RA is diagnosed based on patients' symptoms and clinical examination by a doctor. Blood tests showing elevated inflammatory markers (e.g. erythrocyte sedimentation rate or C-reactive protein) are helpful. Antibody tests such as rheumatoid factor and/or anti-cyclic citrullinated peptide are not essential for diagnosis but may help predict disease outcome. X-ray or ultrasound scans of the hands or feet may also be conducted.
A positive rheumatoid factor alone is not diagnostic of RA in the absence of any clinical symptoms. Up to 3-8% of the normal population may have a positive rheumatoid factor.
Rheumatoid arthritis is a chronic condition that can be effectively treated with medications and lifestyle changes. Prompt treatment can reduce symptoms and prevent joint damage and deformities. It is important for patients with RA to attend regular medical check-ups and take medications as prescribed even when they feel well, to avoid disease flares.
• Disease-modifying anti-rheumatic drugs (DMARDs) are the mainstay of long-term RA management. These are medications that suppress the overactive immune system from further damaging the joints. Methotrexate (MTX) is the cornerstone of treatment and is usually prescribed to most patients with RA. MTX is given weekly in the form of tablets or subcutaneous injections (injections under the skin usually given in the abdomen or thighs). Folic acid is usually taken the day after MTX to reduce side effects associated with MTX. Other conventional DMARDs include oral medications (e.g. hydroxychloroquine, sulfasalazine, leflunomide)
• Biologic medications are more targeted injection medications given subcutaneously or through the veins (e.g. infliximab, adalimumab, golimumab, etanercept, certolizumab pegol, rituximab, abatacept and tocilizumab).
• Newer targeted DMARDs have been developed. These are oral tablets and are usually given for patients with more severe disease or when conventional DMARDs have failed to control disease activity adequately (e.g. tofacitinib, baricitinib, upadacitinib and filgotinib)
• Some patients require combination therapy with more than one of the above medications. Patients on DMARDs will require regular blood tests to monitor for any potential side effects.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and low dose steroids may be used as adjunctive treatment in the early management of RA as these medications work quickly to relieve symptoms. These medications may be given as tablets or through intramuscular injections. In patients with severe joint inflammation, steroids may be injected directly in the affected joint(s) for rapid relief.
Physiotherapy and occupational therapy may be recommended in patients who have functional impairment from joint deformities and to relieve pain.
RA is often associated with other medical conditions such as osteoporosis, high cholesterol, diabetes and high blood pressure. These conditions should be addressed as part of holistic care for RA. Certain vaccinations are recommended to prevent common infections, such as influenza, pneumococcal, shingles and Respiratory Syncytial Virus (RSV).
Seek a doctor's advice as soon as possible. You will be referred to a specialist (rheumatologist) who can confirm the diagnosis and start you on the appropriate treatment. Once diagnosed, it is important to start treatment as soon as possible. Any delay may result in accumulation of permanent damage to your joints; however, this can be prevented with appropriate, early treatment.
This condition is managed by the Division of Rheumatology and Allergy. The division runs a specialised multidisciplinary TARGET Arthritis clinic to provide fast-track care for patients with early inflammatory arthritis and difficult-to-treat RA using a structured treat-to-target approach.
