Published on 21 December 2022

    Rheumatoid arthritis is not just a joint problem. Understand the facts and causes of this disease, and learn how to avoid triggers and manage flare-ups.

    Creaky, stiff and painful joints are typical of both rheumatoid arthritis (RA) and osteoarthritis. Beyond these symptoms, these two types of arthritis are actually quite different.

     Rheumatoid arthritisOsteoarthritis
    CausesAn autoimmune disease where the body's immune system attacks the joints. The cause is unknown, though genes play a part and smoking increases the risk.Caused by many factors that contribute to wear and tear, including but not limited to genes and being overweight. 
    What happens to the joints?The immune system attacks the synovial membrane that protects and lubricates joints, causing inflammation, pain and swelling. Joint erosion may follow.The cartilage that lines and cushions the joints wears away. Bony outgrowths may occur. All this causes pain and swelling. 
    Onset occursCan happen at any age, though typically in the forties and fifties.Usually develops gradually and later in life after years of mechanical wear and tear.
    SymptomsPain and stiffness in the joints are often accompanied by ‘flu-like’ symptoms, such as tiredness. Pain is more prolonged and functionally limiting, and especially worse in the morning or after inactivity.The symptoms are limited to pain in and around the joints. It is often worse during activity, such as walking, and gets better with rest. However, there may also be a few minutes of ‘gelling’ after inactivity.
    • Clinical diagnosis, based on history and physical examination

    • X-rays may be done to check for joint damage

    • Blood tests are usually done to test for the presence of inflammation factors and other parameters

    • Timely diagnosis is important as permanent joint damage can start within weeks of disease onset

    • Clinical diagnosis, based on history and physical examination

    • X-rays are usually done to check for joint damage

    • Blood tests are usually not necessary

    • Diagnosis helps to empower and educate patients on how to manage symptoms

    • Disease Modifying Anti-Rheumatic Drugs (DMARDs) are the cornerstone of treatment. Other adjunctive treatments may include:

    • Pain medicine

    • Steroid injections

    • Heat therapy

    • Exercise

    • Lifestyle changes

    • Weight loss, strengthening low-impact exercises, and lifestyle changes are the cornerstone of treatment. Other adjunctive treatments may include:

    • Pain medicine

    • Steroid injections

    • Heat therapy

    Will I need surgery?Surgery is rarely needed nowadays as effective medical treatment options are available to help prevent joint damage and tendon rupture. If medication, weight loss, and lifestyle changes do not adequately relieve the pain in a joint and the damage becomes too extensive, surgery may be recommended to replace the joint.


    Untreated, both these conditions can lead to joint deformities and disability. In RA, it is particularly important to use Disease Modifying Anti-Rheumatic Drugs (DMARDs) to treat the patient, as untreated RA can otherwise lead to many other complications such as tendon ruptures, and even heart disease, eye inflammation, and inflammation of the lung, said Dr Lahiri. At NUH’s Division of Rheumatology, a holistic management approach is taken to manage autoimmune diseases such as RA and to achieve remission – a state wherein the disease is no longer active and no longer causes damage to the joints. Ultimately, early detection is the best protection. “Early, appropriate treatment of RA is key, and can prevent poor outcomes,” explained Dr Manjari Lahiri, Senior Consultant, Division of Rheumatology, National University Hospital (NUH). Rheumatoid Arthritis Facts Why Arthritis Hurts Managing Arthritis Well Arthritis is achronic disease,but it can be treated with medicines that Relieve pain Reduce inflammation AUTOIMMUNEDISEASE Causes jointinflammation Treatment also helps toprotectthe jointsand prevent them from being irreversibly damaged by the disease. Stiffness Pain Swelling Affects about of thepopulation Occurs at any age (but typically at40-50 years old) More common inwomen Flaresan increase in symptoms – can occurdue to triggers Modulate the immune activity that is causing the inflammation Rheumatoid Arthritis commonly affects the hands, wrists, ankles, and feet. Other joints can be affected too. Be regular with your blood tests;They help assess disease activity and help your doctor monitor medication side effects Take your medicationregularly and at the prescribed dose to achieve the best outcomes Be informedabout the diseaseAnd empower yourself to make the best of your treatment plan. Ask our nurse educators to tell you more Discuss optionswith your doctor to find the drug treatment plan that works best for you StaypositiveAs research shows that this is imperative for physical wellbeing Adopt a healthylifestyleIncluding a balanced diet and regular exercise to achieve wellbeing Attend yourappointments consistentlyTo enable your doctors to monitor your progress and adjust your treatment plan Healthy jointThe synovial membraneis like an inner tube. It wraps around the joint and produces lubricating fluid that ‘cushions’ and nourishes the joint. During a flare,the body’s own immune cells attack the synovial membrane, leading to inflammation, swelling and pain. Over time, this inflammation damages the joint, wearing it away and causing bony defects (erosions). Joint affected by arthritisInflamed synovial Synovial membrane InflamedSynovial membrane

    Called Treat to Target, this framework comprises close monitoring, blood tests, and adjustment of DMARDs as necessary to achieve and maintain a state of remission. Achieving remission allows patients to live normal, active lives. 

    In consultation with Dr Manjari Lahiri, Senior Consultant, Division of Rheumatology, Department of Medicine, NUH.

    Download the full infographics here.

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