Rheumatoid arthritis usually manifests over a period of several months. However for some people it can appear much more rapidly. A thorough examination by an experienced doctor is the first step to diagnosis. They may ask if there’s a family history of the disease.
Blood tests can reveal signs of inflammation and the presence of ‘rheumatoid factor’ (an antibody present in about 80% of people with rheumatoid arthritis), although this antibody can also be found in other inflammatory autoimmune diseases. A different autoantibody directed against so called citrullinated peptides is specific for rheumatoid arthritis — it too occurs in around 80% of cases.
An x-ray may also be taken to determine if any damage to cartilage or bones has occurred, although this is usually only seen in later stages of the disease.
Supportive treatments include:
- Physiotherapy: heat, cold and exercises to relieve pain and stiffness, improve joint movement and strengthen the muscles
- Rest: when there is a worsening of joint inflammation
- Occupational therapy: including training, advice, counselling, splinting, as well as walking aids and specialised utensils to help with daily activities.
Drugs (often taken in combination) play an important role in dampening the underlying inflammatory and autoimmune process, but must be taken under the supervision of a rheumatologist to minimise the risk of side effects. They include:
- Non-steroidal anti-inflammatory drugs (NSAIDs): these lessen inflammation.
- Corticosteroids: used sparingly in more severe cases.These work by suppressing the immune response.
- Disease-modifying anti-rheumatic drugs (DMARDs): these can slow the progress of disease. They now include antibodies directed either against inflammatory substances known as ‘cytokines’, in particular one called TNF which work against the immune cells responsible for joint inflammation. These antibodies represent the most significant advance in treating rheumatoid arthritis in the past 40 years.
Diet is a factor that may influence the severity of symptoms. Fish oils that contain omega-3 fatty acids have been found to help reduce inflammation associated with arthritis.
In some cases, surgery (for example, a knee replacement) is an option, especially if a joint has been badly damaged.