Rheumatoid arthritis
Are you a clinician? See the clinical version of this page.
- Treating RA early, in the first months after symptoms start, gives the best chance of protecting the joints and feeling well.
- The main treatments are disease-modifying medicines, called DMARDs. They work on the cause of the inflammation, not just the pain. Methotrexate is the one most people start with.
- Your team will set a goal with you, usually to get the disease quiet, and will measure how you are doing at each visit and adjust the plan until you reach it.
- Smoking makes RA worse and can stop the medicines working as well. Stopping smoking is one of the most useful things you can do for your joints.
- RA can raise the risk of heart and blood vessel problems over time. Controlling the inflammation, staying active, and looking after blood pressure and cholesterol all help protect your heart.
Understanding this condition
What rheumatoid arthritis is
In RA, the immune system, which normally fights infection, turns on the thin lining inside your joints, called the synovium. That lining becomes inflamed, thickened, and swollen. Over time, ongoing inflammation can wear away the nearby cartilage and bone if it is not treated. RA can also cause tiredness and affect other parts of the body, because it is a whole-body condition and not only a joint problem. The good news is that today's treatments can switch much of that inflammation off.
Signs and symptoms
The most common symptoms are pain, swelling, and stiffness in the joints, especially the small joints of the hands, wrists, and feet. It often affects the same joints on both sides. Morning stiffness that lasts a while, often more than half an hour, is a classic sign. Many people also feel tired or generally run down. Symptoms can come and go, but joint swelling that lasts for several weeks should always be checked.
Who gets it, and why
RA can affect anyone, but it is more common in women and often starts in middle age, though it can begin at any age. Part of the risk is in the genes you are born with, and part comes from things in the environment. Smoking is the best-known trigger and also makes the disease harder to treat. Having RA is not caused by anything you did wrong, and it is not passed on in a simple way from parent to child.
How it is diagnosed
There is no single test that proves RA. Your rheumatologist makes the diagnosis by putting several things together: your history, an examination of your joints, blood tests, and sometimes scans. Blood tests can look for antibodies linked to RA, such as rheumatoid factor and anti-CCP, and for signs of inflammation. Some people have these antibodies and some do not. Scans like ultrasound or x-ray can show inflammation or early joint changes. Getting a clear diagnosis early means treatment can start sooner.
What to expect over time
RA is a long-term condition, but the outlook today is far better than it used to be. With early treatment and regular follow-up, many people reach a state where the disease is quiet, sometimes called remission, and can live full and active lives. The aim is not just to ease symptoms but to stop joint damage before it happens. Some people need to try more than one medicine to find the right fit, and that is normal.
Living with and treating it
The goal of treatment
The goal is to get the inflammation as low as possible, ideally to a quiet state, and to keep it there. This protects your joints and helps you feel better. Your team measures how active the disease is at each visit, using your symptoms, an examination, and sometimes a score, and adjusts your medicine until you reach the goal you agreed on together. This step-by-step, measure-and-adjust approach is the modern standard of care.
Treatments that change the disease
The main medicines are DMARDs, which work on the immune process behind RA. Most people start with methotrexate, often with a short course of a steroid to settle things quickly while the DMARD takes effect. If the first medicine is not enough, your team can add or switch to other options, including biologic medicines and targeted tablets that block specific parts of the immune signal. Anti-inflammatory painkillers can help symptoms but do not change the disease on their own. Your plan is chosen with you, based on how active the disease is and your other health needs.
Monitoring and follow-up
RA care means regular check-ins, more often at the start and when medicines change. At visits your team asks how you are, examines your joints, and checks blood tests. Some blood tests track how active the disease is; others make sure the medicines are being tolerated, for example keeping an eye on your blood counts and your liver. Telling your team early about new symptoms or side effects helps keep your plan on track.
Flares, and what to do
A flare is a period when RA becomes more active again, with more pain, swelling, and stiffness, and often more tiredness. Flares can happen even when your RA is usually well controlled, and they can be set off by things like infection or stress, or for no clear reason. Have a plan agreed with your team for what to do: this may include a short adjustment to medicine and rest for the joint. Contact your team if a flare is severe, does not settle, or comes with a fever.
Living well with RA
Medicine is the foundation, but daily habits matter too. Regular movement keeps joints and muscles working and helps pain and mood; a physiotherapist can build a program that fits you, and our virtual exercise program can help. Not smoking, a balanced diet, and keeping to a healthy weight all support your joints and your heart. Protecting your joints during tasks, pacing busy days, and looking after sleep and mental health are part of living well with RA. Fatigue is one of the most common parts of RA, and it is worth raising with your team, because new or worsening fatigue can be a sign the disease is more active. Ask your team about staying up to date with recommended vaccines.
Quitting smokingWhy it matters for arthritis, what helps, and free Ontario programs→Looking after the rest of you
Because RA is a whole-body condition, it is linked with some other health risks that are worth watching. The main one is heart and blood vessel health, because inflammation can affect the arteries. RA and some of its treatments can also raise the risk of infections, and steroids over time can weaken bones. Your team helps you stay ahead of these by controlling the disease and checking the things that protect your general health.
What to expect at your rheumatology visit
At your first appointment your rheumatologist will ask about your symptoms and health, examine your joints, and arrange blood tests and sometimes scans. It helps to bring a list of your symptoms, when they started, any medicines you take, and your questions. You will talk through what the diagnosis means and the treatment choices, and decide the next step together. Follow-up visits are usually closer together at first, then spaced out as things settle.
The usual aim is to get RA into a quiet state (remission), or as close as possible (low disease activity), and to keep it there. Your team measures how active the disease is at each visit and adjusts the plan with you until you reach the goal.
RAID: track the impact of your disease7 quick questions on pain, function, fatigue, sleep, and wellbeing, save your result and print it for your visit→RAPID3: track your disease activityA quick patient-reported activity score from function, pain, and overall wellbeing, no bloods or joint exam needed→HAQ: track your physical function8 areas of daily activities scored 0 to 3, the standard function measure in RA, save and print for your visit→How treatment is stepped up
- 1
First step
Start a disease-modifying medicine, usually methotrexate. A short course of a steroid is sometimes used to settle symptoms while the DMARD takes effect, using as little as possible for as short a time as possible.
- 2
If the goal is not met
If the first medicine is not enough after a fair trial, your team may adjust it, combine medicines, or move to the next step.
- 3
Advanced treatment
Biologic medicines (usually given by injection or drip) or targeted tablets block specific parts of the immune signal. Your team chooses one with you, based on your health and preferences.
- 4
When the disease is well controlled
Once RA has been quiet for a good while, at least six months, your team may carefully reduce some medicine, watching closely in case symptoms return. Many people stay on a steady dose.
Medication guides
Plain-language guides to the medicines used for this condition. Each has a patient and a clinician view.
The numbers, in plain terms
about 1 in 100 adults
RA affects roughly one in a hundred adults. It is one of the more common types of inflammatory arthritis.
Living well, beyond the diagnosis
The whole-person side of living with a rheumatic disease, the parts patients tell us matter most. These guides apply across conditions.
When to get medical help
- A single joint that is very painful, hot, and swollen, especially with a fever. This can be a joint infection and needs same-day care.
- A fever, night sweats, or feeling very unwell while taking medicines that lower the immune system.
- New shortness of breath, a cough that will not go away, or chest pain.
- Signs of infection such as burning when passing urine, a spreading red patch on the skin, or a cough with coloured phlegm, while on DMARDs or biologic medicines.
- A flare that is severe, or that does not settle with your usual plan.
- New numbness, weakness, or pins and needles, or any problem with bladder or bowel control.