Living with
Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease where your body’s immune system mistakenly attacks the lining of the joints (the synovium) and causes damage to the nearby cartilage, bone and soft tissues.
It is a chronic inflammatory disorder that can also affect other parts of the body, beyond bones and joints.


While new types of medication have improved the quality of life for people with rheumatoid arthritis, severe disease can still cause serious physical disability.

How do you know you have rheumatoid arthritis?

Sometimes the symptoms of rheumatoid arthritis develop and progress quickly over several days, but more often they develop gradually over several weeks or months. The symptoms vary between individuals and may come and go. If you have rheumatoid arthritis, you may experience flare-ups, when your condition gets worse and your symptoms become more severe.


Symptoms can occur in any of your joints but are often first detected in the small joints of the fingers in the hands and toes in the feet. Symptoms are also typically symmetrical (both joints on both sides of the body are affected at the same time and to the same extent); unlike osteoarthritis which tends to affect only one joint at a time.


Typical symptoms of rheumatoid arthritis include:

  • Swelling, tenderness, warmth or redness of joints
  • Joint pain and stiffness that is usually worse on waking in the mornings and after rest or periods of inactivity
  • Loss of joint mobility/function and deformity of the joint
  • Some people also report firm swellings, called rheumatoid nodules, under the skin around affected joints.

An estimated 40 % of people with rheumatoid arthritis may also experience general symptoms, unrelated to the musculoskeletal system, due to inflammation in the body, including:

  • Fatigue
  • Fever
  • Sweating
  • Loss of appetite
  • Unexplained weight loss
  • Dry eyes and inflamed eyes
  • Chest pain if the heart or lungs are affected.


What causes rheumatoid arthritis?

According to the Arthritis Foundation of South Africa (AFSA), an estimated 1 % of the general population has rheumatoid arthritis.


Rheumatoid arthritis is an autoimmune disease that occurs when your body’s immune system accidentally attacks the membrane lining your joints (the membrane is called the synovium). The resulting inflammation causes the synovium to thicken and the surrounding cartilage to thin and become more brittle. The tendons and ligaments that hold the joint together also weaken and stretch, gradually causing the joint to lose its stability.


Your genes may make you more susceptible to environmental factors, such as infection, that can trigger the autoimmune response that causes rheumatoid arthritis.
However, there are several factors that increase your risk of developing rheumatoid arthritis, including the following:

  • Sex: Women are three times more likely to develop rheumatoid arthritis than men.
  • Age: While rheumatoid arthritis can occur at any age, it is most common to develop the condition when you are aged between 40 to 50 years old.
  • Genetics/Family history: Rheumatoid arthritis appears to run in families, with some genes seeming to increase the likelihood of developing the condition.
  • Environmental exposure/infections: Although we do not yet entirely understand why, exposure to certain bacteria (like those associated with periodontal disease) and certain viruses (notably the Epstein-Barr virus) increase the risk of developing rheumatoid arthritis.
  • Overweight or obesity: If you are overweight or obese, especially if you are a women 55 years or younger, then you are at a somewhat higher risk of developing rheumatoid arthritis, as excess weight places more pressure on joints.
  • Smoking: Cigarette smoking increases your risk of developing rheumatoid arthritis and appears to increase severity of symptoms, particularly if you have a genetic predisposition.
  • Excessive and frequent alcohol consumption: Those who drink infrequently and moderately are at less risk of developing rheumatoid arthritis than those who drink heavily.

How is rheumatoid arthritis diagnosed?

Your doctor will examine you physically to check your joints for any signs of arthritis.
However, rheumatoid arthritis may be difficult to diagnose in the early stages and difficult to differentiate between other types of arthritis.
Therefore, your doctor may also ask to take blood samples from you for laboratory testing.


Blood tests can show if you have elevated markers of inflammation, such as raised levels of C-reactive protein (CRP) or an increased erythrocyte sedimentation rate (ESR).
Additionally, 80 % of people with rheumatoid arthritis will test positive for rheumatoid factor (RF), and this, in combination with other blood tests, the physical exam and radiographical (X-ray) findings, will help your doctor make a diagnosis of rheumatoid arthritis.

