Académique Documents
Professionnel Documents
Culture Documents
Rheumatoid
arthritis
Rheumatoid
arthritis
This booklet provides information
and answers to your questions
about this condition.
www.arthritisresearchuk.org
Arthritis Research UK
Rheumatoid arthritis
Whats inside?
2 Rheumatoid arthritis at a glance 26 Self-help and daily living
4 What is rheumatoid arthritis? Managing a flare-up
How does a normal joint work? Exercise
What happens in a joint affected Diet and nutrition
byrheumatoid arthritis? Complementary medicine
Is it the same as osteoarthritis? Supports, aids and gadgets
Sleep
6 What are the symptoms
Sex and pregnancy
ofrheumatoid arthritis?
Work
When should I go to the doctor?
34 Research and new
8 Who gets rheumatoid arthritis?
developments
9 What causes
34 Patient stories
rheumatoidarthritis?
Does the weather affect 36 Glossary
rheumatoidarthritis? 39 Where can I find out more?
10 What is the outlook?
44 Were here to help
11 How is rheumatoid
arthritisdiagnosed?
Blood tests
X-rays and other tests
13 What treatments are there
forrheumatoid arthritis?
Drugs
Painkillers
Non-steroidal anti-inflammatory
drugs (NSAIDs)
Disease-modifying anti-rheumatic
drugs (DMARDs)
Steroids
Physical therapies
Surgery
At a glance
Rheumatoid arthritis Rheumatoid
arthritis is the
second most
common form
of arthritis in
What is rheumatoid arthritis? the UK.
Rheumatoid arthritis is an autoimmune
disease that causes inflammation inyour
joints. The main symptoms are joint
pain and swelling. Its the second most
common form of arthritis in the UK.
Research shows that the sooner you
start treatment for rheumatoid arthritis,
the more effective its likely to be, so its
important to see your doctor if you have How is it diagnosed?
joint pain and morning stiffness.
No single test can give a definite diagnosis
of early rheumatoid arthritis. Doctors have
What are the symptoms? to arrive at a diagnosis based on your
symptoms, a physical examination and
Common symptoms of rheumatoid the results of a variety of x-rays, scans and
arthritis include: blood tests. Blood tests include:
joint pain and swelling tests to measure inflammation:
stiffness erythrocyte sedimentation rate (ESR)
fatigue, depression and irritability C-reactive protein (CRP)
anaemia tests for antibodies called rheumatoid
flu-like symptoms, such as feeling factor and anti-CCP
generally ill, feeling hot and sweating. tests for anaemia.
Less common symptoms include: Other tests include:
weight loss x-rays
inflammation in the eyes ultrasound scan
rheumatoid nodules magnetic resonance imaging (MRI)scan.
inflammation of other parts of the body.
2
Arthritis Research UK
Rheumatoid arthritis
Capsule
(ligaments)
Cartilage Synovial fluid
Synovium
(capsule lining)
Tendon
Tendon sheath
4
Arthritis Research UK
Rheumatoid arthritis
Figure 2
Muscle
Bone A joint badly
affected by
Erosion rheumatoid
into Capsule arthritis
corner (ligaments)
of bone
Inflamed
synovium
Thinning of spreading
cartilage across
joint surface
Synovial fluid
Tendon
Inflamed tendon sheath
5
Both conditions are called arthritis What are the symptoms
because it means inflammation of the
joint. Some inflammation does occur ofrheumatoid arthritis?
inosteoarthritis, but its not the same as Symptoms of rheumatoid arthritis tend
inrheumatoid arthritis. Some wear may to come and go. You may have flare-ups
take place in joints that have previously when your joints become more inflamed
been damaged by rheumatoid arthritis, and painful. The joints that are most likely
but this complication only occurs later to be affected by rheumatoid arthritis are
inpeople with rheumatoid arthritis. shown in Figure 3.
The conditions are quite different in Common symptoms of rheumatoid
their treatment and its important not arthritis include:
toconfuse the two. If you have any doubt joint pain and swelling
about which type of arthritis you have,
stiffness
askyour doctor.
fatigue, depression and irritability
See Arthritis Research UK booklets anaemia
Osteoarthritis; What is arthritis?
flu-like symptoms, such as feeling
generally ill, feeling hot and sweating.
Less common symptoms include:
weight loss
inflammation in the eyes
Arthritis Research UK
Rheumatoid arthritis
Figure 3
Joints
frequently
affected by
Shoulders rheumatoid
arthritis
Wrists
Knuckles
and middle
joints of Less commonly
fingers affected are
Knees elbows, hips
andthe neck
Middle
joints Ankles
of toes Balls of feet
Photography used with kind permission of Elsevier. Elsevier 2011. Taken from Rheumatology, fifth edition.
Edited by Marc C Hochberg, Alan J Silman, Josef S Smolen, Michael E Weinblatt and Michael H Weisman.
7
Anaemia (a lack of red blood cells) arthritis, the more effective its likely to be,
affects about four out of five people so early diagnosis is important.
with rheumatoid arthritis. Occasionally To help with this, some rheumatology
this can be a side-effect of drug departments have Early Arthritis
treatments, butits more often caused Clinics, which aim to see people very
by the condition itself. Somepeople quickly when theyre referred by their
with uncontrolled rheumatoid arthritis GP. Allconsultants should have a fast
lose weight, andmany complain of response when possible rheumatoid
feeling hot and sweating because of arthritis referrals are made.
theinflammation.
