Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune condition in which the immune system attacks the joints, causing painful inflammation, swelling, and stiffness that can lead to permanent joint damage if untreated. Early diagnosis and disease-modifying treatment significantly reduce long-term disability and preserve joint function.
Speak to an English-speaking rheumatologist about RA assessment or management. No referral needed.
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This page provides general health information only and is not a substitute for professional medical advice.
What is rheumatoid arthritis?
Unlike osteoarthritis — which is caused by wear and tear — rheumatoid arthritis is driven by an abnormal immune response. The synovium (joint lining) becomes chronically inflamed, damaging cartilage and bone over time. RA is a systemic condition that can also affect the heart, lungs, eyes, and blood vessels.
The course of RA is variable — some people have mild, intermittent symptoms while others experience rapidly progressive joint destruction. Early, aggressive treatment with disease-modifying drugs (DMARDs) is the standard of care and has transformed long-term outcomes dramatically over the past 30 years.
Symptoms
- Painful, swollen, and warm joints — typically small joints of the hands and feet first
- Morning stiffness lasting more than 30–60 minutes — a hallmark feature that distinguishes RA from osteoarthritis
- Symmetrical joint involvement — both hands or both wrists affected simultaneously
- Fatigue — often severe and disproportionate to joint symptoms
- Low-grade fever and general malaise during flares
- Rheumatoid nodules — firm lumps under the skin, typically near joints
- Over time: joint deformity and loss of function if untreated
Causes
RA results from a combination of genetic susceptibility and environmental triggers. The HLA-DR4 gene is the strongest known genetic risk factor. Environmental triggers include smoking (the most significant modifiable risk factor), certain infections, and hormonal factors — RA often improves during pregnancy and flares post-partum.
When to see a doctor
See a doctor urgently if you develop persistent symmetrical joint swelling, prolonged morning stiffness, or unexplained fatigue affecting multiple joints. The window of opportunity for preventing joint damage is greatest in the first weeks to months of disease — early referral to rheumatology is essential.
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No referral, no waiting room. Online consultations available within 24 hours.
Treatment options
- Methotrexate — the anchor DMARD for RA; taken weekly, highly effective at controlling inflammation and preventing joint damage
- Hydroxychloroquine and sulfasalazine — often used in combination with methotrexate
- Leflunomide — alternative DMARD for those intolerant of methotrexate
- Biologic DMARDs (adalimumab, etanercept, rituximab, tocilizumab) — for moderate-severe RA not controlled by conventional DMARDs; highly effective
- JAK inhibitors (baricitinib, tofacitinib) — oral targeted therapies as an alternative to biologics
- Corticosteroids — for rapid symptom control during flares or while DMARDs take effect
- NSAIDs — for pain and inflammation; used alongside DMARDs
How eMedClinic can help
Our rheumatologists provide RA assessments, arrange diagnostic blood tests (RF, anti-CCP, CRP, ESR), prescribe DMARDs, and provide ongoing monitoring. We are particularly well placed to support expats with established RA who need to continue their treatment and monitoring without interruption after moving abroad.
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