Rheumatoid arthritis: symptoms, tests, treatment and which doctor to see

What rheumatoid arthritis is, the early signs, the tests a rheumatologist uses, why early treatment protects your joints, and how it is managed.

Also known as: Arthritis, rheumatoid; RA

What rheumatoid arthritis is

Rheumatoid arthritis (RA) is a long-term autoimmune condition. The immune system, which normally fights infection, attacks the thin lining of the joints. The lining becomes inflamed and thickened, and if this continues untreated it can damage the cartilage and bone and change the shape of the joints.

RA is not the same as osteoarthritis. It usually starts earlier in life, typically affects the small joints of the hands and feet on both sides of the body, and involves the whole body: it can cause tiredness and affect the lungs, eyes, blood vessels and heart. The good news is that modern treatment, started early, can control it well in many people.

Symptoms

RA often begins gradually over weeks to months. The common symptoms are:

• Joint pain and joint swelling, most often in the knuckles, the middle finger joints, the wrists and the balls of the feet
• The same joints affected on both sides of the body
• Morning stiffness that lasts well over half an hour, sometimes for hours
• Tiredness, a mild fever, loss of appetite or weight loss
• Rheumatoid nodules — firm, painless lumps under the skin, often near the elbows
• Difficulty making a fist, opening jars or buttoning clothes

Larger joints such as knees, shoulders and ankles can also be involved. Symptoms may flare and settle, which can make it tempting to wait. Swelling in several joints that lasts more than a few weeks should be checked.

Causes and who is at risk

The exact cause is not known. It is thought to result from a mix of inherited tendency and something in the environment that switches on the immune response. Your risk is higher if you:

• Are a woman — RA is more common in women than in men
• Have a close relative with RA or another autoimmune condition
• Smoke now or have smoked in the past
• Have gum disease or carry excess weight

Smoking is the most important risk you can change. It makes RA more likely, makes it more severe and makes some treatments work less well.

How it is diagnosed

No single test proves or rules out RA. A rheumatologist puts together your history, an examination of each joint and a set of tests:

• Rheumatoid factor and anti-CCP antibodies — blood tests for antibodies linked to RA. Anti-CCP is more specific. Some people with RA test negative, and some healthy people test positive for rheumatoid factor, so the result is read alongside the examination.
• ESR and CRP — blood tests that measure inflammation and help track how active the disease is.
• A blood count, liver and kidney tests — to look for anaemia and to check it is safe to start medicines.
• X-ray of the hands and feet — to look for early damage and to set a baseline.
• Ultrasound or sometimes MRI — to show inflammation in a joint that is not obvious on examination.

Doctors aim to diagnose RA early because the first months are when treatment does the most to prevent permanent joint damage.

Which doctor to see

If you have swollen, painful joints for more than a few weeks, see a general physician promptly and ask to be referred to a rheumatologist. A rheumatologist confirms the diagnosis, chooses the long-term medicines and monitors them.

Others often share care. Physiotherapists, who are allied-health professionals, help keep joints moving and muscles strong. An orthopaedic surgeon is involved if a damaged joint needs surgery. You can find rheumatologists in Bengaluru on The Doctor Index, each with a registration you can check.

Treatment

There is no cure, but the aim of treatment today is remission or very low disease activity — swelling settled, blood markers improved and joints protected. Your rheumatologist will set the target with you and adjust treatment until it is reached.

Disease-modifying medicines

DMARDs (disease-modifying anti-rheumatic drugs) are the core of treatment because they calm the immune attack itself, not just the pain. Methotrexate is usually the first choice; others include hydroxychloroquine, sulfasalazine and leflunomide, often in combination. They take several weeks to work. Regular blood tests are needed to check for side effects on the blood count and liver, so keep every monitoring appointment.

Biologic medicines and newer targeted tablets are used when standard DMARDs do not control the disease. Because they affect the immune system, you will be screened for infections such as tuberculosis and hepatitis B before starting them, which matters particularly in India.

Steroids and pain relief

Steroids work quickly and are useful for a short period while DMARDs take effect, or for a flare. Long-term use has serious side effects, so they are tapered off when possible. Never stop steroids suddenly on your own. Anti-inflammatory painkillers ease symptoms but do not prevent joint damage.

Physiotherapy and self-care

Physiotherapy and regular exercise keep joints flexible and muscles strong. Occupational therapy can suggest splints and aids for daily tasks. Stopping smoking, keeping a healthy weight and looking after your teeth and gums all help.

Living with rheumatoid arthritis

RA is a long-term condition, and follow-up is how it stays controlled. Expect regular reviews and blood tests, more often in the early months. RA increases the risk of heart disease and osteoporosis, so blood pressure, cholesterol and bone health should be checked. Ask about vaccinations, such as against influenza and pneumonia, before or soon after starting treatment. If you are planning a pregnancy, talk to your rheumatologist well in advance, because some medicines, including methotrexate, must be stopped beforehand.

When it is an emergency

Call 112 or 108, or go to the nearest emergency department, for:

• Fever, chills or feeling very unwell while on DMARDs, biologics or steroids — infections can become serious quickly
• A single joint that suddenly becomes hot, red and very painful
• Sudden breathlessness, chest pain or coughing blood
• New weakness or numbness in the arms or legs, or neck pain with tingling — RA can rarely affect the neck joints

Questions to ask at your appointment

• How sure are we that this is rheumatoid arthritis?
• What is our treatment target, and how will we measure it?
• Which blood tests do I need while on these medicines, and how often?
• Which side effects should make me call you?
• Which vaccinations should I have?
• What should I do if I am planning a pregnancy?

Common questions

All rheumatology conditions →

Sources

• MedlinePlus, US National Library of Medicine — Rheumatoid Arthritis
• World Health Organization — Rheumatoid arthritis fact sheet
• MedlinePlus, National Library of Medicine — Rheumatoid Arthritis — Public-domain health-topic summary
• MedlinePlus Genetics — Rheumatoid arthritis — Public-domain Genetics summary

Rheumatoid arthritis: symptoms, tests, treatment and which doctor to see is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.

General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-2059.