Although arthritis means inflammation
of the joints, other parts of the body can Who gets rheumatoid
sometimes be affected. Tendons have arthritis?
alubricating system thats very similar
Rheumatoid arthritis affects around
tothe joints, so its not surprising that
400,000 people in the UK. It can affect
they can also be affected by rheumatoid
adults of any age, but it most commonly
arthritis. Some people have
starts between the ages of 40 and 50.
inflammationin the eyes, which can
About three times as many women as
become dry and irritable.
men are affected.
A few people may have inflammation
Rheumatoid arthritis does seem to run
around their lungs, blood vessels and
insome families, but the genes we inherit
the membrane around the heart, but this
from our parents dont cause rheumatoid
isvery rare.
arthritis on their own. Our genes may
Some people develop fleshy lumps called only affect our likelihood of developing
rheumatoid nodules. They usually occur the condition. Even the identical twin of
just below the elbows but may develop somebody with rheumatoid arthritis only
on hands and feet too. If your doctor has has a one in five chance of developing
any doubt that the nodules are caused it too. The chances of your children
byrheumatoid arthritis, they can check by not developing rheumatoid arthritis
removing a piece for examination under are greater than the chances of them
amicroscope. This is called a biopsy. developing it.
When should I go to the doctor? There are many possible causes ofjoint
If you have painful, swollen joints and pain, so if someone in your family
stiffness in the morning that lasts for develops joint pain it doesnt necessarily
longer than half an hour, you should see mean that they have rheumatoid arthritis.
your doctor. Research shows that the Even where people in the same family
sooner you start treatment for rheumatoid develop rheumatoid arthritis, the severity
of the condition can be very different.
8
Arthritis Research UK
Rheumatoid arthritis
Theres some evidence that lifestyle may Does the weather affect
affect the risk of developing thecondition. rheumatoid arthritis?
Rheumatoid arthritis is more common Some people find that the weather
inpeople who: can affect their symptoms, especially cold
smoke and damp conditions. The weather doesnt
eat a lot of red meat cause rheumatoid arthritis or affect its
progression, although more severe cases
drink a lot of coffee. are often found in northern Europe.
Rheumatoid arthritis is less common
If youre thinking of moving to a
in people with a high vitamin C intake,
different climate, try the area in all
andthose who drink alcohol in moderation
seasons before you make your final
are at less risk than heavy or non-drinkers.
decision. Weigh up the consequences
of leaving your friends and family, as
What causes rheumatoid well as your familiar healthcare system.
arthritis?
Rheumatoid arthritis is an autoimmune
disease. In autoimmune diseases your
immune system, the bodys defence
against disease, starts attacking the bodys
own tissues as well as attacking germs,
viruses and other foreign substances.
Attack by the immune system causes
inflammation. Where the immune system
is attacking a foreign substance it normally
stops after that substance has been
removed, but in autoimmune diseases
like rheumatoid arthritis the inflammation
is long-lasting (chronic). Finding out why
autoimmune diseases develop is key to
discovering acure for them. Different
autoimmune diseases attack different
tissues, and in rheumatoid arthritis the
joints are affected most.
The genes you inherit from your
parents dont cause rheumatoid
arthritis but theymay increase your
chances of developing it.
What is the outlook? Only about 1 in 20 of those with
rheumatoid arthritis have quite
Because rheumatoid arthritis can affect
severe damage to a lot of their joints.
different people in different ways,
Thecondition may become increasingly
wecant predict how the condition might
worse, often quite quickly. These people
develop for you. However, a study of
tend to have inflammation in other parts
alarge group of people with rheumatoid
of their body besides their joints.
arthritis gave us some general guidelines
(see Figure 4): Blood tests and x-rays will help your
doctor assess how fast your arthritis is
Possibly as many as 1 in 5 people developing and what the outlook for the
with rheumatoid arthritis always have future may be. This will also help your
very mild symptoms that cause few doctor to decide which form of treatment
problems. They may have little or no to recommend.
damage to their joints, or have only very Most people can have periods of
mild damage to a few joints. months or even years between flare-ups,
Most people with rheumatoid arthritis whentheres little inflammation, although
have some damage to a few joints. damage can still be caused in these
10
Arthritis Research UK
Rheumatoid arthritis
Its important to tell
your doctor about
any symptoms you
periods. However, most people, especially
have, even if they
if they get the right treatment, will have dont seem to be
relatively few symptoms and will be able
to lead full lives. The outlook for people
related.
with rheumatoid arthritis isimproving
all the time as new and more effective
treatments become available.
People with rheumatoid arthritis have
a slightly greater chance of having
aheart attack or stroke. It seems
tobe an effect of the inflammation,
and the risk is probably reduced by
controlling the disease, for example
Two kinds of tests may help in confirming
with drug treatments. Other factors
the diagnosis. These are:
such as high cholesterol and smoking
increase the risk, so its a very good blood tests
idea tostop smoking if you have x-rays and other scans.
rheumatoid arthritis. Arthritis Research
UK iscurrently funding research into Blood tests
the link between rheumatoid arthritis Blood tests may be used to detect
and heart attacks. changes in your blood that are produced
by inflammation. The tests to measure
inflammation are:
How is rheumatoid erythrocyte sedimentation rate (ESR)
arthritis diagnosed? C-reactive protein (CRP).
No single test can give a definite diagnosis Both of these may show a high value
of rheumatoid arthritis in the early stages when inflammation is present. The test
of the condition. Doctors have to arrive you have depends on the laboratory your
at a diagnosis based on your symptoms, doctor uses.
a physical examination and the results of
Blood tests can show if youre anaemic
avariety of x-rays, scans and blood tests.
and may be used to detect rheumatoid
Because rheumatoid arthritis can affect factor. Rheumatoid factor is an antibody
other parts of the body, its important produced by a reaction in the immune
totell your doctor about all the symptoms system. The rheumatoid factor test is
youve had, even if they dont seem sometimes called the test for rheumatoid
toberelated. arthritis, but a diagnosis cant be made
based on this alone.