Living and managing

The pain and disability associated with rheumatoid arthritis can affect your every-day life and functioning. You may experience depression or anxiety, or feelings of helplessness and low self-esteem, if you have rheumatoid arthritis.

You can take several steps to help manage your symptoms, such as the following:

  • Staying physically active: By strengthening the muscles around your joints, low-impact exercise can make your joints more stable. Try light aerobic activities (like walking, swimming or water aerobics) that place minimal stress on joints.
    Do not overdo exercise, such that you feel pain in your joints, and stretch and rest as needed before and during exercise. Try not to do hard repetitive movements or to hyperextend joints while exercising.
    You can read here about how much exercise you should be doing regularly in order to stay healthy.
  • Maintain a healthy weight: Carrying extra weight puts more pressure on your joints. Even minor weight loss can relieve the stress on your joints.
    Talk to a dietitian about healthy ways to lose weight, including eating a healthy diet; you can also get recipes from Cooking from the Heart here.
  • Apply heat or cold: These can be used to relieve pain and swelling in your joints. Heat can help relax muscles, while cold can relieve muscle aches after exercise and decrease the chance of muscle spasms.
  • Relax and get enough sleep: Techniques such as meditation, deep breathing and muscle relaxation can all be used to control pain. Rest when you are tired and get enough sleep.
  • Take your medicine regularly: Take your medication as prescribed by your doctor or healthcare provider. Taking your medicine regularly will ensure it works effectively and will also help prevent flare-ups.
  • Quit smoking: Talk to your doctor about ways to quit smoking, as smoking is bad for your health in general and can increase inflammation and worsen many types of arthritis.
  • Limit your alcohol consumption.


What treatment is available for rheumatoid arthritis?

Your doctor (usually a rheumatologist) will prescribe you medication based on your disease progression (how long you have had the condition for and how severe your symptoms are).

Treatments include:

  • Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter/consumer NSAIDs, such as ibuprofen and meloxicam, taken at recommended doses, can relieve rheumatoid pain. Courses of corticosteroids, like cortisone, and stronger NSAIDs are available by prescription from your doctor.
    NSAIDs can cause stomach irritation, cardiovascular and bleeding problems, as well as liver and kidney damage – so take care to use these medications correctly and only as indicated.
    NSAID gels (diclofenac, for example) can be applied to the skin over the affected joint and has fewer side effects and may relieve pain more effectively than oral NSAIDs.
    You can also ask your doctor about injectable cortisone or anti-inflammatory treatments for an affected joint.
  • Disease-modifying anti-rheumatic drugs (DMARDs): These drugs slow the progression of rheumatoid arthritis, mainly by suppressing the immune response or, in the case of biological agents, by reducing the process of inflammation. These types of medication include methotrexate, leflunomide, hydroxychloroquine, sulfasalazine, abatacept, adalimumab, anakinra, baricitinib, certolizumab, etanercept, golimumab, infliximab, rituximab, sarilumab, tocilizumab, and tofacitinib.
    While these newly developed drugs have greatly advanced treatment of rheumatoid arthritis, they do not act immediately and need to be taken continuously over several weeks or months before producing desired effects.
    Do not stop taking these medications without talking to your doctor first. You may need to continue taking them for many years or for the rest of your life. Side-effects vary but are mostly non-dangerous; however, rarely these medications may cause liver damage or bone marrow suppression. Therefore, taking these medications requires regular medical supervision by a doctor or other healthcare provider who may ask for frequent blood or urine tests.

Additionally, your doctor may send you to a physical or occupational therapist who can show you how to do exercises that help to keep your joints flexible or who may suggest new ways to do daily tasks without putting strain on your joints; assistive devices may also help in this regard.


In consultation with your doctor, you may decide that the damage to your joint(s) is too severe, and that your medications are not helping as they should be. Your doctor may then suggest one or more of the following procedures:

  • Synovectomy: This is surgery to remove the inflamed synovium. This can be performed on the knee, elbow, wrist, finger and hip joints.
  • Tendon repair: If the tendons around your joints have loosened or ruptured, your surgeon may be able to repair them and connect them properly in the joint.
  • Surgical joint fusion: This is recommended to stabilise or realign a joint or for pain relief when you cannot have joint replacement surgery.
  • Total joint replacement: In joint replacement surgery (arthroplasty), the damaged parts of your joint are removed, and new prosthesis made of metal and plastic are inserted. Discuss the benefits and risks of surgery carefully with your doctor.

