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What is Rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune condition, meaning the body attacks its own organs.

Inflammation of the lining of joints and other tissues can lead to significant pain, deformity and disability. 

Rheumatoid arthritis affects around 2% or 80,000 Australians, more women than men, and is more common with age [1].

It is the second most common arthritis in Australia, and is different to osteoarthritis, which affects around 10% of the population [2]. 

RA usually starts in the person’s 30s or 40s [3], developing over weeks to months [4]. It attacks symmetrical joints in the hands, wrists and feet, with:

  • Stiffness
  • Pain 
  • Swelling 

Other joints can be affected, but not usually the back [4].

As well as joint problems, people with RA can experience fatigue, fevers, and problems with their skin, nerves, heart and blood vessels, spleen, lungs, eyes and kidneys.

Research suggests RA is caused by multiple factors, for example:

  • A gene has been identified which makes people prone to developing RA [5]
  • First-degree relatives of someone with RA are more likely than second-degree relatives to develop RA [6]
  • A person related to someone with young onset RA (aged 17-65) is more likely to develop RA than if their relative developed RA after the age of 65 [6]
  • Cigarette smoking is the strongest known risk factor for RA [7].

RA is diagnosed mainly by symptoms and physical examination [8]. It is usual for people diagnosed with RA to be referred to a rheumatologist as it can be complex to manage.

Diagnostic tests ordered are listed in Table 1; other tests may be required to exclude other diagnoses and complications of RA. Most people with RA have anti-CCP and/or RhF antibodies, called seropositive RA. Seropositive RA is associated with more severe disease [9].


Tests used to diagnose rheumatoid arthritis

Blood tests [10]
  • Full blood count, inflammatory markers (CRP, ESR*)
  • Auto-antibodies (Anti-CCP, RhF**)
  • Kidney and liver function
X-Rays or other imaging [8]
  • Appropriate in some patients

*CRP = C-reactive protein, ESR = Erythrocyte sedimentation rate

**Anti-CCP = Anti-cyclic citrullinated peptide; RhF = Rheumatoid factor

Treatment should begin within 12 weeks of diagnosis. This is “the window of opportunity” where intensive treatment can increase likelihood of earlier remission, better physical functioning and quality of life [11].

Your doctor will usually start you on a steroid called prednisolone to help with joint symptoms.

At this time or soon after, a conventional disease-modifying antirheumatic drug (DMARD) is usually started by your rheumatologist, typically methotrexate. DMARDs are the mainstay of treatment as they slow or even halt disease progression.

However, sometimes more than one drug is required due to adverse effects or poor response.

All DMARDs require regular monitoring. Depending on the drug, adverse effects include abdominal pain, nausea, mouth ulcers, anaemia, kidney or liver toxicity, increased risk of infection or cancer.

Table 2 summarises common medications which your doctor may prescribe for you.


Tests used to diagnose rheumatoid arthritis

Medication type Examples How they work
Pain relief [10]

Ibuprofen, diclofenac, meloxicam, celecoxib, steroid injection into joint

Reduces pain and joint inflammation

No evidence that they stop joint damage

Oral corticosteroid [12,13]


Reduces inflammation and dampens immune reaction

Typically used as “bridging therapy” for up to three months when changes made in DMARD* therapy

Conventional DMARDs*

Methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, prednisolone

Relieves symptoms

Slows disease progression

Biologic DMARDs*

This group is split into several classes depending on their modes of action: drugs include abatacept, adalimumab, anakinra, tocilizumab, rituximab

Relieves symptoms

Slows disease progression

*DMARD = Disease-modifying anti-rheumatic drug

Currently, there is no cure, and no strong evidence for any particular diet [14] or supplements [15–17] although supervised exercise may help [18,19]

New treatment under development at the Bionics Institute

Bionics Institute researchers are developing an electrical medical device for people with rheumatoid arthritis that aims to:

Provide a drug-free treatment for rheumatoid arthritis using vagus nerve stimulation 

Trigger the body’s natural anti-inflammatory response to reduce inflammation caused by rheumatoid arthritis 

Give long-term relief from pain and disability without the side effects of drug treatment. 

How does it work?

• A tiny electrode array is attached to the vagus nerve just under the diaphragm

• The vagus nerve connects the brain to the gut and controls natural anti-inflammatory processes in the body

• The vagus nerve is stimulated by the electrode array in response to inflammation caused by rheumatoid arthritis 

• The vagus nerve initiates a natural anti-inflammatory response and reduces the pain and symptoms of rheumatoid arthritis 

• The electrode array is powered by a small battery implanted at hip level.

• The battery only needs to be replaced every 10 years ensuring the device provides a set-and-forget treatment

• The treatment causes fewer side effects than medications

Read more

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Medical disclaimer

This article contains general information relating to a medical condition. Such information is provided for informational purposes only and does not replace medical advice given by your healthcare professional.


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