11
About four out of five people with rheumatoid arthritis. Thosewho test
rheumatoid arthritis have positive tests for positive for both rheumatoid factor
rheumatoid factor. However, about 1 in 20 and anti-CCP may havemore severe
people without rheumatoid arthritis have rheumatoid arthritis.
positive results as well, so having a positive
rheumatoid factor test doesnt confirm that
X-rays and other tests
X-rays will show any damage caused
you have rheumatoid arthritis.
to the joints by the inflammation in
On the other hand, only about half of all rheumatoid arthritis. These changes often
people with rheumatoid arthritis have a show up in x-rays of the feet before they
positive test for rheumatoid factor when appear in other joints, so your doctor may
the condition starts, so having a negative want to x-ray your feet even if theyre not
rheumatoid factor test doesnt confirm causing you any problems.
that you dont have rheumatoid arthritis.
Doctors are assessing imaging techniques
Some people with rheumatoid arthritis
such as ultrasound scanning and
never develop rheumatoid factor.
magnetic resonance imaging (MRI) scans
Another antibody test known as anti- to see how useful they are for early
CCP (anti-cyclic citrullinated peptide) is diagnosis and monitoring the conditions
also available. Peoplewho test positive progress (see Figure 5). They may be used
for anti-CCP are very likely todevelop more widely inthefuture.
Fat
Bone
Cartilage
Tendon
Muscle
12
Arthritis Research UK
Rheumatoid arthritis
14
Arthritis Research UK
Rheumatoid arthritis
changing circumstances. Your doctor will What are the possible side-effects?
review your medications for a number A common side-effect of painkillers
of reasons, for example if you develop that contain codeine (like co-codamol
another health problem or if youre going orco-dyramol) is constipation, which can
to have an operation. In some cases you occasionally be severe.
may be advised to stop taking a particular
drug, or change the dosage, before having See Arthritis Research UK leaflet
surgery. Steroids, in contrast, may be Painkillers (analgesics).
increased temporarily to help your body
deal with periods of physical stress. Non-steroidal anti-inflammatory
Drugs may be available under several drugs(NSAIDs)
different names. Each drug has NSAIDs reduce pain and swelling without
anapproved (or generic) name but using steroids, and they start working
manufacturers often give their own within a few hours. The effects of some
brand or trade name to the drug will only last for a few hours but others are
as well. For example, Nurofen is a effective all day. Your doctor will help you
brand name for ibuprofen, which to find the preparation and the best dose
is the approved name. Panadol is for you. There are now about 20 different
a brand name of paracetamol. The NSAIDs available, including ibuprofen,
approved name should always be on diclofenac and naproxen.
the pharmacists label even if a brand NSAIDs are usually taken as tablets
name appears onthe packaging, but orcapsules but many are available
check with your doctor, rheumatology asaliquid, as a suppository to be inserted
nurse specialist or pharmacist if youre into the back passage, or as a cream
in any doubt. Well use the approved or gel that you can apply directly to
names in the sections that follow. the painful area. Tablets and capsules
should be taken with a full glass of fluid,
Painkillers withorshortly after food. Theyre often
Painkillers alone arent enough to treat taken inaddition to painkillers.
rheumatoid arthritis, but theyre useful for
topping up the pain-relieving effects of What are the possible side-effects?
other, more specific drugs. Paracetamol Like all drugs, NSAIDs can sometimes have
is most often used. It may be given alone, side-effects, but your doctor will take
alongside other tablets or as a combination precautions to reduce the risk of these
tablet in which its added to codeine or for example, by prescribing the lowest
other drugs (for example, co-codamol is effective dose for the shortest possible
a tablet that contains paracetamol and period of time.
codeine). Somestronger painkillers such
astramadol are now available.
15
DMARDs are
slow-acting so its
important to keep
taking them even Disease-modifying anti-rheumatic
ifthey dont seem drugs (DMARDs)
tohave any effect DMARDs act by altering the underlying
disease rather than treating the symptoms.
at first. They are slow-acting and are not
painkillers, but over a period of weeks or
months they slow down the disease and
its effects on the joints, which should bring
an improvement in your symptoms. In the
short term you may need faster-acting
drugs like NSAIDs and/or steroids to ease
the pain and stiffness while the DMARDs
NSAIDs can cause digestive problems start to work.
(stomach upsets, indigestion or damage There are two types of DMARD:
to the lining of the stomach) so in most
conventional DMARDs
cases NSAIDs will be prescribed along
with a drug called a proton pump biological therapies.
inhibitor (PPI), which will help to protect These drugs are most effective when
the stomach. treatment is started early on in the
Although the increase is small, NSAIDs disease. Most people with rheumatoid
also carry an increased risk of heart attack arthritis should expect to take them for
or stroke. Your doctor will be cautious many years or even for life. Youll need
about prescribing NSAIDs if there are regular check-ups when youre taking
other factors that may increase your DMARDs, which may include blood and
overall risk for example, smoking, urine tests. This is to look for any possible
circulation problems, high blood pressure, side-effects but also to assess how well
high cholesterol or diabetes. the drugs are working for you. With
careful supervision, these drugs are well
Dampening down inflammation early tolerated and very effective.
