Patient information · Rheumatology
Rheumatoid arthritis
the first twelve weeks change the outcome
Rheumatoid arthritis is an autoimmune condition attacking the joint lining. Unlike osteoarthritis it is inflammatory, systemic, and causes permanent joint damage if untreated — and there is a well-defined window early on during which treatment substantially alters the long-term course.
Seek urgent assessment if you have
- a single hot, red, swollen joint with fever — possible septic arthritis
- severe neck pain with pins and needles, weakness or clumsiness in the hands
- breathlessness, chest pain or a persistent dry cough
- a red painful eye or sudden visual change
- a flare with fever and feeling systemically unwell while on immunosuppressive treatment
- new numbness or foot drop
Anyone on immunosuppressive treatment who develops a fever needs prompt assessment, as infection can present atypically and progress quickly. Neck instability is a recognised complication of long-standing rheumatoid arthritis and must be flagged before any general anaesthetic.
Referral should be within weeks, not months
NICE recommends urgent referral to rheumatology for anyone with persistent swelling of the small joints of the hands or feet, or more than one joint, or a delay of three months or more between symptom onset and seeking help — and to refer even if blood tests are normal. Around a third of people with rheumatoid arthritis have negative rheumatoid factor. A normal blood test in someone with persistent joint swelling should not close the door; it should prompt referral. Starting treatment within about twelve weeks of symptoms beginning gives the best chance of long-term remission.
Early symptoms
- Morning stiffness lasting more than 30 minutes, often an hour or more — the key distinction from osteoarthritis, where stiffness lasts minutes
- Swelling of the small joints of the hands and feet, typically symmetrical, sparing the end finger joints
- difficulty making a fist, gripping, or squeezing across the knuckles
- fatigue that is out of proportion, low-grade fever, weight loss
- improvement with movement and worsening with rest — the reverse of wear-and-tear pain
- early foot involvement is common and frequently overlooked
Tests
- Rheumatoid factor and anti-CCP antibodies — anti-CCP is more specific and can be positive years before symptoms.
- CRP and ESR, and a full blood count.
- Ultrasound detects synovitis and erosions earlier and more sensitively than X-ray, and can confirm inflammation where examination is equivocal.
- X-rays of hands and feet as a baseline.
- None of these makes the diagnosis alone — it is clinical, supported by tests.
Treatment
- Conventional DMARDs — methotrexate is usual first-line, often combined with others. It takes 6 to 12 weeks to work fully, and folic acid is taken alongside to reduce side effects.
- Methotrexate is once weekly. Taking it daily by mistake is dangerous and has caused deaths — check the day on the box, and keep it separate from daily medicines.
- Steroids as a short bridge while DMARDs take effect, or for flares.
- Biologics and JAK inhibitors where response is inadequate.
- Regular blood monitoring is required throughout.
- Avoid live vaccines on immunosuppression; have flu, COVID and pneumococcal vaccination.
Alongside treatment
- Keep moving. Exercise does not damage inflamed joints and improves pain, function and fatigue. Hydrotherapy and low-impact work suit flares.
- Stop smoking — it both causes rheumatoid arthritis and reduces treatment response.
- Cardiovascular risk is raised by the inflammation itself; blood pressure, lipids and glucose should be checked annually.
- Occupational therapy for hand splints, joint protection and workplace adjustments.
- Dental health matters — gum disease is associated with worse disease activity.
Why come to us. The delay between noticing swollen fingers and seeing a rheumatologist is where the damage happens. We can assess you within days, take anti-CCP, rheumatoid factor, CRP, ESR and full blood count in-house with results explained the same visit, and perform ultrasound on site to confirm synovitis — then refer to rheumatology with the workup complete rather than starting the queue from scratch. Seven days a week, no referral needed.
Assessed in days, with the workup already done
Anti-CCP and ultrasound on site, results the same visit.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.