Rheumatoid arthritis: Which lifestyle changes are recommended to help manage the condition?

Though the exact causes of rheumatoid arthritis are as yet not fully understood, several factors, including genetics and experiencing stressful life events, are known to be related to the onset of the condition. In this informative article, Professor Tom Sheeran, a highly respected consultant rheumatologist reveals which are the most common symptoms of rheumatoid arthritis and how treatment of the condition has advanced throughout his career. The revered specialist also shares his expert insight on the most impactful lifestyle changes that patients can make to help manage and improve symptoms of rheumatoid arthritis.

What is rheumatoid arthritis? What causes it?

Rheumatoid arthritis is the most common inflammatory joint disease and affects more women than men. Nobody really knows exactly what causes rheumatoid arthritis but there are certain parameters that are important which we divide into thirds:

The first is a hereditary factor and this accounts for a third of the risk of getting rheumatoid arthritis. We know from studies of twins that only a third of twins with identical genetic backgrounds will get rheumatoid arthritis if the other twin has rheumatoid arthritis.

The second important factor is a triggering event. Often, this is an infection of some sort but nobody is really sure whether it is bacterial or viral but there is anecdotal evidence for both of those organisms.

The third thing is that we need to have some sort of stressful event. A stressful event could be anything as it's very difficult to measure stress. However, these events are nearly always part of a person’s lifestyle, such as a death in the family, a divorce, moving house or starting a new job. These key and important stressful events seem to contribute to the cause of inflammatory arthritis.

Although this may sound very vague, this is the summary of our current understanding of the causes of rheumatoid arthritis.

What are the symptoms of rheumatoid arthritis?

The most common presentation for rheumatoid arthritis is inflammation which results in swelling, pain, loss of function in the small joints of the body which are mainly concentrated in the hands and feet. Other presentations include polymyalgia, where people experience aches and pains in the limbs, and generalised inflammation in other parts of the body outside of the joints, although this is less common.

I have also seen patients who present with symptoms of Raynaud’s disease or an inflammatory response and they have a lot of weight loss. There can also be lung involvement so the symptoms can be quite variable. Mostly, however, patients complain of joint pain in the small joints and it's mainly a symmetrical problem.

What are the different treatment options available for rheumatoid arthritis?

Over the last twenty years, the treatment options have changed dramatically. We used to have a pyramid of treatment; starting with anti-inflammatories, aspirin and paracetamol, and then moving up through Hydroxychloroquine to gold injections and finally, steroids.

Now, this treatment pathway has been turned on its head and so patients often get a shot of steroids first. After this, they are put onto quite aggressive treatment, as compared to twenty years ago, including Methotrexate combination therapy with either Hydroxychloroquine, Sulfasalazine, or even Leflunomide. Patients will also get joint injections quite early on and will move on to biologic therapies quite quickly (within about three to six months) if possible.

Recent advances have really revolutionised the management of rheumatoid arthritis. Initially, these treatments were all given parenterally, either as an injection or an infusion. Nowadays, we better understand how these drugs work and so we have moved on to a new oral preparation which does almost exactly the same job as these very expensive protein biologic drugs. With the variety of treatment options increasing and improving so dramatically, particularly within the last twenty years or so, the outcomes for patients have also changed.

What role do lifestyle changes play in managing rheumatoid arthritis?

This is a very important question. When we talk about lifestyle, from my perspective, the emphasis is on trying to get the patient back to their normal routine and daily activities, whether that's picking the kids up from school, going to work, going to the gym, or being able to do the gardening and the housework. These are very important lifestyle parameters by which we judge the effectiveness of the treatment because if you're not able to do those particular aspects of your life, we're not succeeding.

Therefore, the changes that patients should make relate to trying to keep up their normal daily activities and maintaining their exercise programme. Exercise is very important even as we get older as we recognise that sarcopenia, a loss of bone and muscle strength, is a major problem. For this reason, exercise, even as an eighty year old person, including going to the gym or doing tai chi or Pilates is still very important.

The other important aspect of doing exercise is that it allows us to maintain our stamina and muscle tone, making falls and breaks far less likely. Additionally, exercising helps you to keep control of your weight. This is key as your weight goes through very important limb joints and the supporting joints of the knees, hips, and ankles any problems there are made worse by carrying excessive weight.

We also advocate that diet is very important. It’s impossible to say exactly what drives the inflammatory response in an individual patient but we do recognise that your biome is very important in driving elements of your immune system. I would encourage people to read up on diet and arthritis in particular books by people such as Professor Tim Spector OBE, who led the ZOE campaign which centred on nutrition-science and later branched out into Covid-19 during the pandemic. I recommend patients look into these very interesting insights into diet and how it can help to control inflammation.

If you wish to schedule a consultation with Professor Sheeran, you can do so by visiting his Top Doctor’s profile.