What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that primarily attacks the synovium — the lining of joints. Unlike osteoarthritis (wear and tear), RA is driven by the immune system mistakenly attacking healthy joint tissue, causing inflammation that eventually damages cartilage and bone. RA affects about 1% of the global population and is 2–3 times more common in women. It most commonly begins between ages 30–60.
Blood tests for RA diagnosis and monitoring
| Test | Normal | What it shows in RA |
|---|---|---|
| Rheumatoid Factor (RF) | <14 IU/mL | Positive in 70–80% of RA; not specific |
| Anti-CCP antibodies | <20 U/mL | Positive in ~95% of RA; highly specific |
| CRP | <10 mg/L | Active inflammation; tracks disease activity |
| ESR | <20 mm/hr (women), <15 (men) | Ongoing inflammation |
| CBC | Normal | Anaemia of chronic disease common in RA |
| Liver function | Normal at baseline | Monitored during DMARD therapy |
Seropositive vs Seronegative RA
Seropositive RA: both RF and anti-CCP positive. Generally more severe disease with higher risk of joint destruction and extra-articular complications (lung disease, vasculitis, nodules). Seronegative RA: RF and anti-CCP negative. Diagnosis based on clinical features. May have slightly milder course but still requires treatment.
Symptoms of RA
- Symmetrical joint swelling — both hands, both wrists (not one side like gout)
- Morning stiffness lasting more than 1 hour (key distinguishing feature from osteoarthritis)
- Warm, tender, swollen joints
- Fatigue and low-grade fever
- Small joints of hands and feet involved first
- Rheumatoid nodules — firm lumps under the skin near elbows
- Weight loss in active disease
DAS28 — measuring disease activity
The Disease Activity Score (DAS28) is used to track RA severity and guide treatment. It combines joint counts, CRP or ESR, and the patient's own assessment of disease activity. Scores: <2.6 = remission; 2.6–3.2 = low disease activity; 3.2–5.1 = moderate; >5.1 = high activity.
Treatment overview
| Treatment | Stage | Notes |
|---|---|---|
| NSAIDs | Symptom relief | Does not slow disease progression |
| Corticosteroids (short course) | Acute flares | Rapid relief; long-term side effects |
| Methotrexate | First-line DMARD | Gold standard; weekly dose + folic acid |
| Hydroxychloroquine / Sulfasalazine | Mild RA or combination | Often used with methotrexate |
| Biologics (TNF inhibitors, JAK inhibitors) | Moderate–severe RA not controlled by DMARDs | Adalimumab, etanercept, tofacitinib |
Questions to ask your doctor
- Are both my RF and anti-CCP positive?
- What is my DAS28 score?
- Should I start methotrexate?
- How often should I monitor my blood tests on DMARDs?
- Do I need hand X-rays to check for joint erosions?