isone of the important ways in which
treatment of rheumatoid arthritis Conventional DMARDs
has advanced and is one reason why These are slow-acting and can take
treatment is more effective than several weeks to work, so its important
itused to be. to keep taking them even ifthey dont
seem to have any effect atfirst. Many of
See Arthritis Research UK these drugs can be used in combination
drugleaflet Non-steroidal anti- with each other, which increases
inflammatory drugs (NSAIDs). their effectiveness. Methotrexate and
sulfasalazine are commonly used
16
Arthritis Research UK
Rheumatoid arthritis
Gold injections are given into a muscle once a week to begin with, though it may
(Myocrisin): be possible to take them less often after a time
can be continued for life if theyre helpful
can cause side-effects including problems with the blood,
kidneysor skin, so regular blood and urine tests are needed
can sometimes cause an allergic reaction, which is slightly
morelikely if youre taking ACE inhibitors for heart disease
orbloodpressure.
Leflunomide (Arava): is taken in tablet form once a day, with or without food
can affect the blood, blood pressure or liver, so regular blood tests
and blood pressure checks are needed.
17
Disease-modifying anti-rheumatic drugs (DMARDs) continued:
Methotrexate: is usually taken in tablet form once a week on the same day,
thoughitmay be given by injection if you have problems taking
the tablets
can affect the blood or the liver, so regular blood tests are required
can cause some side-effects, for example nausea, so folic acid
tablets may be recommended to reduce the risks of side-effects
affects the immune system so youll need careful monitoring
can interact with alcohol and damage the liver, so drink only small
amounts of alcohol.
DMARDs, but if one drug doesnt work Why are new drugs not always
well for you, or if you develop any side- available to all patients in the UK?
effects, then your doctor may suggest There are two things that affect whether
trying one of the others. these drugs can be used in the UK.
The drug must first be licensed by the
See Arthritis Research UK Medicines and Healthcare Products
drugleaflets Azathioprine; Gold Regulatory Agency (MHRA) or the
injections; Hydroxychloroquine; European Medicines Evaluation Agency
Leflunomide; Methotrexate; (EMEA). This allows the manufacturer to
Sulfasalazine. market the drug in the UK for specific
conditions. However, some doctors and
Biological therapies NHS trusts will decide not to prescribe the
Biological therapies (also known as drug until national guidance on its use
biologics) are newer drugs that have has been issued. This guidance advises
been developed in recent years as a doctors on which drugs should be tried
result ofresearch into the processes in first, in what situations, and when different
the body that lead to inflammation and treatments should be offered instead.
damage in the joints. Biological therapies This guidance is issued by the National
target individual molecules involved in Institute for Health and Care Excellence
these processes and have proved very (NICE) in England, the All Wales Medicines
effective in the treatment of rheumatoid Strategy Group, the Scottish Medicines
arthritis. Several biological therapies Consortium, or the Department of Health,
target a protein called tumour necrosis Social Services and Public Safety in
factor (anti-TNF drugs), while others target Northern Ireland.
differet proteins.
Biological therapies tend to work more
quickly than conventional DMARDs,
though it may still be several weeks or
months before you feel the full benefit.
Biological therapies are only given
when conventional DMARDs alone
havent worked well enough. In most Drugs must be
cases, they are given in combination
with a conventional DMARD such
licensed and
as methotrexate. However, in some approved before
cases biological therapies may be
given on their own if conventional
they can become
DMARDs arent suitable for you. widely available.
19
Anti-TNF drugs:
Adalimumab is given by injection under the skin once every other week
(Humira):
Certolizumab pegol is given by injection under the skin every two weeks this can
(Cimzia): bereduced to a maintenance dose after the first three injections
Etanercept (Enbrel): is given by injection under the skin twice (or sometimes once)
aweek
Infliximab is usually given by infusion (a drip into a vein) the second
(Remicade): infusion will be two weeks after the first, followed by a third one
fourweeks after that and then an infusion every eight weeks
20
Arthritis Research UK
Rheumatoid arthritis
21
Alert card Biological Therapy
If youre prescribed a biological therapy,
we recommend you carry a biological
therapy alert card, which you can get
from your doctor or rheumatology nurse,
or at www.arthritisresearchuk.org. If you
become unwell, anyone treating you will
know that youre on biological therapy
and are therefore at risk of its side-
effects, including infections.
22
Arthritis Research UK
Rheumatoid arthritis
Steroids
Steroids (sometimes known by their
full name, corticosteroids) arent the
same as the steroids used by athletes to
build up their body (anabolic steroids).
Somesteroids, like cortisone, are
hormones that are produced naturally
bythe body. Cortisonewas first used
23
A physiotherapist
can suggest
exercises to
help ease your cataracts
symptoms and a rise in blood sugar or blood pressure
stretch your joints. increased risk of developing infections.
Doses of steroid tablets are kept as
low as possible to keep the risk of side-
effects to a minimum. Your doctor
may also advise that you take calcium
and vitamin D supplements or drugs
called bisphosphonates alongside the
steroidsto help protect your bones
Steroids can be given:
against osteoporosis.
by injection into the joint itself
(intra-articular) You shouldnt stop taking your steroid
by injection into a muscle tablets or alter the dose unless advised
(intramuscular) or vein (intravenous) to by your doctor. It can be dangerous
these are sometimes called pulses to stop steroids suddenly.
in tablet form.
See Arthritis Research UK booklet
What are the possible side-effects? and drug leaflets Osteoporosis; Local
Steroid injections have few side-effects, steroid injections; Steroid tablets.
but they may include:
thinning and other changes in the skin Physical therapies
at the site of the injection (atrophy) Looking after your joints is very important
facial flushing in the treatment of rheumatoid arthritis.
