Rheumatoid arthritis – what you need to know

In our latest Ask the Expert article Dr Shilpa Selvan, Consultant Rheumatologist explains the signs and symptoms of rheumatoid arthritis and what you can do about it.
What is rheumatoid arthritis?
Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints.
 

What are the signs and symptoms of rheumatoid arthritis?
Rheumatoid arthritis usually presents with painful swelling of the hands, feet and wrists. There is also associated early morning stiffness or stiffness after rest which improves with movement, leading to difficulty in doing everyday tasks. The symptoms tend to wax and wane with ‘flare-ups’ when the symptoms worsen.

If you have painful, swollen joints and stiffness in the morning that lasts for longer than half an hour, you should see your doctor. Research shows that the sooner you start treatment for rheumatoid arthritis, the more effective it’s likely to be, so early diagnosis is important.
What causes rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease. This is where your immune system (that usually fights infection) attacks the cells that line your joints, causing inflammation.  If left untreated, this inflammation will damage the joint and can eventually lead to deformity.

The precise mechanism of what causes this problem with the immune system is still unclear. However we know that risk factors for developing rheumatoid arthritis include being female, smoking, and having a family history of rheumatoid arthritis.
When should I see a doctor?
You should see your GP if you have painful, swollen joints with early morning stiffness that lasts over half an hour.  The early diagnosis, and treatment of rheumatoid arthritis is important as the sooner treatment is started, the more effective treatment is likely to be, reducing the chance of joint damage.
What happens if I have a consultation with you?
During the consultation, I would assess you by taking a full history and examination and would organise appropriate investigations where there is a suspicion of early rheumatoid arthritis. In cases where there is strong evidence of rheumatoid arthritis, I would also commence treatment with steroids with or without disease-modifying agents, and would follow your progress up closely.
How is rheumatoid arthritis diagnosed?
Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms can be subtle, and may mimic those of many other diseases. In the early stages of the condition, there is no one blood test or physical finding to confirm the diagnosis. Doctors arrive at a diagnosis based on your symptoms, a physical examination and the results of x-rays, scans and blood tests.

During the physical exam, your doctor will examine your joints for swelling and warmth.
What tests are there for rheumatoid arthritis?
We can use a variety of tests when diagnosing rheumatoid arthritis including blood tests, x-rays and ultrasound.

Blood tests
We are particularly interested in looking at the levels of inflammatory markers (CRP and ESR) and antibodies (rheumatoid factor and anti-CCP) present in the blood.

• When there is inflammation, the levels of CRP or ESR tend to be higher.
• About 4 out of 5 people with rheumatoid arthritis will test positive for rheumatoid factor. However 1 in 20 people without rheumatoid arthritis also have positive results.
• People who test positive for anti-CCP are very likely to develop rheumatoid arthritis.
• People who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe rheumatoid arthritis.

X-rays and Ultrasound 
X-rays show any damage caused to the joints by the inflammation in rheumatoid arthritis. The changes often show up in x-rays of your feet before they appear in other joints, so your doctor may want to x-ray your feet even if they’re not causing you any problems. X-rays can be useful to show the progression of damage in the joints over time. Ultrasound of the joints is now increasingly used to detect the presence of inflammation.
What treatments are available for rheumatoid arthritis?
Although there is no cure for rheumatoid arthritis, there are a range of treatments available which reduce inflammation and prevent joint damage from progressing. Early diagnosis and starting of treatment will reduce long term joint damage and help most people to lead full lives and continue regular employment. The earlier you start treatment, the more effective it is likely to be.

The 3 main treatment options include:

• Drugs – medication taken in the long-term to relieve symptoms and slow the progress of the condition
• Supportive treatments – physiotherapy and occupational therapy can help keep you mobile and find solutions to any problems you have with daily activities
• Surgery –  to correct any joint problems that develop.

What is the long-term outlook if I have been diagnosed with rheumatoid arthritis?
As rheumatoid arthritis can affect people in different ways, it is difficult to predict how the condition might develop for you. Most people, especially if they receive appropriate treatment, will have relatively few symptoms and will be able to lead full lives.

Dr Shilpa Selvan, holds clinics at The Holly private Hospital on Thursday evenings. An initial consultation for a new patient costs £200 and £150 for a follow-up appointment.

To book a consultation, call our friendly appointments team on 020 8936 1201. 

For more information on self-pay pricing just call our friendly Self-Pay Team on 020 8936 1157 or email info@theholly.com