Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that primarily affects the joints. In RA, the immune system mistakenly attacks the lining of the joints (called the synovium), causing inflammation, pain, swelling, and over time, damage to the joint itself.
Unlike osteoarthritis – which results from wear and tear – RA is driven by immune system dysfunction and can occur at any age. In some people, RA can also affect other body systems including the skin, eyes, lungs, heart, and blood vessels. RA typically affects joints on both sides of the body symmetrically – for example, both wrists or both knees at the same time. This symmetrical pattern is a key distinguishing feature.
There is no cure for RA, but early diagnosis and treatment can significantly slow joint damage and improve quality of life. Many people with RA are able to live full, active lives with the right management.
How common is Rheumatoid Arthritis?
According to the Australian Institute of Health and Welfare (AIHW), an estimated 514,000 Australians (2.0% of the population) were living with rheumatoid arthritis in 2022.
RA is more common in women, affecting 2.5% of females compared with 1.6% of males. While it can develop at any age, prevalence increases with age and is highest in people aged 75 and over.
Symptoms of RA can vary in severity and tend to come and go in episodes called flares, with periods of remission in between.
Common symptoms include:
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- Tender, warm, and swollen joints – most often in the hands, wrists, and feet in the early stages, typically affecting both sides of the body
- Morning stiffness – joints that feel stiff and difficult to move after rest, particularly in the morning, lasting 30 minutes or longer
- Fatigue – persistent tiredness that is not relieved by rest, often one of the first and most disabling symptoms
- Fever and general feeling of being unwell, particularly during flares
- Loss of appetite and unintentional weight loss
- Joint deformity and reduced range of motion in more advanced or untreated disease
RA can also cause inflammation outside the joints, including in the eyes (dryness, redness), lungs, and blood vessels – particularly in people with long-standing or severe disease.
The exact cause of RA is not known.
It is thought to result from a combination of factors:
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- Genetics – RA tends to run in families, suggesting a genetic component, though having a family member with RA does not mean you will develop it
- Immune system – RA is an autoimmune condition in which the immune system attacks healthy joint tissue, triggering chronic inflammation
- Hormones – RA is significantly more common in women, suggesting hormonal factors may play a role
- Environmental triggers – cigarette smoking is the strongest known environmental risk factor for developing RA and worsening its severity. Other possible triggers include certain infections and exposure to pollutants
RA is not contagious and cannot be passed from person to person.
There is no single test for RA.
Diagnosis is based on a combination of:
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- A detailed review of your symptoms, their pattern and duration, and family history
- A physical examination of your joints for swelling, warmth, and tenderness
Blood tests – several blood tests help support a diagnosis:
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- Rheumatoid factor (RF) – present in about 80% of people with RA, though a negative result does not rule it out
- Anti-cyclic citrullinated peptide antibodies (anti-CCP) – more specific to RA than RF
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) – markers of inflammation
Imaging – X-rays, ultrasound, and MRI can detect joint inflammation and damage, and help track disease progression over time.
Early referral to a rheumatologist is important. Australian guidelines recommend that people with suspected RA see a rheumatologist within six weeks of symptom onset, as early treatment leads to significantly better long-term outcomes.
Treatment for RA aims to reduce inflammation, relieve symptoms, prevent joint damage, and maintain function.
The approach has improved dramatically in recent decades – most people treated early can achieve remission or low disease activity.
Self-care: Regular low-impact exercise (such as walking, swimming, or cycling) helps maintain joint mobility and reduce fatigue. Quitting smoking is strongly recommended as it worsens RA severity and reduces the effectiveness of some medications.
Physiotherapy and occupational therapy are valuable for maintaining function.
Medications
NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or naproxen provide short-term symptom relief but do not slow disease progression. Corticosteroids such as prednisolone are used short-term to reduce inflammation during flares.
Conventional DMARDs (disease-modifying anti-rheumatic drugs) are the foundation of RA treatment. Methotrexate is the most commonly used first-line option; others include hydroxychloroquine, sulfasalazine, and leflunomide. These suppress the immune system to slow disease progression and reduce joint damage.
When conventional DMARDs don't provide adequate control, biologic DMARDs are used. These target specific parts of the immune system and must be prescribed by a rheumatologist. Types include TNF inhibitors, IL-6 inhibitors, T-cell co-stimulation inhibitors, and B-cell depleting agents.
JAK inhibitors (Janus kinase inhibitors) are a newer class of oral medications that block specific immune signalling pathways, used when other treatments have been insufficient.
The following specialty medications are available at Ace, a specialty pharmacy for Rheumatoid Arthritis.
Biosimilars are also available on the PBS. Speak with your Ace pharmacist about your options.
With Ace, you’ll benefit from:
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- Expert Support — Our dedicated team of health concierges is always available to answer your questions, provide guidance, and help you navigate your condition with confidence.
- Specialty Medication — We offer a wide range of specialty medications and support services, designed specifically for those living with chronic illnesses. Whether you’re looking for help managing a specific condition, or simply need access to the medications you need, we’ve got you covered.
- A Wide Range of Conditions — From diabetes to heart disease, and everything in between, we help manage a variety of special condition
Take control of your health and well-being, and start your journey to better health with Ace today.
There are many organisations that support Australians living with rheumatoid arthritis.
See below for a selection.
Support Organisations
Clinical & Research Resources