Exercise is an important part of this,
interference with the menstrual cycle and a physiotherapist can suggest
changes in mood, although this is more different exercises that may help ease
common in people with a history of your symptoms, strengthen muscles
mood disturbances. and stretch your joints safely. They can
Steroid tablets tend to have more side- also teach you about joint protection
effects, particularly when theyre used and can refer you to other healthcare
in high doses. These include the same professionals ifnecessary.
side-effects as for the injections, but may A podiatrist can help with problems with
also include: your feet and ankles. They can advise
weight gain you on how to reduce pain when youre
standing or walking and can suggest
thinning of the bones (osteoporosis) suitable footwear for both daily life
muscle weakness andsport.
24
Arthritis Research UK
Rheumatoid arthritis
25
Because of this unpredictability, its
See Arthritis Research UK booklets tempting to do all your jobs when youre
Foot and ankle surgery for arthritis; having a good day. But overdoing it on
Hand and wrist surgery; Hip replacement the good days can cause a flare-up the
surgery; Knee replacement surgery; next day. Pacing yourself is an important
Shoulder and elbow joint replacement. aspect of learning to live with rheumatoid
arthritis. Make it clear to your family
and friends that not all days are the
Self-help and daily living same. Itsimportant they realise that
The symptoms of rheumatoid arthritis activities you enjoy on a good day may be
tend to come and go with no particular impossible on a bad one.
pattern, and you may have flare-ups. The effects of any condition can be
Sometimes flare-ups have an obvious mental as well as physical, andpeople
cause, such as another illness or stress, with rheumatoid arthritis are more likely
but usually theres no obvious trigger. to experience depression. Howyou feel
Thisunpredictability is frustrating and mentally can also affect how you feel
makes it difficult to plan ahead. physically, so if you feel down or depressed
it can make your symptoms harder to cope
with. Dont be embarrassed to talk about
this with your doctor if youre feeling low
managing how you feel is as important
as managing the physical symptoms.
There are also support groups available if
you want to meet other people who have
rheumatoid arthritis, and you might find
that information on pain management
helps you to stay positive.
Managing a flare-up
Over time, you may get better at noticing
the early signs of a flare-up. Sometimes
afew days rest are all you need, though
its important to do gentle exercise to
help ease stiffness. Someof the following
tips will also help you to cope with a
flare-up and to manage your symptoms
in general. Dont forget that you can also
take painkillers, andapplyinghot or cold
pads (for example a hot-water bottle or
Arthritis Research UK
Rheumatoid arthritis
pack of frozen peas) to affected joints may another activity that you enjoy. See Figure
ease pain too. Make sure you dont apply 6 for alist of recommended exercises.
them directly to the skin to avoid injury. Figure 6 Recommended exercises for
If youre having regular flare-ups, people with rheumatoid arthritis
youshould mention this to your doctor. Recommended Not recommended
Itmay be that you need to review
Low-impact sports: Contact sports:
yourtreatment.
swimming rugby
See Arthritis Research UK booklets cycling football
Fatigue and arthritis; Pain and arthritis. walking Vigorous, high-
aquarobics impact sports:
squash
Exercise
Its important to strike a balance between step exercises
rest and exercise. Rest will make inflamed
joints feel more comfortable, but without Swimming is a particularly good way
movement your joints will stiffen and ofexercising for people with rheumatoid
muscles will become weaker. Its possible arthritis. It exercises the whole body
to exercise the muscles without even but puts minimal strain on your joints
moving the joint by doing isometric because the water supports your
exercises. These exercises are done weight. Contact sports and vigorous
in static positions so the joint angle types ofexercise should be avoided.
and muscle length doesnt change. Whicheversport or exercise you do, make
Manyyoga positions are isometric sure you warm upproperly.
exercises. A physiotherapist may be able If you go to a gym or health club, tell the
to suggestsome of this type of exercise. instructor about your condition so that
Youll need to find out for yourself what they can draw up a suitable exercise plan
the right balance is for you. for you. Your physiotherapist can advise
Exercise is good for your general health, you about this too.
so use your muscles and joints as much Take care when you choose footwear for
as you can without harming them. sports. Good shoes with shock-absorbing
Ifaparticular activity causes one or soles are essential. A podiatrist will be
more of your joints to become warm able to advise you on suitable footwear
and swollen, or if it causes severe pain, ifnecessary.
stop and rest. If not, you should be
fine to continue. If aparticular activity See Arthritis Research UK booklets
always causes a flare-up of symptoms, Keep moving; Looking after your joints
itsprobably best to avoid it and find when you have arthritis.
27
Whichever sport
or exercise you do,
make sure you warm
up properly. before starting any strict diet as the
disadvantages may outweigh the
advantages.
Keeping to a healthy weight is strongly
recommended. Because of the way the
joints work, the force put through your
knees when you walk, run or go up
and down stairs can be up to five or six
times your body weight, so keeping your
weight down will help reduce the strain
on your joints.
