Rheumatoid Arthritis Explained: Symptoms, Diagnosis and Treatment
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that primarily affects the joints, but can also involve other parts of the body. It is one of the most common forms of inflammatory arthritis and a major cause of pain, stiffness and disability worldwide.
Importantly, rheumatoid arthritis today is very different from how it was viewed 20 or 30 years ago. With earlier diagnosis and modern treatments, many people now achieve good disease control, remission, and a near-normal quality of life.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis is an immune-mediated inflammatory disease. This means the immune system becomes overactive and mistakenly attacks the lining of the joints (the synovium).
This leads to:
persistent joint inflammation
swelling and pain
stiffness and reduced movement
gradual joint damage if untreated
Over time, uncontrolled inflammation can damage cartilage and bone, resulting in joint deformity and loss of function.
Unlike osteoarthritis, which is largely mechanical and degenerative, rheumatoid arthritis is driven by ongoing immune system activation.
Who Gets Rheumatoid Arthritis?
Rheumatoid arthritis can affect people of any age, but it most commonly begins between the ages of 30 and 60.
Women are affected about two to three times more often than men
A family history of autoimmune disease increases risk
Smoking is a strong environmental risk factor
RA may develop gradually over weeks or months, or occasionally quite suddenly.
What Causes Rheumatoid Arthritis?
The exact cause of RA is not fully understood, but it arises from a combination of genetic susceptibility and environmental triggers.
Immune Pathways
Research has identified key immune pathways involved in RA, particularly those driven by:
tumour necrosis factor (TNF)
interleukin-6 (IL-6)
other inflammatory cytokines
These inflammatory signals drive joint inflammation, pain, swelling and structural damage. This scientific understanding directly led to the development of modern biologic therapies.
(Related reading: Anti-TNF Treatments in Rheumatology – What Patients Should Know)
Common Symptoms
Rheumatoid arthritis typically causes symmetrical joint inflammation, meaning the same joints on both sides of the body are often affected.
Common features include:
joint pain, swelling and tenderness
morning stiffness lasting more than 30–60 minutes
stiffness after periods of rest
fatigue
reduced grip strength
difficulty with fine hand movements
Joints commonly involved include:
wrists
hands (MCP and PIP joints)
feet
shoulders
knees
Early Rheumatoid Arthritis
In early disease, symptoms may be subtle or fluctuate.
People may notice:
vague hand or wrist stiffness
fatigue
difficulty making a fist in the morning
swelling that comes and goes
Because symptoms can be mild initially and blood tests may be normal, early RA is sometimes missed or misattributed to mechanical problems.
Why Blood Tests May Be Normal
A common misconception is that rheumatoid arthritis always causes abnormal blood tests.
In reality:
CRP and ESR may be normal, particularly early on
rheumatoid factor (RF) may be negative
anti-CCP antibodies may be negative
This is known as seronegative rheumatoid arthritis.
Diagnosis relies on clinical assessment and imaging, not blood tests alone.
(Related reading: Blood Tests in Rheumatology – What Do CRP, ESR and Autoantibodies Really Mean?)
What Are Rheumatoid Factor and Anti-CCP Antibodies?
Two blood tests are commonly associated with rheumatoid arthritis: rheumatoid factor (RF) and anti-CCP antibodies(also called anti-citrullinated peptide antibodies).
These tests look for immune markers that are more common in people with RA, but they are not diagnostic on their own and must always be interpreted in clinical context.
Rheumatoid Factor (RF)
Rheumatoid factor is an antibody that can be present in rheumatoid arthritis, but it is not specific to RA.
Important points:
RF is positive in around 60–80% of people with established RA
It may be negative in early disease
It can be positive in healthy individuals, particularly with increasing age
It can be positive in other autoimmune or inflammatory conditions
It may rise during infections
This means that:
a positive RF does not automatically mean RA
a negative RF does not rule RA out
Anti-CCP Antibodies
Anti-CCP antibodies are more specific for rheumatoid arthritis than RF.
Key features:
Anti-CCP is positive in around 60–70% of people with RA
It is rarely positive in people without RA
It may be detectable years before symptoms begin
It is associated with a higher risk of more persistent or erosive disease
A positive anti-CCP test:
strongly supports a diagnosis of RA when symptoms are suggestive
may help guide prognosis and treatment decisions
However:
some people with clear RA are anti-CCP negative
a negative result does not exclude RA
Seropositive and Seronegative Rheumatoid Arthritis
People with RA are often described as:
Seropositive RA – RF and/or anti-CCP positive
Seronegative RA – RF and anti-CCP negative
Both forms are genuine rheumatoid arthritis.
Seronegative RA:
is common, particularly early in the disease
may be just as symptomatic
still requires the same careful assessment and treatment
Diagnosis relies on symptoms, examination and imaging, not antibody status alone.
Why These Tests Must Be Interpreted Carefully
RF and anti-CCP are useful tools, but they are not screening tests and should not be used in isolation.
