Rheumatoid Arthritis: The Complete Guide to Symptoms, Treatment and Living Well

Rheumatoid arthritis (RA) is the most common autoimmune form of inflammatory arthritis. It affects roughly half a percent to one percent of adults worldwide, most often women, and usually begins between the ages of 30 and 60, although it can start at any age. Without treatment, RA can damage joints within the first few months and years, causing pain, deformity and disability, and it shortens life expectancy, mainly through heart disease.

The outlook has transformed over the past 30 years. With early diagnosis and modern treatment, most people with RA can now reach remission or low disease activity, keep working, and live full lives. But this depends on recognising the symptoms early, starting the right medicines quickly, and adjusting treatment until the disease is controlled. This complete guide explains what RA is, how to spot it, how it is diagnosed and treated, how to manage flares and fatigue, and how to protect your heart, bones, mental health and future.

What is rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease. Normally, the immune system protects the body against infections. In RA, it mistakenly attacks the body’s own tissues, particularly the synovium, the thin lining of the joints. The synovium becomes inflamed and thickened, producing excess fluid and inflammatory chemicals. This causes swelling, pain and stiffness. Over time, the inflamed tissue can erode cartilage and bone, damaging the joint and surrounding tendons and ligaments.

RA is a systemic disease, meaning it can affect the whole body, not just the joints. The inflammation can affect the eyes, lungs, heart, blood vessels, skin and nerves, and it causes fatigue, a general feeling of being unwell and sometimes weight loss or low-grade fever.

RA is different from osteoarthritis, the “wear and tear” arthritis that is far more common. Osteoarthritis is mainly a disease of cartilage and bone, usually affects weight-bearing joints such as knees and hips, causes stiffness that eases within about 30 minutes, and is not driven by autoimmune inflammation. You can read more in our article on the differences between osteoarthritis and rheumatoid arthritis.

What causes rheumatoid arthritis?

The exact cause is not fully understood. RA develops from a combination of genetic and environmental factors:

• Genes: certain genes, particularly variants of the HLA-DRB1 gene known as the “shared epitope”, increase the risk. RA is more common in people with a family history, but most people with a relative who has RA will not develop it themselves.
• Sex and hormones: women are two to three times more likely to develop RA than men. Hormonal changes may play a role; RA often improves during pregnancy and may flare after birth.
• Smoking: the strongest known environmental risk factor. Smoking increases the risk of developing RA, particularly the type with certain antibodies, makes the disease more severe and reduces the response to some treatments.
• Gum disease: a bacterium involved in periodontitis may help trigger the autoimmune process in some people.
• Obesity: associated with a higher risk and with less response to treatment.
• Dust and pollutants: exposure to silica dust and some occupational exposures have been linked to RA.

Changes in the immune system, including the development of antibodies such as rheumatoid factor and anti-CCP antibodies, can start years before joint symptoms appear.

Symptoms of rheumatoid arthritis

RA usually develops gradually over weeks to months, although sometimes it begins suddenly. Common symptoms include:

• Joint pain and swelling, typically in the small joints of the hands (the knuckles and middle finger joints, not usually the joints nearest the fingertips) and feet (the joints at the base of the toes), and the wrists.
• Symmetry: the same joints on both sides of the body are usually affected.
• Morning stiffness lasting more than 30 minutes, often an hour or more.
• Stiffness after rest, for example after sitting for a while.
• Warmth over swollen joints.
• Fatigue, which can be severe and is one of the most disabling symptoms.
• Feeling generally unwell, with flu-like symptoms, low mood or loss of appetite.
• Pain when squeezing across the knuckles or across the balls of the feet.

Larger joints such as the elbows, shoulders, knees, ankles and hips can also be affected. The neck may be involved in long-standing disease. Over time, untreated RA can cause visible joint deformities, such as fingers drifting sideways towards the little finger.

Early warning signs not to ignore

Specialist rheumatology organisations encourage urgent referral, ideally within weeks, for anyone with:

• Swelling in three or more joints.
• Swelling in the small joints of the hands or feet, or pain when the knuckles or the balls of the feet are squeezed.
• Morning stiffness lasting 30 minutes or more.

The first three to six months after symptoms start are often called the “window of opportunity”. Starting treatment within this time gives the best chance of controlling the disease and preventing joint damage.

