Rheumatoid arthritis: your questions

Rheumatoid arthritis (RA) is an autoimmune disease: the immune system mistakenly attacks the lining of the joints, causing inflammation, pain, swelling, and stiffness, often worst in the morning and often in the same joints on both sides. This is different from osteoarthritis, which is mainly wear of the joint cartilage over time. RA is driven by inflammation, which is why it is treated with medicines that calm the immune system.

Because it is an inflammatory disease, catching it early and treating it well protects the joints from damage. There is much more on the rheumatoid arthritis guide.

The goal of treatment is remission, which means little or no active inflammation, or at least the lowest disease activity possible. Many people reach it with the right treatment. Remission does not always mean cure, and for most people staying on some treatment is what keeps the disease quiet.

If your disease has been well controlled for a good while, your team may discuss carefully reducing treatment. This is done slowly and with monitoring, because stopping or lowering medicines can let the disease flare. It is a shared decision, and being able to get back in quickly if you flare is part of the plan.

It is common to try more than one treatment before finding the one that suits you, and that is a normal part of the process, not a failure on your part. Treatment is stepped: if the first option does not control things well enough, or does not suit you, there are several other classes of medicine to move on to.

The RA guide explains how treatment is stepped up, and you can track how you are doing between changes with the RAID, RAPID3, and HAQ trackers.

Every medicine has trade-offs, and the medicines used in RA can affect things like the blood count, the liver, or the risk of infection. The reassuring part is that these are monitored with regular blood tests that catch any change early, usually before you would notice anything, so it can be dealt with simply.

See our guide to blood tests and monitoring for what the tests are for and what an out-of-range result really means.

It can. Because RA is a whole-body inflammatory disease, it can sometimes affect the lungs, the heart and blood vessels, and the eyes, and it is linked with a higher long-term risk of cardiovascular disease. This is one reason keeping the inflammation well controlled matters beyond the joints, and why your team may ask about symptoms that seem unrelated.

The RA guide covers the systemic side in plain terms. Tell your team about new breathlessness, chest symptoms, or eye problems.

Fatigue affects the large majority of people with RA and is often one of the hardest parts. It is a real feature of the disease, not a sign you are not coping, and it deserves attention in its own right. New or worse fatigue can also be a clue that the disease is more active, so it is worth mentioning.

Things that help include the right kind of activity, pacing, and treating sleep problems properly. See sleep and fatigue and energy and pacing.

Yes, and planning ahead makes a real difference. Some RA medicines are not safe in pregnancy and need to be switched in advance, while others can be continued, and going into pregnancy with your disease well controlled gives the best outcomes. Because some of this has to be sorted out before you conceive, it is worth raising early, even if pregnancy is a way off.

See the rheumatic disease and pregnancy section, and talk to your team before trying.