--- title: "Rheumatoid arthritis: Symptoms & Treatment | HealthAnswers" description: "Rheumatoid arthritis (RA) — joint pain and swelling, morning stiffness, diagnosis, NHS DMARD treatment, and when to see a GP urgently." url: https://healthanswers.co.uk/conditions/rheumatoid-arthritis/ robots: noindex --- # Rheumatoid arthritis: Symptoms & Treatment | HealthAnswers Health A–Z Rheumatoid arthritis (RA) — joint pain and swelling, morning stiffness, diagnosis, NHS DMARD treatment, and when to see a GP urgently. Written by HealthAnswers editorial team Medically reviewed by [HealthAnswers UK doctor review panel](https://healthanswers.co.uk/our-doctors/) Reviewed 3 July 2026 ## Quick answer What is rheumatoid arthritis? Rheumatoid arthritis is an autoimmune disease causing painful, swollen joints — often hands, wrists, and feet — with morning stiffness lasting over 30 minutes. It can affect the whole body including fatigue. Early treatment with disease-modifying drugs (DMARDs) like methotrexate prevents joint damage. See a GP urgently if you have hot, swollen joints with fever — exclude septic arthritis. ## Who is this page for? This page is for people in the UK who want a plain-English overview of Rheumatoid arthritis, including when to seek help and what NHS care usually involves. It explains general information, not what is wrong with you personally. ## Who should skip this page? Skip this page if you need a diagnosis, a prescription, or emergency care. It cannot replace a GP, pharmacist, NHS 111 or 999. If you are in immediate danger, call 999; for urgent advice that is not life-threatening, call 111 in England, Scotland or Wales, or use your GP out-of-hours service in Northern Ireland. On this page 9 sections ## Key facts about rheumatoid arthritis - RA affects about 1 in 100 people in the UK — women more than men; peak onset 40 to 60. - Symmetrical joint swelling (both hands, both wrists) and prolonged morning stiffness suggest RA. - Early referral to rheumatology and DMARDs within 3 months of symptom onset improves long-term outcomes. - Methotrexate is the most common first-line DMARD — requires blood monitoring. - RA increases cardiovascular disease risk — manage blood pressure, cholesterol, and stop smoking. ## Rheumatoid arthritis — autoimmune joint disease **Rheumatoid arthritis (RA)** is a **chronic autoimmune disease** where the immune system attacks **joint lining (synovium)**, causing **inflammation, pain, swelling, and progressive damage**. Unlike [osteoarthritis](https://healthanswers.co.uk/conditions/osteoarthritis/) (wear-and-tear), RA is **systemic** — it can affect **lungs, heart, eyes**, and increase **cardiovascular risk**. Affects roughly **400,000 people** in the UK — **women twice as often** as men. **Early treatment** within **3 months** of symptom onset prevents irreversible joint erosions. ## Symptoms **Joint features:** - painful, swollen, warm joints - symmetrical pattern — both hands, both wrists, both feet - morning stiffness lasting >30 minutes — key inflammatory clue - small joints — MCP, PIP finger joints, wrists, MTP toes - spares DIP joints (end finger joints) — unlike osteoarthritis **Systemic:** - fatigue — often disproportionate - low-grade fever , weight loss - rheumatoid nodules — firm lumps under skin (advanced) **Variable course:** flares and remissions — without treatment, progressive deformity. ## Extra-articular manifestations RA can affect: - eyes — scleritis, dry eyes - lungs — interstitial lung disease, nodules - heart — increased MI and stroke risk - blood — anaemia of chronic disease - ** nerves** — cervical spine instability (rare, atlanto-axial) ## Diagnosis GP suspects RA from history and examination. **Refer urgently to rheumatology** if: - ≥3 swollen joints - positive RF or anti-CCP antibodies - elevated CRP/ESR with typical pattern **Blood tests:** - ** rheumatoid factor (RF)** — not specific alone - anti-CCP antibodies — more specific for RA - CRP, ESR — inflammation markers - FBC — anaemia common **Imaging:** - X-rays — erosions in established disease - ultrasound/MRI — early synovitis — rheumatology ## Treatment — treat-to-target Goal: **clinical remission** or low disease activity — prevents damage. ### First-line DMARDs **Methotrexate** — anchor drug: - weekly oral or subcutaneous injection - folic acid supplementation - blood monitoring — FBC, LFTs every 1 to 3 months initially - contraception — teratogenic; stop before pregnancy with specialist plan **Alternatives/additions:** - hydroxychloroquine - sulfasalazine - leflunomide Often **combination DMARDs** early. ### Short-term - NSAIDs — ibuprofen, naproxen — symptom relief, not disease-modifying - steroid injections into joints or short oral prednisolone bridge while DMARDs work ### Biologics If DMARDs insufficient — **anti-TNF** (adalimumab, etanercept), **rituximab**, **tocilizumab**, **abatacept**, **JAK inhibitors** (tofacitinib, baricitinib) — rheumatology specialist. ### Physiotherapy and occupational therapy Joint protection, splints, exercise — maintain function. ## Lifestyle - stop smoking — worsens RA and reduces treatment response - cardiovascular risk management — statins, BP control — RA equals diabetes-level CV risk - vaccinations — flu, pneumococcal; avoid live vaccines on biologics - weight management - ** exercise** — maintains strength without flaring joints — physiotherapy guides ## RA vs other conditions | Condition | Clues | | --- | --- | | Osteoarthritis | Older, asymmetric, bony enlargement, short stiffness | | Gout | Sudden monoarthritis, big toe, uric acid | | Psoriatic arthritis | Psoriasis skin/nail changes, asymmetric | | Viral arthritis | Self-limiting post-viral | | Septic arthritis | Single hot joint, systemically unwell — emergency | ## Pregnancy and RA Many DMARDs **unsafe in pregnancy** — preconception rheumatology planning: - hydroxychloroquine , sulfasalazine , azathioprine — relatively safer options under specialist care - methotrexate, leflunomide, biologics — stop before conception per guidance RA may **improve, worsen, or fluctuate** in pregnancy. ## Prognosis **Without treatment:** progressive disability, erosions, loss of work capacity. **With early modern therapy:** majority achieve **low disease activity or remission** — normal life expectancy approaching general population if CV risk managed. **Window of opportunity:** first **3 to 6 months** — do not delay specialist referral. Rheumatoid arthritis is serious but **transformed by early DMARD treatment** — persistent hand/wrist swelling with long morning stiffness needs GP assessment, not paracetamol alone. ## ! When to see a GP about rheumatoid arthritis See a GP if you have painful, swollen joints lasting more than 6 weeks — especially symmetrical hand/wrist/foot joints with morning stiffness over 30 minutes. Urgent same-day assessment for a hot, red, severely painful single joint with fever — possible septic arthritis (999/A&E if systemically unwell). Early rheumatology referral is recommended — do not accept "wait and see" for suspected inflammatory arthritis. ## Common questions about rheumatoid arthritis What are the first signs of rheumatoid arthritis? Painful, stiff, swollen joints — often small joints of hands and feet, wrists, knees. Morning stiffness lasting over 30 minutes improving with movement. Fatigue, low-grade fever, and general unwellness. Usually develops over weeks — not sudden single joint unless septic arthritis. What is the difference between rheumatoid arthritis and osteoarthritis? RA is autoimmune inflammation — symmetrical small joint swelling, long morning stiffness, systemic symptoms. Osteoarthritis is wear-and-tear — usually asymmetric, worse with use, short morning stiffness, larger weight-bearing joints. Blood tests and examination distinguish — GP refers if unsure. Is rheumatoid arthritis curable? No cure — but modern DMARDs and biologics induce remission in many people, preventing erosions and disability. Early aggressive treatment changes prognosis dramatically compared to historical outcomes. What is methotrexate for rheumatoid arthritis? First-line DMARD — weekly tablets or injection — suppresses immune inflammation slowing joint damage. Takes 6 to 12 weeks for full effect. Requires regular blood tests for liver and blood count. Folic acid co-prescribed. Not safe in pregnancy — contraception essential. Can diet cure rheumatoid arthritis? No specific diet cures RA — Mediterranean-style anti-inflammatory eating supports general health. Fish oil may modestly help symptoms. Avoid unproven restrictive diets that cause malnutrition. Weight loss reduces joint load if overweight. Does rheumatoid arthritis run in families? Partial genetic risk — first-degree relatives have higher incidence but most cases are sporadic. Smoking is the strongest modifiable environmental risk factor — especially in people with genetic susceptibility (shared epitope). ## Sources - [NHS — Rheumatoid arthritis](https://www.nhs.uk/conditions/rheumatoid-arthritis/) - [NICE — Rheumatoid arthritis management](https://www.nice.org.uk/guidance/ng100)