Effects beyond the joints

RA can affect many parts of the body:

• Rheumatoid nodules: firm lumps under the skin, often over the elbows or fingers.
• Eyes: dry eyes (part of secondary Sjögren’s syndrome), and, less commonly, inflammation of the white of the eye (scleritis), which causes a painful red eye and needs urgent assessment.
• Lungs: interstitial lung disease (scarring of the lungs) and inflammation of the lining of the lungs. Report a new persistent cough or breathlessness.
• Heart and blood vessels: a higher risk of heart attack and stroke, and inflammation of the lining of the heart.
• Blood: anaemia is common.
• Nerves: carpal tunnel syndrome, causing tingling and numbness in the fingers.
• Bones: a higher risk of osteoporosis.
• Mental health: depression and anxiety are common.

How rheumatoid arthritis is diagnosed

There is no single test that diagnoses RA. Diagnosis is made by a healthcare provider, ideally a rheumatology specialist, based on symptoms, examination and tests:

• Examination of the joints for swelling, tenderness and range of movement.
• Rheumatoid factor (RF): an antibody present in many but not all people with RA. It can also be found in other conditions and in some healthy older people.
• Anti-cyclic citrullinated peptide (anti-CCP) antibodies: more specific for RA. A positive result makes RA more likely and is linked with more aggressive disease.
• Inflammatory markers: erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are often raised.
• Full blood count, kidney and liver tests: to check for anaemia and to prepare for treatment.
• X-rays of the hands and feet: to look for erosions and to provide a baseline.
• Ultrasound or MRI: can detect inflammation and early damage not visible on X-ray.

About a third of people with RA test negative for RF and anti-CCP. This is called seronegative RA. A negative blood test does not rule out RA, and people with typical symptoms should still be referred to a specialist.

Before starting treatment, screening tests for infections such as hepatitis B, hepatitis C, HIV and tuberculosis are usually done, because some treatments can reactivate these infections.

The goals of treatment

Modern RA care follows a “treat to target” approach. The aims are:

• To reach remission (no signs of active disease) or, if that is not possible, low disease activity.
• To prevent joint damage and disability.
• To control pain and fatigue.
• To maintain the ability to work and take part in everyday life.
• To reduce long-term risks, especially heart disease.

Disease activity is measured regularly using scores such as the DAS28, which combines the number of tender and swollen joints, blood test results and how the person rates their own health. In the early stages, reviews are typically every one to three months, and treatment is adjusted if the target is not being reached within around three to six months.

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs are the foundation of RA treatment. Unlike painkillers, they slow or stop the disease process itself and prevent joint damage. They usually take several weeks to months to work fully.

Conventional DMARDs

• Methotrexate: the first-choice DMARD for most people. It is taken once a week, as tablets or as an injection under the skin. It is essential to take it on the same day each week, not every day; taking it daily by mistake can be very dangerous. Folic acid is usually prescribed on a different day to reduce side effects. Regular blood tests check the blood count, liver and kidneys. Alcohol should be limited. Methotrexate must be stopped some months before trying to conceive, for both women and men, according to current guidance from your specialist team.
• Sulfasalazine: often used in combination or when methotrexate is not suitable. It is considered compatible with pregnancy. It can turn urine and tears orange.
• Hydroxychloroquine: a milder DMARD often used in combination. It requires regular eye checks because of a small risk of damage to the retina with long-term use.
• Leflunomide: an alternative to methotrexate. It must not be used during pregnancy, and special steps are needed to clear it from the body before conception.

Combinations of conventional DMARDs are commonly used.

Steroids

Corticosteroids such as prednisolone act quickly to reduce inflammation. They are often used as “bridging” treatment while DMARDs start working, or for flares, given as tablets or injections into a muscle or joint. Long-term steroids have serious side effects, including weight gain, diabetes, high blood pressure, osteoporosis, cataracts and infections, so the aim is to use the lowest dose for the shortest time and taper off when possible.

Biologic and targeted synthetic DMARDs

If conventional DMARDs do not control the disease, or if the disease is severe, more targeted medicines are used. Their availability depends on the country and health system.

• TNF inhibitors such as adalimumab, etanercept, infliximab, certolizumab and golimumab block tumour necrosis factor, a key inflammatory messenger.
• Interleukin-6 inhibitors such as tocilizumab and sarilumab.
• Abatacept, which affects how immune T cells are activated.
• Rituximab, which reduces B cells.
• JAK inhibitors such as tofacitinib, baricitinib, upadacitinib and filgotinib, which are tablets that block signalling pathways inside immune cells. Regulators have advised caution in people over 65, smokers and those with risk factors for heart disease, blood clots or cancer.

