Rheumatoid arthritis

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• A fever or feeling severely unwell while taking medication that suppresses the immune systemContact us or go to an emergency department the same day, and say what you are taking. Treatment that damps the immune system also damps the usual signs of infection.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• Newly swollen, tender joints with morning stiffness lasting more than an hourWorth being seen quickly rather than waiting. There is a window early on where treatment prevents damage, and it does not stay open indefinitely.
• New neck pain with pins and needles in the arms or unsteadiness on your feet

What usually happens

This is not the arthritis of wear and tear, and the difference decides how quickly you should be seen. Osteoarthritis hurts more the more you use the joint; rheumatoid arthritis is stiffest after rest, worst in the morning, and comes with visible swelling.

There is a genuine early window. Treatment started within the first months prevents joint damage that cannot be reversed later, which is why new swollen joints are worth pushing for an appointment about rather than watching for a few months.

Feeling better does not mean the inflammation has stopped, and treatment usually continues through the good spells for exactly that reason. Damage accumulates quietly in joints that are only mildly symptomatic.

It is not confined to joints. Fatigue is often the most disabling part, and the eyes, lungs and cardiovascular risk can all be affected — so it is worth mentioning symptoms that seem to belong elsewhere.

The medications that work suppress part of the immune system, which means vaccinations, infections and planning around surgery or pregnancy all need thinking about in advance rather than at the time.

At your appointment

We will look for swelling rather than relying on pain alone, and ask how long the morning stiffness lasts, since that is one of the more useful questions in the whole assessment.

Blood tests including markers of inflammation and antibodies, understanding that normal antibodies do not exclude it — a fair proportion of people have rheumatoid arthritis without them.

Early referral to rheumatology where the picture fits, with monitoring and day-to-day management shared here afterwards.

Regular blood monitoring while on treatment, plus attention to vaccinations and cardiovascular risk, both of which matter more than usual here.

Worth asking

• —How quickly can I be seen by rheumatology?
• —Is my disease actually controlled, or only quiet symptomatically?
• —What should I do if I get an infection while on this treatment?
• —Which vaccinations should I have, and when?