Rheumatoid Arthritis | Guide to Symptoms, Diagnosis, Treatment

Joon Nah BScPT
Registered Physiotherapist
updated Mar 28, 2025

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What is Rheumatoid Arthritis?

Rheumatoid arthritis or RA, is an autoimmune condition that mainly affects your joints, but can also cause issues with other area of your body such as your heart and blood vessels, lungs, skin and your vision. With RA, your immune system attacks your joint lining (synovium) which leads to inflammation, pain, stiffness, swelling and eventually joint damage over time and potentially other organ complications.  It is a chronic life-long condition but can vary in how much it impacts one person to another.

 

What are the symptoms of rheumatoid arthritis?

The symptoms of rheumatoid arthritis can differ from person to person, though they have general similarities and nearly always have patterns of flare-ups and remissions. These are the most common symptoms of RA:

Joint specific issues

• pain, stiffness and swelling in several areas, that can affect any joint in your body.
• both sides of your body are usually equally affected
• pain and stiffness is usually worse in the morning or if you haven’t moved for a long time
• joints can be warm or red and will lose range of motion over time

Other symptoms

• chronic and persistent fatigue
• skin nodules (firm lumps) especially around bony areas like knees and elbows.
• flare-ups with increased symptoms, possible fever or flu-like issues

Long-term symptoms

Over time, RA can cause:

• muscle atrophy and weakness due to inflammation and lack of use
• joint deformities from gradual cartilage loss and wearing away of bone surfaces
• poorer functioning of organs such as heart and blood vessels, lungs and changes to your vision.

 

What are the causes of rheumatoid arthritis?

The exact causes of RA are largely unknown. However, we do know that the eventual problems with your joints and organs are a result of the chronic inflammation from RA, as your immune system attacks these areas repeatedly over time. The following factors are thought to be involved in starting this process:

Autoimmune
The HLA (human leukocyte antigen) system is responsible for identifying self (normal) vs. non-self (abnormal) cells in the body. At some point, the immune system begins to treat normal tissue as abnormal and starts attacking and creating an inflammatory response to “self”.

Genetics
Someone who is related to a person with rheumatoid arthritis does have a higher chance of contracting the disease themselves, though the risk is only slightly higher. Certain genes such as HLA-DR4 and HLA-DR1 appear to be involved with rheumatoid arthritis.

Hormonal changes
There is some evidence that sudden changes in hormones such as estrogen, are involved in causing rheumatoid arthritis. This makes sense, as women are more likely to contract RA and more often experience hormonal fluctuations (e.g. menopause and pregnancy).

Environmental triggers
Some individuals with rheumatoid arthritis have associated certain triggers with the onset of their condition. These include smoking, silica dust, air pollutants and toxic chemicals.

Infections and microbiome changes
Bacterial and viral infections have been associated with the early symptoms of rheumatoid arthritis, as well as imbalances or changes to the microbiome of the gut.

 

How is rheumatoid arthritis diagnosed?

Though it can be a little confusing to diagnose rheumatoid arthritis, particularly in the early stages, there are some hallmark features that can help confirm the condition. As with most dysfunctions, the process involves ruling out other factors while ruling in RA. The primary medical professional should be a rheumatologist, with supportive consultations from the patient’s physician and physiotherapists.

Patient medical history

A careful review of the patient’s symptoms and their progression can highlight an RA diagnosis.

• a gradual (vs. sudden) onset of joint pain, stiffness, and swelling (often in the small joints of hands, wrists, and feet)
• symmetrical pain (the same on both sides of the body)
• Morning stiffness lasting more than 30 minutes
• Fatigue, generalized weakness and occasional fever

Physical Examination

• joint examination looking for areas affected, tenderness, swelling, redness
• loss of range of movement and/or strength
• changes in joint alignment or deformity
• nodules over bony areas of the body

Blood tests

• 80% of patients are positive for rheumatoid factor (RF)
• evidence of systemic inflammation:  C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR)

Imaging

• X-rays may detect damage to joints if the rheumatoid arthritis has advanced far enough
• MRIs can be helpful in detecting joint inflammation before joint damage occurs.

 

Who is most affected by rheumatoid arthritis? What are the risk factors?

The following are risk factors for rheumatoid arthritis:

• Age: though RA can occur at any age, typically its onset occurs between the ages of 30 to 60
• Gender: women are 3x more likely to develop RA than men, primarily due to hormonal factors
• Genetics: if someone in your family already has rheumatoid arthritis, you are somewhat more likely to develop RA
• Smoking:  increases chronic inflammation in the body, making RA more likely
• Obesity and Poor Diet:  increases generalized inflammatory factors
• Chronic stress:  has a negative impact on immune system function

 

How do you treat rheumatoid arthritis?

Since many factors can cause rheumatoid arthritis to flare-up, it makes sense that the most effective treatment for RA involves a combined approach.