Biosimilars, which are highly similar versions of original biologic medicines, have made these treatments more affordable and accessible in many countries.

All these medicines affect the immune system, so they increase the risk of infections. Live vaccines are generally avoided while taking them. Tell your healthcare team immediately if you develop a fever or signs of infection.

Pain relief

Painkillers and anti-inflammatory medicines help symptoms but do not change the course of the disease:

• Paracetamol can help mild pain.
• NSAIDs such as ibuprofen or naproxen reduce pain and stiffness, but carry risks to the stomach, kidneys and heart, so they are used at the lowest effective dose for the shortest time, often with stomach protection.
• Topical treatments, heat and cold packs can help individual joints.

If you need painkillers frequently, it often means the disease is not controlled. Discuss this with your rheumatology team, as your DMARD treatment may need adjusting.

Managing flares

A flare is a period when symptoms get worse, with more pain, swelling, stiffness and fatigue. Flares can be triggered by infections, stress, overexertion, stopping medicines or sometimes no obvious cause. Having a flare plan agreed with your rheumatology team helps:

• Rest the affected joints, but keep gently moving to prevent stiffness.
• Use heat for stiffness and cold packs for hot, swollen joints.
• Use agreed pain relief.
• Pace your activities and prioritise essentials.
• Contact your rheumatology helpline or nurse if the flare lasts more than a few days, is severe, or affects new joints. A steroid injection or treatment change may be needed.
• Seek urgent advice if a single joint becomes very hot and swollen and you feel unwell or have a fever, as this could be a joint infection.

Exercise and physical activity

People with RA used to be told to rest. We now know that regular exercise is one of the most important parts of managing RA. It reduces pain, improves function and fatigue, strengthens muscles that support joints, protects the heart and bones, and lifts mood.

• Range-of-motion exercises: daily gentle movement of each joint through its full range to maintain flexibility.
• Strengthening exercises: using bands, light weights or body weight two to three times a week.
• Aerobic exercise: walking, cycling, swimming or water exercise, building up to 150 minutes a week if possible.
• Hand exercises: a structured hand exercise programme has been shown to improve hand function in RA.

Some discomfort after exercise is normal, but pain that lasts more than two hours afterwards suggests you have done too much. Physiotherapists and occupational therapists can design a safe programme for you.

Fatigue

Fatigue affects most people with RA and is often described as more troublesome than pain. It is caused by inflammation, anaemia, poor sleep, pain, low mood, inactivity and sometimes medicines. Strategies that help include controlling inflammation, treating anaemia, regular physical activity, pacing (balancing activity and rest across the day), good sleep habits and cognitive behavioural approaches designed for RA fatigue. Tell your healthcare team about fatigue; it is a real symptom that deserves treatment.

Diet and RA

No diet has been proven to cure RA, and you should never stop prescribed medicines in favour of a diet. However, a healthy diet supports overall health and may help symptoms:

• A Mediterranean-style diet rich in vegetables, fruit, legumes, wholegrains, fish and olive oil may reduce inflammation and protects the heart.
• Omega-3 fatty acids from oily fish, or fish oil supplements at adequate doses, have some evidence for reducing joint pain and stiffness.
• Calcium and vitamin D are important for bone health, especially if you take steroids.
• Maintaining a healthy weight reduces strain on joints and may improve response to treatment.
• Limit alcohol, especially if you take methotrexate or leflunomide.

Some people find that certain foods worsen their symptoms. Cutting out whole food groups without guidance can lead to poor nutrition, so speak to a dietitian if you want to try an elimination diet.

Protecting your heart

People with RA have a significantly higher risk of heart attack and stroke than the general population. Chronic inflammation damages blood vessels, and some treatments, such as long-term steroids and NSAIDs, add to the risk. Controlling inflammation itself reduces cardiovascular risk. Other steps include:

• Stopping smoking.
• Having your blood pressure, cholesterol and blood sugar checked regularly and treated if needed.
• Being physically active.
• Maintaining a healthy weight.
• Using steroids and NSAIDs only as needed.

