Rheumatoid arthritis

Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation in joints. The main symptoms are warm, swollen and painful joints. It can cause problems in any joint in the body, although generally the small joints in the hands and feet are often the first to be affected.

Rheumatoid Arthritis is generally seen in adults between 45 and 60 years of age. Symptoms can fluctuate over time and there may be periods where the symptoms flare-up and become worse. It is often characterised by persistent, prolonged joint stiffness that can last for periods of one to two hours or even in severe cases, the whole day. The inflammation is present in the synovium, the tissue that lines the joint, causing joint instability, wear to the surface of the bone and friction between the bones when movement occurs.

The main symptoms of rheumatoid arthritis vary from individual to individual and usually develop gradually but in some cases the progression may be much quicker.

Generally they are;

  • Joint pain with an aching or throbbing sensation
  • Swelling, warmth or redness as the lining of the joints become inflamed
  • Swellings called rheumatoid nodules may also develop under the skin around affected joints
  • Stiffness
  • Loss of energy and appetite
  • Low fevers
  • Dry eyes and mouth that can arise from a related health problem (Sjogren's syndrome)

Pain and stiffness of the joints can often be experienced after periods of inactivity or first thing in the morning and can persist for a longer time than that associated with osteoarthritis.

Whilst the actual cause of rheumatoid arthritis is not known, the symptoms centre on certain cells of the immune systems that begin to attack healthy tissue.  In rheumatoid arthritis, the inflammation is in the synovium, the tissue that lines the joint.

The cartilage that lines the ends of bones allows them to move against each other without friction or bone damage.  Synovium tissue surrounds the joint and in addition produces a small amount of fluid that supports the cartilage and lubricates the joint.

When this tissue becomes inflamed , it presents as a red, swollen area that feels warm to the touch.  In addition, nerve endings may be irritated by the chemicals produced by the inflammation, and the tough outer layer of the synovium (capsule) is stretched by the swelling in the joint. This swelling can move the joint into unusual positions, which in turn leads to instability of the joint, even when the inflammation has passed.

Rheumatoid arthritis can be difficult to diagnose as there is currently no one definitive blood test or physical finding to confirm a diagnosis.

A physical exam will examine your joints for swelling, redness and warmth and also check your reflexes and muscle strength.

Blood tests can identify the presence of an inflammatory process in the body, but do not conclusively prove or exclude a diagnosis or rheumatoid arthritis. These include C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor and anti-cyclic citrullinate peptide (anti-CCP) antibodies. Patients with rheumatoid arthritis are often anaemic (lack of red blood cells) but being anaemic doesn't prove that you have rheumatoid arthritis.

Joint imaging using X-rays, ultrasound scans and magnetic resonance imaging (MRI) scans can help tell the difference between different types of arthritis and to monitor how your condition progresses.

It is generally accepted that early diagnosis and treatment for the condition is more likely to lead to better management and you will be less likely to have the type of joint damage that could lead to joint replacement.

MRI scan

MRI (magnetic resonance imaging) is a special technique that uses powerful magnets, radio waves and computers to produce detailed images (or scans) of the inside of your body.

X-ray

An X-ray is used to diagnose and explore a wide variety of conditions mostly in the bones and joints, but can sometimes look at problems affecting soft tissues. They can also be used to monitor on-going conditions.

Blood tests

Blood tests are a commonly used diagnostic tool to assess your general state of health, or to check for something more specific.

CT scan

CT stands for ‘computerised tomography’. A CT scan is a detailed X-ray used to create detailed images of the inside of your body.   

What next?

If you are suffering with a suspected condition, you should seek the advice of your doctor who will be able to refer you to Benenden Hospital for diagnosis and treatment.

There are four ways to access treatment at Benenden Hospital which include self-funding, using private medical insurance or your Benenden membership, or through the NHS e-Referral scheme.