Diet and nutrition Occasionally some people with arthritis
You might see stories in the media about find that a specific type of food upsets
diets that claim to cure rheumatoid them, but this is quite unusual. The foods
arthritis. Although a specific diet wont that do this vary from person to person.
cure rheumatoid arthritis, theres some If you think you may be intolerant of
scientific evidence that certain diets help a particular food, try removing it from
ease the symptoms for some people. your diet for at least a month and then
The diets most likely to help are low in reintroducing it. If you do have a food
saturated fats and high in unsaturated intolerance youll notice a flare-up in your
fats, especially omega-3 fatty acids, arthritis within a few days.
which are found in oily fish. In the UK,
dietary guidelines recommend eating See Arthritis Research UK booklet
two portions of fish a week, including one Diet and arthritis.
oily, but you can take fish oil supplements
to top up your levels of omega-3. We Complementary medicine
recommend taking pure fish body oil Many people with rheumatoid arthritis
rather than fish liver oil. Increasing your try different types of complementary
intake of vitamin C may also help. medicine. Most types havent been
Theres some evidence that a very proven to be effective in the treatment
strict vegetarian diet can help to ease of rheumatoid arthritis, but there are
the symptoms of rheumatoid arthritis, a couple that have some scientific
although the reasons for this arent evidence to support their use, including
clear. People who eat a lot of red meat fish body oil. Eveningprimrose oil (EPO)
may have a slightly increased risk and borage seed oil may also offer some
of developing rheumatoid arthritis. benefit, although evidence for these is
Speak toyour doctor or a dietician morelimited.
28
Other types of complementary medicine In many cases the risks linked with
that may ease your symptoms are complementary and alternative therapies
acupuncture, which is generally available are more to do with the therapist than the
on the NHS, and massage. Massage is therapy. Its important to go to a legally
often soothing and relaxing, although registered therapist or one whos fully
theres little evidence that specific oils insured and has a set ethical code.
add any particular benefit. Homeopathy If you decide to try therapies or
hasnt been proven to ease the symptoms supplements, you should be critical
ofrheumatoid arthritis. ofwhat theyre doing for you, and base
Generally speaking, complementary your decision to continue on whether
and alternative therapies are relatively younotice any improvement.
well tolerated, although there are some
risks linked with specific therapies. See Arthritis Research UK booklet
Herbalremedies in particular may interfere Complementary and alternative
with your medication, and you should medicine for arthritis.
discuss using any form of complementary
therapy with your doctor before you try
it. You should also think about what the
potential side-effects might be.
30
Arthritis Research UK
Rheumatoid arthritis
Supports, aids and gadgets Check that your bed is supportive and
Its very important to protect your joints comfortable. If your neck and shoulders
from unnecessary strain. Thereare are stiff or painful, try experimenting with
different ways of carrying out many different pillows.
everyday activities, so use the methods If youre having trouble winding down,
that put the least strain on your joints. try to get into a bedtime routine.
An occupational therapist can give Avoideating, smoking and drinking tea,
youdetailed advice about changing the coffee and alcohol close to bedtime.
way you do things to reduce strain and Regular exercise should help you to sleep,
using simple aids or adaptations to make but dont exercise within three hours of
tasks easier. going tobed.
A huge variety of gadgets is available Discuss your sleep problems with your
tohelp with daily tasks, whether at doctor or rheumatology nurse specialist.
work, around the home or in the garden. Although doctors advise against using
Help ofthis sort can often allow you to sleeping tablets in the long term, theycan
continue many activities. You can buy be useful for short spells when alack
gadgets from specialist shops as well as ofsleep is a serious problem.
many department stores and the Arthritis
Research UK online shop. If youre stiff when you wake up, try these
exercises while still lying in bed:
Sleep 1. Bend one leg so your foot is flat on the
Aside from the fatigue caused by bed. Hold the other leg straight and lift
inflammation, you may find that you the foot just off the bed. Hold for a slow
become tired because your sleep is count of five then lower. Repeat five
affected. People with rheumatoid arthritis times with each leg.
are also much more likely to suffer 2. Lie on your back. Pull each knee to
disturbed sleep than those who dont yourchest in turn, keeping the other
have arthritis. Lack of restful sleep can legstraight.
make it more difficult to cope with your
symptoms. If youre not sleeping well, 3. If youre able to, lie on your back,
thefirst thing to do is to work out why: handsbehind your head (or by your
side if your shoulders are painful).
Are you being kept awake/woken up
Bendyour knees and, keeping your feet
bypain and stiffness during the night?
to the floor, roll your knees to one side
Are you finding it difficult to slowly. Holdthis position for 10 seconds.
winddown? Repeatthis three times for each side.
If pain and stiffness are affecting your
sleep, taking painkillers or having a warm See Arthritis Research UK booklet
bath before going to bed may help. Sleep and arthritis.
31
Sex and pregnancy Most mothers with rheumatoid arthritis
Theres no reason why you should feel better during the pregnancy though
stop having sex. You may find that symptoms are likely to return once the
some positions are more comfortable, baby is born. The reason for this isnt fully
soexperiment to find suitable ones. understood, but it seems that the mothers
Tiredness might affect your desire immune system is partially suppressed
for sex, so talk to your partner. totolerate the growing baby. As the
Goodcommunication is the key to activity of the immune system is reduced,
resolving anydifficulties. so is the inflammation in the joints. Any
flare-up of symptoms after the birth can
The contraceptive pill wont make a
usually be dealt with quickly.
difference to your arthritis or its treatment,
so its fine to keep taking it. Theres no
reason why you shouldnt have a baby See Arthritis Research UK booklets
ifyou do want children, but its important Pregnancy and arthritis; Sex and arthritis.
to make sure youre not taking any drugs
that could harm them. Discuss your plans Work
with your doctor well in advance as you With modern treatments its usually
may need to change your medications possible to keep on working, unless your
some time before you start trying. job involves a lot of manual labour, such as
This is important for both men and lifting heavy items. Help is available if your
women to do if either partner is taking workplace needs to be adapted because
certain drug treatments before or at the of your condition. Theemployment service
time of conception, itcan affect the offers help if you do need to change
babys development. your job or retrain ask the Disability
Employment Adviser at your local
Jobcentre or Jobcentre Plus office.