Protecting your bones

RA increases the risk of osteoporosis because of inflammation, reduced activity and steroid use. Weight-bearing exercise, adequate calcium and vitamin D, avoiding smoking and excess alcohol, and bone density scans where recommended all help. People taking steroids long term may need bone-protecting medicines.

Infections and vaccinations

RA itself and many of its treatments increase the risk of infections. Vaccination is an important protection. Recommended vaccines usually include annual influenza vaccination, pneumococcal vaccination, COVID-19 vaccination, and shingles vaccination using the non-live vaccine where available. Ideally, vaccines are given before starting immune-suppressing treatment, but most inactivated vaccines can be given at any time. Live vaccines, such as yellow fever and some others, are usually avoided while on biologics or high-dose immunosuppression. Check with your rheumatology team before travel.

Pregnancy, fertility and family planning

Women with RA can have healthy pregnancies, but planning is important. Some RA medicines, including methotrexate and leflunomide, can harm an unborn baby and must be stopped well before conception, with timing advised by your specialist. Other medicines, including sulfasalazine, hydroxychloroquine, low-dose steroids and certain biologics, are considered compatible with pregnancy and breastfeeding in many cases. RA often improves during pregnancy and may flare after birth. Discuss pregnancy plans with your rheumatology team at least several months in advance. Men taking certain medicines should also seek advice before trying for a baby.

Work, daily life and adaptations

• Occupational therapy: occupational therapists can teach joint protection techniques, provide splints, and recommend aids such as jar openers, kettle tippers, thick-handled cutlery, tap turners and dressing aids.
• Footcare: foot pain is common. A podiatrist can provide insoles and advice on footwear.
• Work: many people with RA continue to work. Adjustments such as flexible hours, ergonomic equipment, voice recognition software and the ability to work from home on bad days can make a big difference. In many countries, RA is covered by disability or equality laws.
• Driving: adapted steering wheels, automatic gearboxes and key turners can help.
• Relationships and sex: pain, fatigue and changes in body image can affect intimacy. Open communication, planning and trying different positions can help, and your healthcare team can provide advice.

Mental health and RA

Depression and anxiety are around twice as common in people with RA as in the general population. Living with pain, fatigue, uncertainty and physical limitations is hard, and inflammation itself may affect mood. Depression can also make pain and fatigue feel worse. Talk to your healthcare team if you feel low or anxious most days. Psychological therapies, support groups, and sometimes medicines can help. Many countries have patient organisations offering education, peer support and helplines.

Juvenile idiopathic arthritis

Arthritis in children under 16 is called juvenile idiopathic arthritis (JIA). It is not the same as adult RA, although one subtype is similar. Children with persistent joint swelling, limping, stiffness or reluctance to use a limb should be assessed. Some types of JIA are associated with eye inflammation that has no symptoms, so regular eye screening is essential.

A note for nurses and healthcare workers

Rheumatology nurse specialists play a central role in RA care around the world, running helplines, education sessions, monitoring clinics and injection training, and often adjusting treatment under protocols. For nurses in any setting, key contributions include recognising early inflammatory arthritis and pushing for prompt referral, making sure methotrexate is prescribed and given weekly rather than daily, checking for infection in patients on immunosuppressive treatment, ensuring vaccinations are up to date, and asking about fatigue, mood and work. Nurses who themselves have RA should discuss reasonable adjustments with occupational health, particularly for manual handling and night shifts.

Common myths about rheumatoid arthritis

• “RA is just arthritis from getting older.” RA is an autoimmune disease that often starts in working-age adults.
• “If my blood tests are negative, I can’t have RA.” About a third of people with RA have negative antibody tests.
• “Painkillers are enough.” Only DMARDs prevent joint damage.
• “Exercise will wear out my joints.” Regular, appropriate exercise improves pain and function.
• “RA medicines are too dangerous.” All medicines have risks, but uncontrolled RA carries serious risks too, and monitoring keeps treatment as safe as possible.

Understanding your monitoring blood tests

If you take DMARDs, you will have regular blood tests, especially in the first months of treatment. These tests are there to keep you safe, and understanding them helps you feel more in control:

• Full blood count: checks white blood cells (which fight infection), red blood cells (to detect anaemia) and platelets (which help blood clot). Some DMARDs can lower these counts.
• Liver function tests: methotrexate, leflunomide and some other medicines can affect the liver. Small rises are common and often settle with a dose change.
• Kidney function: affects how some medicines are cleared from the body and which doses are safe.
• ESR and CRP: measure inflammation and help assess whether the disease is controlled.

