Rheumatoid arthritis

What it is

Rheumatoid arthritis is an autoimmune condition in which the immune system attacks the synovial lining of joints, producing inflammation, pain, swelling and, if uncontrolled, joint destruction. It characteristically affects the small joints of the hands and feet symmetrically, with morning stiffness lasting over an hour.

Alongside the joint disease sits rheumatoid cachexia: loss of muscle mass driven by the inflammatory process itself, present in a majority of patients even when weight is stable. It contributes substantially to disability and it responds to resistance training, which was discouraged for decades on the mistaken belief that it would damage joints.

What it feels like

• Swollen, painful joints, typically symmetrical and in the small joints of the hands and feet
• Morning stiffness lasting more than an hour
• Fatigue that is out of proportion and not relieved by rest
• Improvement with movement through the day
• Flares and remissions rather than a steady course

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Autoimmune synovitis

The immune system attacks the joint lining, which thickens and produces inflammatory chemicals that damage cartilage and bone. This is the primary disease and it needs medical treatment.

Rheumatoid cachexia

Inflammatory cytokines drive muscle protein breakdown directly. Muscle mass is reduced in most patients, often with fat gain masking it on the scales, and it contributes substantially to disability.

Reduced activity from pain and fatigue

Pain and exhaustion reduce activity, which compounds the muscle loss and the cardiovascular risk. The deconditioning is a large part of the functional limitation.

Corticosteroids

Frequently used to control flares and they cause their own muscle and bone loss. The cumulative effect over years of intermittent courses is substantial.

Genetics

Family history and specific genetic markers raise risk considerably, though most people with the risk genes never develop the disease.

Smoking

The strongest known environmental risk factor, particularly in genetically susceptible people. It also worsens disease severity and reduces the effectiveness of treatment.

Increased cardiovascular risk

Chronic inflammation accelerates atherosclerosis. Cardiovascular disease is the leading cause of death in rheumatoid arthritis, which is one of the strongest arguments for exercise.

Bone loss

Inflammation, steroids and reduced loading all reduce bone density. Osteoporosis is substantially more common and is under-treated.

Sex and hormones

Two to three times more common in women, with onset often around hormonal transitions.

The old advice to rest

Not a cause of the disease but a cause of avoidable disability. Rest was standard advice for decades and it produced deconditioning, muscle loss and worse outcomes.

Who tends to get it

• Women, in whom it is two to three times more common
• Smokers, in whom risk and severity are both higher
• Anyone with a family history of rheumatoid or other autoimmune disease
• People with existing autoimmune conditions
• Adults between forty and sixty, when onset peaks

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineInflammatory Arthritis (RA, PsA & Axial SpA)

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Hot swollen joints with fever could be septic arthritis - urgent; new inflammatory symptoms need rheumatology, not exercise alone

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Modern disease-modifying treatment has transformed the outlook, and joint destruction is far less common than it was. Exercise adds substantially on top: resistance training improves muscle mass, function and disease activity scores without accelerating joint damage, and aerobic exercise addresses the cardiovascular risk that is the leading cause of death. Scale intensity to disease activity, and avoid loading a specific joint that is actively flaring - but do not stop.

Prevalence basis: Rheumatology registries

Others the same routine covers

These share the Inflammatory Arthritis (RA, PsA & Axial SpA) routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.