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What is it?

Rheumatoid arthritis (RA) is a chronic disease that affects the joints. The hand and wrists are most commonly affected but also elbows, neck, shoulders, hips, knees, feet and jaw. RA causes swelling, stiffness, pain and loss of function in the joints. Other symptoms include fatigue, fever and a sense of not feeling well (malaise). Some people with RA develop anaemia. It also increases the risk of thinning of the bones -osteoporosis, particularly if someone is taking corticosteroid drugs such as prednisone. The disease can affect other bodily organs as well and cause dry eyes and mouth - symptoms of Sjögren’s syndrome

Early treatment (within six weeks of the onset of symptoms) is critical and if the results of CCP antibodies testing are positive, it is important to see a rheumatologist as quickly as possible.

Rheumatoid arthritis usually develops slowly between the ages of 20 and 45. More than 75 per cent of people affected are women. RA is different from osteoarthritis, in which joint tissue wears down from age or injuries such as sports injuries. RA usually affects joints in a balanced way - if one knee is affected, the other knee is also affected. The disease may be partly inherited through genes but other factors are thought to be involved, including some kind of a trigger for the gene, perhaps bacteria or viruses. The disease is not contagious. It is also thought that changes in certain hormones may promote RA in people with certain genes who have been exposed to a triggering agent. Smoking is a known risk factor for RA, and is associated with more severe disease.

What tests are used?

Rheumatoid arthritis is diagnosed from signs and symptoms. This is supported with blood tests. Firstly, testing can be performed for an antibody known as rheumatoid factor (RF). Results of this test are positive in about 80 per cent of people with RA, although it can take many years before it becomes positive. Also, RF antibodies can be present in the blood of people who do not have the disease.

Testing for another group of antibodies called CCP antibodies (cyclic citrullinated peptide antibodies) commonly used. This is positive in about 60 per cent of people with RA, including some who are RF negative. The presence of these antibodies is associated with a more aggressive course of the disease.

Other common blood tests to support a diagnosis of RA and to monitor its treatment include:

What treatments exist?

Several different types of medication are used to treat RA, including pain relievers, non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs, immunosuppressants and corticosteroids (also known as glucocorticoids). Over the past few years, groups of drugs that are given by infusion (into a vein) or injection (under the skin) have been introduced. These are often termed biologic therapies. These drugs specifically target molecules involved in inflammation or the cells that produce them. They have been particularly useful in treating those with severe disease.

People with RA can also make beneficial lifestyle changes such as getting more exercise and eating moderate diets, resting, avoiding stress and taking special care of joints with well-designed tools and other devices that are easy on joints. Surgery is helpful for some people.

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Last Review Date: January 13, 2020

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