Typically, tests are done every two to four weeks when starting or changing a medicine, then every three months once stable. Keep a record of your results and the dates of your next tests. If you miss a blood test, your prescription may be paused for safety, so plan around holidays and travel.

Remission and reducing medicines

For many people, the long-term goal is sustained remission: no swollen joints, normal inflammatory markers and minimal symptoms. When someone has been in stable remission for a prolonged period, often a year or more, the rheumatology team may discuss gradually reducing the dose of a biologic or other medicine, or spacing out injections. This is done slowly, with close monitoring, because some people flare when treatment is reduced. Stopping all treatment suddenly is not recommended, as the risk of a flare is high. If a flare does occur after reducing medicines, restarting the previous dose usually brings the disease back under control.

Smoking and rheumatoid arthritis

If you have RA and smoke, stopping is one of the most effective things you can do for your condition. Smoking makes RA more active and more likely to cause joint damage, reduces the effectiveness of methotrexate and several biologic medicines, increases the risk of lung disease and dramatically increases the already raised risk of heart attack and stroke. People who stop smoking tend to have better responses to treatment. Stop-smoking services, nicotine replacement therapy and prescription stop-smoking medicines roughly double or triple the chance of success compared with willpower alone. Our complete guide to quitting smoking explains your options.

Sleep and rheumatoid arthritis

Poor sleep is very common in RA, caused by pain, stiffness, needing to change position, low mood and sometimes medicines such as steroids taken late in the day. Poor sleep, in turn, increases pain sensitivity and fatigue. Helpful steps include taking steroids in the morning (if prescribed), using pain relief at a time that covers the night, a supportive mattress and pillows to support painful joints, a warm bath or shower before bed to ease stiffness, regular sleep and wake times, and limiting caffeine and screens in the evening. If you snore, wake gasping or are very sleepy in the day, ask to be checked for sleep apnoea.

Surgery for rheumatoid arthritis

Thanks to modern medicines, far fewer people with RA need joint surgery than in the past. However, surgery can still help when a joint is badly damaged and causing pain or loss of function despite good medical treatment. Options include joint replacement (most commonly hips and knees, but also shoulders, elbows and finger joints), joint fusion (especially in the wrist and ankle, to relieve pain), tendon repair, and removal of inflamed synovium. If you are having surgery, your rheumatology and surgical teams will advise whether to pause certain medicines around the operation to reduce infection risk and support wound healing. Do not stop medicines on your own without advice.

Older-onset rheumatoid arthritis

RA can start after the age of 60. In older adults, it may begin more suddenly, affect larger joints such as the shoulders, and be confused with osteoarthritis or a condition called polymyalgia rheumatica. Older adults are more likely to have other health conditions and to take several medicines, so treatment choices need careful thought, but the same principles apply: early diagnosis and effective DMARD treatment to prevent damage and disability.

RA in men

Although RA is more common in women, men develop it too, and they may delay seeking help or put symptoms down to work injuries. Men with RA are more likely to smoke and to have positive antibody tests, and they may have a higher risk of lung complications and heart disease. Men who plan to father a child should ask their rheumatology team about any medicines that may need to be paused before conception.

Access to care around the world

Access to rheumatology care varies enormously between and within countries. In many low- and middle-income countries there are very few rheumatology specialists, and biologic medicines may be unaffordable or unavailable. Even so, much can be achieved with early diagnosis and conventional DMARDs such as methotrexate, sulfasalazine and hydroxychloroquine, which are relatively inexpensive and on the World Health Organization’s essential medicines list. Nurses, general healthcare providers and pharmacists trained in recognising inflammatory arthritis and monitoring DMARDs can greatly extend access. If you live somewhere with limited specialist services, ask your healthcare provider whether methotrexate-based treatment can be started and monitored locally, with specialist advice by referral or telemedicine.

Complementary therapies

Many people with RA try complementary therapies. Some, such as tai chi, yoga, massage and relaxation techniques, may help with pain, stiffness, stress and wellbeing as part of an overall plan. Supplements such as fish oil have some evidence. Others, such as copper bracelets and magnet therapy, have not been shown to work. Some herbal products can interact with RA medicines, affect the liver or blood clotting, or contain undeclared steroids. Always tell your healthcare team about any supplements or remedies you take, and never stop DMARDs in favour of an unproven treatment, because joint damage can occur quickly once inflammation is uncontrolled.

