Rheumatoid arthritis
Also called: RA, rheumatoid disease, inflammatory arthritis, autoimmune arthritis
Rheumatoid arthritis is a long-term condition in which the immune system attacks the lining of the joints, causing pain, swelling and morning stiffness, often in the hands and feet. Early treatment with disease-modifying medicines can protect the joints.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Rheumatoid arthritis (RA) is an autoimmune condition. This means the body's defence system, which normally fights germs, attacks its own tissues by mistake. In RA it attacks the synovium (the thin lining inside a joint). The lining becomes inflamed and swollen, and over time this can damage the nearby cartilage and bone.
RA usually starts in the small joints of the hands and feet, and it often affects both sides of the body in the same way. Symptoms tend to build up over a few weeks. They can settle for a while and then get worse again, which is called a flare. RA is not the same as osteoarthritis, the common wear-related arthritis of older age. A clue is that stiffness in RA usually lasts more than half an hour in the morning. Because RA affects the whole body, people may also feel tired, unwell or feverish, and other organs such as the eyes, lungs and heart can sometimes be involved.
There is no cure, but treatment has improved a great deal. Guidelines advise starting disease-modifying medicines as early as possible, ideally within three months of lasting symptoms, because early control of inflammation reduces long-term joint damage. Most people are looked after by a rheumatologist (a joint and immune specialist) together with a team that can include nurses, physiotherapists and occupational therapists.
In Pakistan
A review of Pakistani studies found that most patients seen with RA were women, many did not know much about their disease, and about one in four did not take methotrexate regularly. Monthly treatment costs were high compared with patients' incomes, so ask your doctor about affordable options and keep to regular follow-up.
Symptoms
- Joint pain that throbs or aches, often worse in the morning or after resting
- Joint stiffness, especially in the morning, that usually lasts longer than 30 minutes
- Swollen, warm and tender joints, sometimes with redness
- Small joints of the hands and feet affected first, often on both sides of the body
- Difficulty bending the fingers fully or making a fist
- Tiredness, a mild fever, sweating, poor appetite or weight loss
- Firm lumps under the skin near joints (rheumatoid nodules)
- Dry eyes, or chest pain if the lungs or heart are affected
- Flares: periods when symptoms suddenly get worse
Causes and risk factors
Causes
- The immune system wrongly attacks the lining of the joints, causing inflammation
- The exact trigger is not known; ideas such as an infection have not been proven
- Genes play a small part, so it can run in families
- Smoking is the most consistent outside factor linked to RA
- Female hormones such as oestrogen may play a part, but this is not proven
What makes it more likely
- Being a woman: RA is more common in women than in men
- Having a close relative with rheumatoid arthritis
- Smoking
- Middle age: in Pakistani studies, patients were on average in their mid-40s when seen
Complications
If inflammation is not controlled, the joints can be damaged and become deformed, which makes everyday tasks harder. Swollen wrists can press on a nerve and cause carpal tunnel syndrome (tingling and numbness in the hand). Inflammation can also affect the lungs, heart, eyes or blood vessels (vasculitis). People with RA have a higher risk of heart and blood vessel disease, and are also more likely to have high blood pressure, thin bones (osteoporosis) and depression. After many years, RA in the neck can rarely press on the spinal cord (cervical myelopathy). Some medicines for RA raise the chance of infections such as tuberculosis and shingles. Good control of the disease lowers most of these risks.
When to see a doctor
- One joint suddenly becomes very hot, swollen and painful, especially with fever: this can be a joint infection and needs same-day care
- New neck pain with numbness, tingling or weakness in the arms or legs
- Chest pain or shortness of breath: get emergency medical help straight away
- Fever, cough or other signs of infection while taking medicines that weaken the immune system
- Suddenly being unable to straighten or bend a finger, which can mean a tendon has torn
- A bad flare that does not settle: contact your rheumatology team quickly
- Swollen small joints in the hands or feet, or several joints, lasting more than a few weeks: see a doctor soon for referral
Diagnosis
There is no single test that proves RA. A doctor asks about symptoms and examines the joints for synovitis (swollen, inflamed joint lining). Anyone with possible RA and lasting joint swelling should be referred to a rheumatologist, and urgently if the small joints of the hands or feet or more than one joint are affected, even if blood tests are normal. Tests should not delay the referral.
Blood tests include rheumatoid factor (RF) and, if that is negative, anti-CCP antibodies. ESR and CRP show how much inflammation there is, and a full blood count is also common. X-rays of the hands and feet look for erosions (small areas of bone damage). A positive anti-CCP test or erosions mean a higher chance that damage will get worse, so closer follow-up is needed. Once treatment starts, CRP and a disease activity score are checked regularly until RA is under control.
Treatment
- See a rheumatologist early. Disease-modifying medicine should start as soon as possible, ideally within three months of lasting symptoms.
- The first medicine is usually methotrexate. Leflunomide or sulfasalazine are used if methotrexate is not suitable, and hydroxychloroquine may be used for mild RA. Safety point: methotrexate is taken once a week, not every day. Check your day with your doctor or pharmacist.