Misinterpretation can lead to:
false reassurance when tests are negative
unnecessary anxiety when tests are positive
delays in appropriate referral and treatment
This is why RA diagnosis is based on the overall clinical picture, supported by targeted investigations rather than scatter-gun testing.
How Is Rheumatoid Arthritis Diagnosed?
There is no single test that confirms RA. Diagnosis is based on a combination of:
Clinical Assessment
pattern and distribution of joint symptoms
duration of stiffness and swelling
functional impairment
Physical Examination
joint swelling and tenderness
reduced range of motion
joint symmetry
Investigations
blood tests (RF, anti-CCP, CRP, ESR)
ultrasound to detect synovitis and power Doppler activity
MRI in selected cases
Imaging is particularly valuable when symptoms suggest inflammatory arthritis but blood tests are normal.
Why Early Diagnosis Matters
Early diagnosis and treatment are crucial.
Starting treatment early:
improves symptom control
reduces joint damage
increases the chance of remission
improves long-term quality of life
This concept is known as the “window of opportunity” in rheumatoid arthritis.
A Patient Experience: Early Diagnosis and Modern Treatment
This experience reflects what is now possible when rheumatoid arthritis is diagnosed early and treated promptly using a structured, evidence-based approach.
“I first visited Dr Singh just over two months ago. At that time, I could barely walk and couldn’t lift my 15-month-old baby. I was living with chronic pain every day, and it was getting worse. I felt very frightened and feared I was heading towards life in a wheelchair. Even the smallest tasks, like fastening a button, caused pain in my hands.
Dr Singh carried out a thorough consultation and, after blood tests and X-rays, diagnosed me with rheumatoid arthritis. It was a daunting diagnosis for a 42-year-old mother with young children, but Dr Singh reassured me and created both a short-term and long-term plan. I instantly felt I was in safe hands.
Just two months later, I am back at work full-time. I can hold my baby, get dressed on my own, and walk my dog again. I feel so much stronger. Dr Singh immediately knew the right path for me and guided me carefully through the medications and what side effects to watch for. His careful monitoring has been a blessing.
I know I still have a journey ahead, but with Dr Singh’s support I feel positive about the future. I am very grateful to have found him.”
Outcomes like this are now increasingly common in early rheumatoid arthritis when inflammation is recognised promptly and treated using modern disease-modifying therapies.
Treatment Options
Treatment is individualised and depends on disease activity, severity and patient factors.
Corticosteroids (Steroids)
Short courses of corticosteroids (steroids) may be used to rapidly suppress inflammation and improve symptoms, particularly at the start of treatment or during disease flares, while longer-term therapies such as DMARDs take effect. Because of potential side effects, steroids are usually used at the lowest effective dose for the shortest possible time.
Disease-Modifying Drugs (DMARDs)
The cornerstone of RA treatment is early use of DMARDs, most commonly:
methotrexate
sulfasalazine
leflunomide
Hydroxychloroquine
These drugs suppress immune-driven inflammation and help prevent joint damage.
Biologic and Targeted Therapies
If disease remains active despite conventional DMARDs, biologic or targeted therapies may be used.
These include:
anti-TNF drugs
IL-6 inhibitors
JAK inhibitors
Rituximab
These treatments have transformed outcomes for many patients.
(Related reading: Anti-TNF Treatments in Rheumatology – What Patients Should Know)
Remission and Modern Outcomes
With modern treatment strategies:
many patients achieve low disease activity or remission
joint damage can often be prevented
long-term disability is now much less common
Treatment is adjusted regularly to maintain disease control.
Living With Rheumatoid Arthritis
RA is a long-term condition, but many people live full and active lives.
Management usually includes:
medication
exercise and physiotherapy
fatigue management
psychological support when needed
Regular follow-up allows treatment to be optimised over time.
In Summary
Rheumatoid arthritis is an autoimmune inflammatory joint disease
It commonly affects the hands and wrists
Blood tests may be normal
RF and anti-CCP are helpful but not diagnostic on their own
Diagnosis relies on clinical assessment and imaging
Early treatment improves outcomes
Modern therapies allow remission for many patients
Persistent joint pain, swelling or stiffness should always be assessed carefully, even when blood tests appear reassuring.
Trusted Patient Information Resources
National Rheumatoid Arthritis Society (NRAS) – UK
NRAS is the UK charity dedicated specifically to people with rheumatoid arthritis. It provides:
clear information on early RA
guidance on diagnosis and modern treatments
education about DMARDs and biologics
practical self-management advice
patient support services
Arthritis UK
Arthritis UK are a national charity for patients with different rheumatic diseases.
They provide excellent advice and information leaflets about rheumatoid arthritis, living with the illness and the medications used.
Please note, these posts are for general information only and do not constitute medical advice. Dr Singh would encourage you to speak to your healthcare professional to be assessed and managed for your specific symptoms.