Travel tips

• Plan blood tests and medicine supplies around your trip, and carry enough medicine for delays.
• If you use injections that need refrigeration, ask your pharmacy or the manufacturer about cool bags and travel letters for airport security.
• Check which vaccines you need well in advance, remembering that live vaccines may not be suitable.
• Take a copy of your medicine list and a summary of your condition.
• Consider travel insurance that covers pre-existing conditions.
• Allow extra time for rest after long journeys, and keep moving on flights to prevent stiffness.

Questions to ask your rheumatology team

• What is my current disease activity score, and what is my target?
• How long should it take for my medicine to work, and what happens if it does not?
• Which blood tests do I need, and how often?
• What should I do if I get a fever or infection?
• Which vaccines should I have, and when?
• Who do I contact during a flare, and how quickly can I be seen?
• Can I see a physiotherapist, occupational therapist, podiatrist or psychologist?
• What do I need to know before planning a pregnancy?
• How is my heart and bone health being checked?

Caring for someone with rheumatoid arthritis

If someone you love has RA, your support can make a real difference. Learn about the condition together, go to appointments if they would like you to, and help them keep track of medicines, blood tests and questions. Remember that RA is unpredictable: a person may manage well one day and struggle to get dressed the next. This is not exaggeration or lack of effort. Offer practical help without taking over, because staying independent matters. Encourage gentle activity, notice signs of low mood, and look after your own wellbeing too, as caring can be tiring. Many patient organisations offer resources for family members and carers.

A realistic picture of life with RA today

A diagnosis of rheumatoid arthritis can be frightening, especially if you have seen older relatives with severely deformed hands or using wheelchairs. It is important to know that the outlook today is very different. For people who are diagnosed early and treated to target, severe deformity has become much less common. Most people continue working, raising families, travelling and exercising. There will be good and bad periods, and it may take time to find the treatment that suits you best. But with a good partnership between you and your healthcare team, RA can become one part of your life rather than the thing that defines it.

Self-management: the daily habits that add up

Medicines control the disease, but daily habits make a big difference to how you feel. People who do well with RA often build a routine that includes taking medicines on time, a few minutes of joint exercises each morning, regular walking or swimming, planned rest breaks, good sleep, and staying connected with friends and family. Using a symptom diary or app helps you spot patterns and gives your healthcare team useful information at appointments. Self-management courses, offered by many hospitals and patient organisations, teach practical skills for pain, fatigue, pacing and problem-solving, and are well worth attending.

Frequently asked questions

Is rheumatoid arthritis curable?

There is currently no cure, but many people achieve remission with treatment. Some can eventually reduce their medicines under supervision while staying well.

Can RA go away on its own?

A small number of people with very early arthritis improve without treatment, but most people with established RA need long-term treatment. Waiting to see often allows joint damage to develop.

Is RA hereditary?

Genes contribute to the risk, but RA is not directly inherited. Most children of parents with RA do not develop it.

How long does methotrexate take to work?

Methotrexate usually starts to work within six to twelve weeks, with full effect taking up to three to six months.

Can I drink alcohol on methotrexate?

Many guidelines allow small amounts, within national limits, with regular liver monitoring. Discuss your situation with your rheumatology team.

Does weather affect RA?

Many people report that cold, damp weather or changes in pressure worsen their symptoms. Research findings are mixed, but keeping warm and active can help.

But what if my treatment is not working?

RA treatment often needs adjusting more than once. If you still have swollen joints, high inflammatory markers or significant symptoms after three to six months, your treatment is not at target. Ask your rheumatology team about increasing doses, combining DMARDs, switching to a biologic or targeted therapy, or checking whether something else is contributing, such as fibromyalgia, osteoarthritis or depression. Treat-to-target means keep adjusting until you get there. You should not accept ongoing active disease as normal.

Related: Osteoarthritis vs rheumatoid arthritis · Osteoarthritis: the complete guide

Sources: European Alliance of Associations for Rheumatology (EULAR) recommendations for RA management, American College of Rheumatology RA guideline, National Institute for Health and Care Excellence (NICE) rheumatoid arthritis guideline, Global Burden of Disease Study, World Health Organization, EULAR recommendations on the role of the nurse in inflammatory arthritis.