- A short course of steroid tablets, an injection into a muscle, or an injection into a joint may be given while the main medicine starts to work. Steroids are stopped as soon as possible, usually within about three months.
- Treatment aims for remission (no active disease), or low disease activity if remission is not possible. You are checked every one to three months. If there is no clear improvement by three months, or the target is not reached by six months, the treatment is changed or another medicine is added.
- If standard medicines are not enough, a specialist may add a biological medicine or a targeted tablet (JAK inhibitor), usually together with methotrexate. You are checked for infections such as tuberculosis before and during this treatment.
- Anti-inflammatory painkillers (NSAIDs) may be used for a short time for pain and stiffness, together with a stomach-protecting medicine. Physiotherapy, occupational therapy and foot care support the medicines.
- Have a full review every year. If RA stays well controlled for a long time, the specialist may slowly lower medicines, but they are not usually stopped completely. Surgery may help badly damaged joints or tendons.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Conventional disease-modifying antirheumatic drugs (DMARDs) | main long-term treatment started early to slow joint damage; methotrexate is usually first and is taken once a week, not daily | Methotrexate (32 brands), Sulfasalazine (4 brands), Hydroxychloroquine (138 brands) |
| Corticosteroids | short-term bridge while a DMARD starts working, and for flares; stopped as soon as possible | Prednisolone (37 brands), Methylprednisolone (27 brands) |
| Non-steroidal anti-inflammatory drugs (NSAIDs) | relief of pain and stiffness for the shortest time needed; not a treatment for the disease itself | Ibuprofen (378 brands), Naproxen (5 brands), Diclofenac (26 brands) |
| Proton pump inhibitors | stomach protection given alongside an NSAID | Omeprazole (498 brands), Esomeprazole (9 brands) |
| Biological DMARDs (TNF inhibitors) | added by a specialist when standard DMARDs have not controlled RA, usually together with methotrexate | Chosen by your specialist |
| Vitamin supplement | folic acid is usually given alongside methotrexate; your doctor decides when to take it | Folic acid (32 brands) |
Also used (not yet in our price list): Leflunomide (conventional DMARD), JAK inhibitors such as tofacitinib (targeted tablets used by specialists), IL-6 receptor inhibitors (biological medicines used by specialists)
Self-care and prevention
Self-care
- Take your medicines as prescribed, even when you feel well, and go for all blood tests and reviews
- Stop smoking
- Balance rest with regular gentle exercise such as walking, swimming or cycling
- Do the hand strengthening and stretching exercises your therapist shows you
- A Mediterranean-style diet may be suggested, though no diet has been proven to treat RA
- Plan ahead and pace daily tasks; an occupational therapist can suggest aids and easier ways of doing things
- Ask about the yearly flu vaccine and the pneumococcal vaccine
- Talk to your doctor before planning a pregnancy, so your treatment can be reviewed
Prevention
- There is no proven way to prevent RA, but not smoking lowers the risk
- Seek help early for joint swelling that lasts more than a few weeks, because early treatment prevents joint damage
- Keep to treatment and regular reviews to prevent flares and complications
- Have your blood pressure, heart risk and bone health checked at your yearly review
Common questions
Is rheumatoid arthritis the same as osteoarthritis?
No. Rheumatoid arthritis is caused by the immune system attacking the joint lining, while osteoarthritis is mainly wear and damage of the cartilage. RA often affects both hands at the same time and causes morning stiffness that lasts more than half an hour.
Can rheumatoid arthritis be cured?
There is no cure yet. However, starting disease-modifying medicines early can control the inflammation, and many people reach remission or low disease activity. This protects the joints and helps people keep working and living normally.
Why is methotrexate taken only once a week?
For rheumatoid arthritis, methotrexate is a once-weekly medicine, not a daily one. Take it on the same day each week exactly as your doctor has told you, and ask your pharmacist if the label is not clear. Folic acid is usually given with it, and regular blood tests are needed.
Is a positive rheumatoid factor test enough to diagnose RA?
No. Rheumatoid factor can be negative in people with RA, and doctors are advised to refer people with swollen joints even when blood tests are normal. The diagnosis is made by a specialist using the joint examination, blood tests and sometimes X-rays.
Can I stop my medicines once I feel better?
Do not stop on your own, because most people flare when medicines are stopped. If RA has been well controlled for a long time, your rheumatologist may slowly lower the medicines and will restart them quickly if symptoms return.
Sources
- NICE. Rheumatoid arthritis in adults: management (NICE guideline NG100) (2020).
- NICE. Overview | Rheumatoid arthritis in adults: management | Guidance | NICE (2024).
- EULAR (Annals of the Rheumatic Diseases). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update (2023).
- NHS. Rheumatoid arthritis - Symptoms - NHS (accessed 2026).
- NHS 111 Wales. NHS 111 Wales - Health A-Z : Rheumatoid arthritis (2024).
- Journal of the Pakistan Medical Association. Epidemiology of rheumatoid arthritis, clinical aspects and socio-economic determinants in Pakistani patients: A systematic review and meta-analysis (2019).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.