Rheumatoid arthritis

What rheumatoid arthritis is

Rheumatoid arthritis (RA) is an autoimmune condition. The immune system, which normally fights infection, attacks the lining of the joints by mistake. The lining becomes inflamed, causing pain, swelling and stiffness. Over time this can damage the joint, cartilage and nearby bone.

It usually affects the small joints of the hands, wrists and feet first, often on both sides of the body. It can start at any adult age but is most often diagnosed around 50. It is more common in women than men.

Things that make it more likely include:

• Being a woman
• A family history
• Smoking
• Being overweight

There is no cure, but modern medicines can control it well. Many people reach remission, where there are few or no signs of active disease.

Forms and patterns

Doctors may describe your rheumatoid arthritis in a few ways. These help decide your treatment.

Symptoms and flares

The main symptoms are throbbing, aching joints that are swollen, warm and tender. Stiffness is usually worse in the morning or after resting, and often lasts more than 30 minutes. Many people also feel very tired, and some have a mild fever, sweats, less appetite or weight loss.

1. Weeks to months

   Onset

   Symptoms usually build up gradually, often in the hands and feet. In some people they come on within days.

2. First months

   Diagnosis and starting treatment

   Referral to rheumatology, tests, and the first disease-modifying medicine, often with a short course of steroids.

3. Days to weeks

   Flares

   Times when symptoms come back or get worse. They can be unpredictable. Infections, stress and stopping medicines can trigger them.

4. Ongoing

   Control or remission

   With treatment, the aim is few or no symptoms. Regular reviews check the disease stays under control.

Timings vary a lot from person to person. Untreated inflammation can damage joints within months, so don't wait to see if it settles.

When to get urgent help

Some RA medicines lower your immune system, so infections can become serious quickly.

Diagnosis and referral

RA can be hard to diagnose early, as there is no single test. Your GP will examine your joints and may order:

• Blood tests for inflammation (CRP and ESR), rheumatoid factor and, if that is negative, anti-CCP antibodies. Normal results don't rule out RA.
• X-rays of the hands and feet, which can show joint damage and give a baseline to compare against later.
• Ultrasound or MRI, sometimes used by specialists to look for inflammation.

Waits for a first appointment vary across the UK. If you have been referred and haven't heard anything, contact the hospital, or ask your GP to chase it.

Treatments and medicines

NICE recommends a treat-to-target approach. Your team sets a target of remission, or low disease activity if remission isn't possible. You should be reviewed about once a month, with medicines adjusted, until you reach your target. After that you should have a full review at least once a year.

1. First DMARD

   Takes weeks to a few months to work

   Disease-modifying anti-rheumatic drugs (DMARDs) calm the immune system and protect your joints. NICE recommends starting with one: methotrexate, leflunomide or sulfasalazine. Hydroxychloroquine may be used for milder disease. They are prescribed by a specialist, then often continued by your GP. You'll need regular blood tests to check your liver, kidneys and blood counts.

   Pregnancy warning: methotrexate and leflunomide can harm an unborn baby. Talk to your team before trying for a baby, and use contraception as advised.

2. Short-term steroids

   Work within days

   A short course of steroid tablets or an injection can calm inflammation while you wait for a DMARD to work, or during a flare. They aren't used long term because of side effects such as weight gain and thinning bones.

3. Adding or switching DMARDs

   If you haven't reached your target

   Your rheumatologist may raise the dose, add a second DMARD or switch to another.

4. Biologics and targeted medicines

   Usually after at least 2 DMARDs haven't worked. Reviewed at 6 months

   Biologics such as adalimumab, etanercept, infliximab, certolizumab, golimumab, abatacept, tocilizumab and rituximab, usually given by injection or drip, often alongside methotrexate. JAK inhibitors, such as baricitinib, tofacitinib, upadacitinib and filgotinib, are tablets. NICE approves them for moderate or severe RA. They are only continued if you have responded well enough after 6 months.

Surgery and other support

Because medicines are now much better, fewer people need surgery. It may help if a joint is badly damaged, or nerves or tendons are affected. Options include:

• Carpal tunnel release to relieve pressure on the nerve in the wrist. A short procedure, usually as a day case.
• Tendon repair if inflammation has damaged tendons in the hand.
• Keyhole surgery (arthroscopy) to remove inflamed joint lining.
• Joint replacement, most often of the hip or knee. Most people go home within a few days and need several weeks to several months to recover.

Your rheumatology team should also give you access to physiotherapy, occupational therapy (for splints, aids and advice on daily tasks) and podiatry (for foot pain and insoles).

Self-help and living well

NRAS runs a free online self-management programme, and many hospitals offer group education. NHS talking therapies can help with anxiety and low mood, and in England you can refer yourself.

Getting the best treatment

Questions to ask

• At your GP: could this be inflammatory arthritis, and can you refer me urgently to rheumatology?
• What is my treatment target, and how will we measure it?
• How long should I give this medicine before we decide if it works?
• What blood tests do I need, and how often?
• Is there a rheumatology advice line I can call during a flare?
• Can I see a physiotherapist, occupational therapist or podiatrist?
• Am I eligible for a biologic or JAK inhibitor yet?
• Which vaccines should I have?

If you feel your symptoms aren't being taken seriously, ask to see another GP. Once under rheumatology, you can ask for a second opinion. NRAS's helpline can help you prepare for appointments.

Rheumatoid arthritis and work

RA can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland) if it has a substantial, more than minor, effect on your daily life and has lasted, or is likely to last, at least 12 months. Conditions that come and go can count, and the law looks at how you would be without treatment. Many people with RA will qualify.

If it does, and your employer knows or should know about it, they must make reasonable adjustments. These might include:

• A later start when morning stiffness is bad
• Flexible hours and working from home
• Time off for appointments and infusions
• An ergonomic keyboard and mouse
• Voice recognition software
• A supportive, adjustable chair
• A sit-stand desk
• Easy-grip tools and door handles
• Help with lifting and carrying
• Regular breaks to manage tiredness
• A parking space near the entrance
• Flexibility on flare-related absence

Access to Work is a government grant that can pay for equipment, travel to work and support. NRAS has detailed guides on working with RA. For advice on your rights, contact Acas or Citizens Advice.

Benefits

If you can't work for a while, you may get Statutory Sick Pay from your employer. Depending on how RA affects you, you may also be able to get Personal Independence Payment (PIP), or Adult Disability Payment in Scotland, Universal Credit or Employment and Support Allowance. If you pay for prescriptions in England, a prepayment certificate can save money. Turn2us and Citizens Advice can help you check.

Support and sources

Last reviewed: October 2026.