Some employers worry that people with
rheumatoid arthritis will have to take
alot of time off. This isnt usually the case.
Although you may need some time off
work to attend outpatient clinics and
Most mothers drug monitoring appointments, thesecan
often be arranged for times that are
with rheumatoid convenient for you so that your work
arthritis feel isdisrupted as little as possible.
32
Arthritis Research UK
Rheumatoid arthritis
Anti-TNF drugs
were pioneered
and developed by
Arthritis Research UK.
Patient stories
Because rheumatoid arthritis is
sovariable, we cant say these stories are
typical and they dont necessarily suggest
what will happen to you, but they may
help you to understand some of the
different ways rheumatoid arthritis can
affect people.
Meeras story
Research and new Ive had rheumatoid arthritis for
developments 24years now. It started in my 40s and
Arthritis Research UK have set up a came on really quickly. At first I noticed
network of experimental arthritis swellingand stiffness in my hands,
treatment centres with the aim of butsoon it had spread to most of my
speeding up the development of joints. This was the hardest time for me;
treatments. We also funded research I felt rotten and very stiff a lot of the
at Newcastle University, which has time, and I was scared about the future.
discovered a new way of potentially Luckily, my doctor realised it was arthritis
treating rheumatoid arthritis by preventing straight away. Because I was very active,
damaging white blood cells from entering I was sentfor a short spell of intensive
the joints. treatment in hospital and the condition
slowly settled down.
The SARAH (strengthening and stretching
for rheumatoid arthritis of the hand) trial, Since then, Ive developed a minor
which looked at specific hand exercises, deformity in my hands and Ive had
has also shown some promising results, an operation on my toes, which were
and researchers are now looking at ways of damaged by the arthritis. I also use a wrist
training healthcare professionals to deliver support in the kitchen and take tablets
the exercise programme around the UK. every day.
Were continuing to fund different strands These days Im doing great. I have to be
of research into the causes and treatments careful about my arthritis, but I can still
of rheumatoid arthritis you can find do the things I love and I have no trouble
out more at our website getting out and about. I still get pain and
www.arthritisresearchuk.org/research. stiffness, but its well controlled and I feel
healthy. On the whole Im just thankful
that I can get on with my life and that
the arthritis doesnt get in the way of
meliving my life to the full.
34
Arthritis Research UK
Rheumatoid arthritis
36
Arthritis Research UK
Rheumatoid arthritis
37
Podiatrist a trained foot specialist.
Theterms podiatrist and chiropodist
mean the same thing, although podiatrist
tends to be preferred by the profession.
NHS podiatrists and chiropodists are
registered with the Health Professions
Council (HPC), having followed a 3-year
university-based training programme.
The podiatrist or chiropodist can deal
with many of the foot problems caused
by arthritis.
Proton pump inhibitor (PPI) a drug
that acts on an enzyme in the cells of the
stomach to reduce the secretion of gastric
acid. Theyre often prescribed along with
non-steroidal anti-inflammatory drugs
(NSAIDs) to reduce side-effects from
theNSAIDs.
Rheumatoid nodule a small lump
of tissue which forms under the skin.
Nodules are most common on the
elbows, where theyre usually painless.
Although theyre less common on the feet
they tend to be more troublesome when
they develop there.
Synovial fluid the fluid produced within
the joint capsule that helps to nourish the
cartilage and lubricate the joint.
Synovium the inner membrane of the
joint capsule that produces synovial fluid.
Tendon a strong, fibrous band or cord
that anchors muscle to bone.
Ultrasound scan a type of scan that
uses high-frequency sound waves to
examine and build up pictures of the
inside of the body.
38
Arthritis Research UK
Rheumatoid arthritis
Where can I find out more? Living with long-term pain: a guide to
self-management
If youve found this information useful
you might be interested in these other Looking after your joints when you
titles from our range: havearthritis
Conditions
Meet the rheumatology team
Osteoarthritis Pain and arthritis
Osteoporosis Practitioner-based complementary and
alternative therapies for the treatment
What is arthritis? of rheumatoid arthritis, osteoarthritis,
Therapies fibromyalgia and low back pain (60-page
Hydrotherapy and arthritis special report)
Occupational therapy and arthritis Pregnancy and arthritis
Physiotherapy and arthritis Sex and arthritis
Sleep and arthritis
Surgeries
Foot and ankle surgery for arthritis Vaccinations and arthritis
Hand and wrist surgery Work and arthritis
Hip replacement surgery Drug leaflets
Knee replacement surgery Adalimumab
Shoulder and elbow joint replacement Azathioprine
Certolizumab pegol
Self-help and daily living
Caring for someone with arthritis Drugs and arthritis
Complementary and alternative Etanercept
medicinefor arthritis Gold injections
Complementary and alternative Golimumab
medicines for the treatment of
Hydroxychloroquine
rheumatoid arthritis, osteoarthritis and
fibromyalgia (63-page special report) Infliximab
Diet and arthritis Leflunomide
Fatigue and arthritis Methotrexate
Feet, footwear and arthritis Non-steroidal anti-inflammatory drugs
(NSAIDs)
Keep moving
Painkillers (analgesics)
39
Rituximab British Acupuncture Council
Local steroid injections 63 Jeddo Road
London W12 9HQ
Steroid tablets Phone: 0208 735 0400
Sulfasalazine www.acupuncture.org.uk
Tocilizumab British Holistic Medical Association
You can download all of our booklets (BHMA)
andleaflets from our website or order West Barn
them by contacting: Chewton Keynsham
Bristol BS31 2SR
Arthritis Research UK www.bhma.org
Copeman House British Medical Acupuncture
St Marys Court Society
St Marys Gate BMAS House
Chesterfield 3 Winnington Court, Northwich
Derbyshire S41 7TD Cheshire CW8 1AQ
Phone: 0300 790 0400 Phone: 01606 786782
www.arthritisresearchuk.org Email: admin@medical-acupuncture.
