is driven by an abnormal immune response and tends to cause prolonged inflammatory stiffness, swelling and pain.
The two conditions can coexist, which makes things even more complicated.
Why does early treatment matter?
This is probably the most important thing I would say about RA.
Years ago, treatment was often less aggressive and some people eventually developed severe joint deformities.
We now understand much more about the disease.
The aim is to control the inflammation early and prevent permanent joint damage.
That is why someone with persistent swollen joints shouldn’t simply keep taking painkillers and hope for the best.
If RA is suspected, referral to a rheumatologist may be necessary.
What treatments are available?
Painkillers can help symptoms, but they don’t stop the disease itself.
The medicines that actually control RA are called disease-modifying antirheumatic drugs, or DMARDs.
One of the most commonly used is methotrexate.
Others include sulfasalazine, hydroxychloroquine and leflunomide.
These medicines work by reducing the abnormal inflammatory activity responsible for the joint damage.
They can take time to work.
And they require monitoring, including blood tests for certain medicines.
That monitoring isn’t unnecessary bureaucracy.
It is part of using these medicines safely.
What about steroids?
Steroids can be extremely effective at rapidly reducing inflammation.
They may be used for short periods while a longer-term treatment starts working, or sometimes given directly into an inflamed joint.
But long-term steroid use comes with significant risks, including osteoporosis, diabetes, high blood pressure and increased susceptibility to infections.
So again, they are useful tools — but not usually the long-term answer.
What if standard DMARDs aren’t enough?
This is where modern rheumatology has changed enormously.
There are biological medicines and targeted synthetic DMARDs that can block specific pathways involved in inflammation.
Examples include medicines targeting TNF, interleukin pathways or other components of the immune system.
For people with significant RA who don’t respond adequately to conventional treatments, these medicines can dramatically improve symptoms and help prevent further joint damage.
But because they alter immune function, they need appropriate screening and monitoring.
Exercise — should you move painful joints?
Many people think:
“If it hurts, I should rest it.”
Sometimes a short period of rest during a severe flare is sensible.
But avoiding movement altogether isn’t a good long-term strategy.
Muscles become weaker.
Joints become stiffer.
Fitness deteriorates.
The aim is to find the right balance.
Low-impact aerobic exercise such as walking, swimming or cycling can be useful.
Strength training is also important because stronger muscles support the joints and help maintain function.
A physiotherapist or occupational therapist can provide particularly useful guidance.
What about diet?
There is no magic “rheumatoid arthritis diet”.
Be suspicious of anyone promising to cure RA by eliminating a particular food group or drinking a special juice.
A healthy, balanced diet is still important.
Maintaining a healthy weight reduces stress on weight-bearing joints and improves general cardiovascular health.
And because RA itself is associated with increased cardiovascular risk, looking after blood pressure, cholesterol, smoking and weight is particularly important.
RA affects more than your joints
People sometimes underestimate the impact of chronic inflammation.
RA can be associated with increased cardiovascular risk.
It can affect the lungs.
It can cause problems involving the eyes or skin.
It can contribute to anaemia and profound fatigue.
And living with chronic pain and unpredictable flares can affect mental health.
So treating RA isn’t simply about getting someone’s fingers to bend properly again.
It is about protecting the person’s overall health.
My view as a pharmacist
The phrase “I’m just getting old” worries me when someone has persistently swollen and stiff joints.
Ageing doesn’t automatically explain everything.
If your hands are swollen every morning, your joints remain stiff for a long time after waking, or you have persistent unexplained joint swelling and fatigue, get it checked.
The earlier rheumatoid arthritis is recognised and treated, the better the chance of controlling the inflammation and preventing permanent damage.
And modern treatment means that a diagnosis of RA doesn’t have to mean a future of severely damaged joints.
For many people, treatment can bring the disease under excellent control.
So don’t simply put up with swollen, painful joints and assume there is nothing to be done.
Sometimes the most important treatment is getting the right diagnosis early.
Until next time take care of yourself.
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