Frequently asked questions about Rheumatoid Arthritis

Osteoarthritis is initially characterised by a loss of joint cartilage, which thins and eventually ends up affecting the bone that forms part of the joint (subchondral bone). There may be some degree of inflammation in osteoarthritis, but this is much less evident than in rheumatoid arthritis. Osteoarthritis is much more common than rheumatoid arthritis and has a clear association with age, being a disease that is predominantly seen in people of more than 45-50 years of age. It causes joint pain that occurs mainly after the joint has been in use (mechanical pain) and which tends to subside when the joint is rested. In rheumatoid arthritis, however, the synovial inflammation occurs first, and cartilage and subchondral bone may be affected later on. The type of joints affected, the characteristics of the pain, the clinical evolution, and the treatment is very different for rheumatoid arthritis compared to osteoarthritis.   

There is a genetic component that increases the risk of getting this disease. The genes most involved in this are part of the so-called major histocompatibility complex. Although relatives of a patient with rheumatoid arthritis have a slightly higher risk of suffering the disease, it cannot be classed as a hereditary disease, since the vast majority (>90%) of patients have no first-degree relatives (parents, siblings, children) who are affected by it.  

Yes, a history of rheumatoid arthritis does not preclude pregnancy. Caution should be exercised with certain background treatments (DMARDs and targeted therapies), which should be discontinued some months before the pregnancy. Patients with rheumatoid arthritis usually experience a good progression of their disease during their pregnancy. Caution must be exercised in the postpartum period as the disease may reactivate.  

No. There are other chronic conditions such as autoimmune diseases (lupus, systemic sclerosis, etc.), microcrystalline arthritis (gout, chondrocalcinosis) and arthritis associated with psoriasis (psoriatic arthritis) which can produce joint symptoms similar to those associated with rheumatoid arthritis. 

Yes, in the vast majority of cases. Currently, patients must keep taking background DMARD treatment to prevent swelling of the joints and avoid damage. The withdrawal of this treatment almost always leads to a flare-up. Even so, a small percentage of patients manage to control their disease with low doses of DMARDs.  

Biological therapies have acceptable safety levels and are very effective, but they do not cure the disease. For this reason, they cannot be discontinued and, in general, they must be taken for life. Once the activity of the disease has been controlled (remission), doses of biological drugs can sometimes be reduced or spaced out. A small percentage of patients are able to stop taking them by keeping some maintenance treatment with DMARDs.   

Cortisone-derived medications (usually prednisone or prednisolone) can be helpful in stages when the arthritis is getting worse or if certain complications arise. In the initial phases of the disease, these are used as bridge therapy while the patient is waiting for DMARDs to take effect. They are discontinued when remission is achieved as they have important adverse effects (overweight, osteoporosis, infections, diabetes, etc.). However, some patients do continue to receive them for long periods of time. At low doses, there are no major side effects and they are effective.  

General infection prevention schemes, such as seasonal flu and pneumococcal vaccines, are recommended for patients with rheumatoid arthritis. If live-attenuated vaccines are required, patients should consult their rheumatologist, as the vast majority of medications contraindicate their use and should be discontinued while the vaccination schedule is followed.   

Management of the disease requires a physical examination, a follow-up by rheumatology and nursing, and a periodic analysis that not only monitors possible adverse effects of the drugs but also checks the disease activity. 

Yes, between 10% and 25% of patients do not present the typical antibodies for rheumatoid arthritis (RF and ACPA), but still have symptoms and signs that are suggestive of the disease. This is referred to as seronegative arthritis. The treatment is usually similar, although the disease progression is usually better than in patients who are positive for the antibodies.   

In some cases, glucocorticoid joint injections are very useful for treating flare-ups in a single joint and avoid changes having to be made to the background treatment. If these are given using general aseptic measures and by trained personnel, they are usually uncomplicated.   

Rheumatoid arthritis is essentially an incurable disease, but nowadays the treatment is very effective, so it is very manageable. To maximise the effectiveness of this treatment, it is important to make an early diagnosis and to begin treatment as soon as possible, before the joint deteriorates, as this is irreversible. 

Rheumatoid arthritis is a chronic disease with a long-term progression and episodes where the arthritis symptoms get worse. If the disease is not managed, the patient may end up developing some degree of joint deformity and disability. Some patients have to give up their job or change what they do. For this reason, rheumatoid arthritis should be considered a serious disease, although no two patients are the same. However, in recent decades, the prognosis has changed and most patients have a good quality of life and are able to live normally. This is thanks to current treatment strategies that strictly control the disease, have ambitious goals (remission), include early diagnosis and treatment, and involve the appropriate use of new anti-rheumatic therapies, which are very effective.