org.uk
The following organisations may also www.medical-acupuncture.co.uk
beable to provide additional advice British Reflexology Association
andinformation: Monks Orchard, Whitbourne
Arthritis Care Worcester WR6 5RB
Floor 4, Linen Court Phone: 01886 821207
10 East Road Email: bra@britreflex.co.uk
London N1 6AD www.britreflex.co.uk
Phone: 020 7380 6500 Brook (sexual health service and advice
Helpline: 0808 800 4050 for under-25s)
Email: info@arthritiscare.org.uk Helpline: 0808 802 1234
www.arthritiscare.org.uk Text service: 07717 989023
Assist UK www.brook.org.uk
Redbank House www.brook.org.uk/find-a-centre
4 St Chads Street (for your nearest centre)
Manchester M8 8QA Brook also offer a webchat service: visit
Phone: 0161 832 9757 their website for more information.
Helpline: 0161 850 9757
Email: general.info@assist-uk.org
www.assist-uk.org
40
Arthritis Research UK
Rheumatoid arthritis
41
Jobcentre Plus Ricability (consumer research charity
www.gov.uk/contact-jobcentre-plus providing free reports for older and
Motability (car scheme) disabled people)
Phone: 0300 456 4566 Unit G03
www.motability.co.uk The Wenlock
5052 Wharf Road
National Institute of Medical Herbalists London N1 7EU
Clover House Phone: 0207 427 2460
James Court, South Street Email: mail@rica.org.uk
Exeter EX1 1EE www.rica.org.uk
Phone: 01392 426022
Email: info@nimh.org.uk Thrive (charity that uses gardening to
www.nimh.org.uk change the lives of disabled people)
The Geoffrey Udall Centre
National Rheumatoid Arthritis Beech Hill
Society (NRAS) Reading RG7 2AT
Ground Floor, 4 The Switchback Phone: 0118 988 5688
Gardner Road Email: info@thrive.org.uk
Maidenhead www.thrive.org.uk
Berkshire SL6 7RJ www.carryongardening.org.uk
Phone: 0845 458 3969 or 01628 823524
Helpline: 0800 298 7650 Links to third-party sites and resources
Email: helpline@nras.org.uk are provided for your general information
www.nras.org.uk only. We have no control over the
contents of those sites or resources
Relate (relationship support)
and we give no warranty about their
Premier House, Carolina Court
accuracy or suitability. You should always
Lakeside
consult with you GP or other medical
Doncaster DN4 5RA
professional.
Phone: 0300 100 1234
www.relate.org.uk Please note: Weve made every effort
www.relate.org.uk/find-your-nearest- to make sure that this content is correct
service (for your nearest centre) at time of publication. If you would like
Relate also offer phone and email further information, or if you have any
counselling services: visit their website for concerns about your treatment, you
more details. should discuss this with your doctor,
rheumatology nurse or pharmacist.
42
Arthritis Research UK
Rheumatoid arthritis
Notes
43
Were here to help
Arthritis Research UK is the charity date with current research and education
leading the fight against arthritis. news, highlighting key projectsthat were
Were the UKs fourth largest medical funding and giving insight into the latest
research charity and fund scientific and treatment and self-help available.
medical research into all types of arthritis We often feature case studies and
and musculoskeletal conditions. haveregular columns for questions
Were working to take the pain away andanswers, as well as readers hints
forsufferers with all forms of arthritis andtips for managing arthritis.
andhelping people to remain active.
Welldo this by funding high-quality
Tell us what you think
research, providing information
andcampaigning. Please send your views to:
feedback@arthritisresearchuk.org
Everything we do is underpinned
or write to us at:
byresearch.
Arthritis Research UK, Copeman
We publish over 60 information booklets House, St Marys Court, St Marys Gate,
which help people affected by arthritis Chesterfield, Derbyshire S41 7TD
to understand more about the condition,
its treatment, therapies and how
A team of people contributed to this booklet.
tohelpthemselves.
The original text was written by Dr David
We also produce a range of separate Walker, who has expertise in the subject.
leaflets on many of the drugs used It was assessed at draft stage by specialist
forarthritis and related conditions. physiotherapist Astrid Matts and specialist
Werecommend that you read the occupational/hand therapist Caroline Wood.
relevant leaflet for more detailed An Arthritis Research UK editor revised
information about your medication. the text to make it easy to read, and a non-
medical panel, including interested societies,
Please also let us know if youd like checked it for understanding. An Arthritis
toreceive our quarterly magazine, Research UK medical advisor, Prof. Anisur
Arthritis Today, which keeps you up to Rahman, is responsible for the overall content.
44
Get involved
You can help to take the pain away
from millions of people in the UK by:
volunteering
supporting our campaigns
taking part in a fundraising event
making a donation
asking your company to support us
buying products from our online and
high-street shops.
www.arthritisresearchuk.org
Registered Charity England and Wales No. 207711, Scotland No. SC041156
Arthritis Research UK 2011
Published June 2014 2033/RA/14-1