What are the complications of rheumatoid arthritis?

Rheumatoid arthritis increases your risk of developing the following as a result of increased inflammation in the body:

  • Joint damage: If left untreated or uncontrolled, the inflammation can damage the joints significantly or permanently, causing lack of mobility, joint deformities or tendon and ligament rupture. These can lead to severe disability in those affected.
  • Osteoporosis
  • Rheumatoid nodules: These are painful, firm bumps of usually round tissue that most commonly form under the skin or attached to tendons around pressure points, such as in the elbows, knuckles or back of the heels. However, these nodules can form anywhere in any joint or part of the body affected by the inflammation, including in the lungs.
    Rheumatoid nodules usually develop when someone with rheumatoid arthritis has a flare-up, and they can press on nerves and blood vessels, causing pain or discomfort.
  • Inflammation of the eye: This may cause scleritis, which causes red and painful eyes, or Sjogren’s syndrome, a disorder where the mucous membranes of the eyes and mouth become dry.
  • Infections: The disease itself, as well as the medications used to treat it, especially immunosuppressive DMARDs, can weaken the immune system, and may increase the risk of an affected person acquiring common infections like a cold or the flu.
  • Carpal tunnel syndrome: This condition is common in people with rheumatoid arthritis and occurs to due to compression of the median nerve which provides sensation to the hand.
    The compression of the nerve can cause the hand to ache or become numb and lead to a tingling sensation in the fingers. This condition can usually be managed with wrist splints and corticosteroid therapy, but you can also have surgery to relive the pressure on the nerve.
  • Cardiovascular disease: Rheumatoid arthritis can increase your risk of developing cardiovascular disease, including heart attack and stroke. This is due to associated inflammation in the arteries that causes the vessels to become hardened.
    This makes it extra important that you avoid cigarette smoke and alcohol if you have rheumatoid arthritis, as these substances increase your risk of heart disease as well.
    Additionally, rheumatoid arthritis can cause inflammation of the sac that surrounds the heart, the pericardium, which can cause chest pain and can be life-threatening in some cases.
  • Lung disease: The inflammation associated with rheumatoid arthritis can affect the lung causing scarring of lung tissues, which can lead to pleurisy and pulmonary fibrosis.
  • Lymphoma: Rheumatoid arthritis increases your risk of developing a group of blood malignancies called lymphomas.
  • Cervical myelopathy: If you have had rheumatoid arthritis for a long time, you are at increased risk of developing a condition where the joints at the top of your spine become dislocated, putting pressure on the spinal cord.
    While this condition is rare, it can cause severe disability or life-threatening spinal cord injury if left untreated. You can have an operation to relieve the pressure on the spinal cord in this case.

Due to the advancements in available treatments, the correct and timeous treatment of rheumatoid arthritis can slow disease progression and delay or stop the development of these complications, particularly in non-joint areas.


Statistics: Maharaj A. (n.d.) Rheumatoid Arthritis: What is Rheumatoid Arthritis? Arthritis Foundation of South Africa. Available from:


National Health Service, UK. Overview: (2019) Rheumatoid arthritis. NHS, UK. Available from:


Mayo clinic staff. (n.d.) Symptoms and Causes: Rheumatoid arthritis. Mayo Clinic. Available from:

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Statistics: Maharaj A. (n.d.) Rheumatoid Arthritis: What is Rheumatoid Arthritis? Arthritis Foundation of South Africa. Available from:


National Health Service, UK. Overview: (2019) Rheumatoid arthritis. NHS, UK. Available from:


Mayo clinic staff. (n.d.) Symptoms and Causes: Rheumatoid arthritis. Mayo Clinic. Available from:

These articles are for information purposes only. It cannot replace the diagnosis of a healthcare provider. Pharma Dynamics gives no warranty as to the accuracy of the information contained in such articles and shall not, under any circumstances, be liable for any consequences which may be suffered as a result of a user’s reliance thereon.

The information the reader is about to be referred to may not comply with the South Africa regulatory requirements. Information relevant to the South African environment is available from the Company and in the Professional Information/Patient Information Leaflet/Instructions for Use approved by the Regulatory Authority.

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