1. Medications

This is the primary and most effective treatment for rheumatoid arthritis. Initially NSAIDs such as ibuprofen and celecoxib are recommended. Often next steps involve corticosteroids and Disease-Modifying Antiheumatic Drugs (DMARDs) such as methotrexate. More aggressive medications beyond that are biologic drugs (TNF inhibitors) such as Humira. These all help to reduce inflammation, manage pain and slow down the progression of the disease. Your rheumatologist will help guide you through a proper medications strategy.

2. Physiotherapy

Physiotherapy has several goals in helping patients with rheumatoid arthritis. This is achieved through patient education and advice, specific exercise prescription and hands-on manual therapy. Here’s how physiotherapy can assist:

• teaching joint protective strategies. How to do your daily tasks/chores/activities in angle, positions, and other ways to minimize the stress on your body.
• show you how to use energy conservation techniques to reduce fatigue and prevent over-stimulation and stress on your at-risk areas
  advice on types of assistive devices (splints, braces, canes) and when to use them
• techniques to manage pain such as acupuncture and joint mobilizations and massage
• postural correction techniques to balance the internal and external forces on your body
• exercise prescription for a variety of factors including: improving range of motion and maintaining mobility, reducing resting pain and pain with activity, increasing strength and stability, improving tolerance to physical activities and reducing fatigue, improving coordination and balance. Common exercises may involve basic equipment such as bands, balls or dumbbells, may require you to move using the different areas of your home, or could involve advanced exercise instruction to undertake in a gym setting.

3. Lifestyle improvements

Permanent changes in your lifestyle can have tremendous positive effects on your rheumatoid arthritis as well as increasing your lifespan and the quality of your life. For RA, we suggest regular, controlled physical activities. Lower impact cardiovascular exercise such as walking, swimming, cycling. Resistance exercise to keep muscles strong, joints more stable.

The two most harmful lifestyle choices for rheumatoid arthritis sufferers are smoking and alcohol consumption. There is no amount of either that doesn’t have a negative impact and should be avoided.

It is recommended that a diet that is higher in fibre and lower in sugar and carbohydrates and reduced in saturated fat be adopted. Foods can have a significant inflammatory and anti-inflammatory effect. Simply what you eat and drink can be directly linked to flare-ups or a worsening of your overall condition.

Cornerstone Physiotherapy has an innovative metabolic rehabilitation program that uses biometric data from  wearables (such as smart watches) to better guide recovery for patients. Some patients with rheumatoid arthritis could benefit from both the standard physiotherapy for RA that our physiotherapists provide, as well as the specialized met rehab that addresses lifestyle issues that impact the level of inflammation in your body. Learn more about this program here.

 

How do you treat a rheumatoid arthritis flare-up?

RA flare ups are not easy to change and often the variable that has the biggest impact is simply time. However there are some strategies that potentially reduce how intense the flare-up feels as well as possibly reducing the length of the flare-up.

• stop or reduce any activities that put stress on joints, however don’t simply become sedentary. Light, repetitive movement can be helpful  e.g. short walks, moving joints gently back and forth, taking several shorter rests rather than one long one.
• some patients find heat more effective on reducing symptoms, whereas others find cold or ice better. This is individual to each person so try both and find out what works best for you over time.
• be sure you haven’t missed any of your prescribed medications. Speak with your doctor and ask their advice on whether a temporary medication change could help to get through the flare-up.
• see a physiotherapist. They may have specific strategies or treatment options that can get you off of a rheumatoid arthritis flare-up more quickly and effectively.

 

When should you get physiotherapy for rheumatoid arthritis?

It is never too early or too late to start physiotherapy for RA. The earlier the intervention, the more you’re able to adopt the strategies that reduce joint wear and tear, that keep you active longer, and that reduce inflammation and pain. These all may potentially have an impact on reducing the progression of your disease.

However if you have the following, you should certainly have physiotherapy top of mind:

• any joint stiffness that reduces your range of motion
• if you’re finding that your strength is regularly lower than it should be
• if you’re noticing any deformities in your joints (e.g. changes in angle or position)
• if you’re beginning to have issues with balance or coordination
• if your regular activities are negatively affected, even in-between flare-ups

 

What is your prognosis if you have rheumatoid arthritis? Can it be cured?

Rheumatoid arthritis is a chronic, autoimmune disease that currently has no cure, but early diagnosis and proper treatment can significantly improve your outcomes. Poorly managed or unmanaged RA can lead to complete joint damage, poor function of heart, lungs, vision and other organ issues.

Early management means starting drugs like DMARDs and biologic therapies. Newer medications such as Janus kinas (JAK) inhibitors have even more promise allowing some patients to into remission with their rheumatoid arthritis.

With good management, people with rheumatoid arthritis can maintain an active and fulfilling life, minimizing the impact of the disease on their daily activities.

 

Cornerstone Physiotherapy has skilled physiotherapists experienced in the treatment of the symptoms related to rheumatoid arthritis and other auto-immune soft-tissue and joint conditions. Contact us today and get us on your team.