Rheumatoid arthritis (RA) is a form of inflammatory arthritis and an autoimmune disease. In RA, for reasons no one fully understands, the immune system � which is designed to protect our health by attacking foreign cells such as viruses and bacteria � instead attacks the body’s own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that’s systemic � meaning it can occur throughout the body. Symptoms : Pain, morning stiffness, swelling, and systemic symptoms are common. Other rheumatoid symptoms include:

• Swelling, pain, and stiffness in the joint, even when it is not being used
• A feeling of warmth around the joint
• Deformities and contractures of the joint 
• Symptoms throughout the body, such as fever, loss of appetite and decreased energy 
• Weakness due to a low red blood cell count (anemia) 
• Nodules, or lumps, particularly around the elbow 
• Foot pain, bunions, and hammer toes with long-standing disease

Investigations: Medical history A blood test may reveal an antibody called rheumatoid factor. This is an indicator of rheumatoid arthritis. X-rays can help show the progression of the disease. The American College of Rheumatology requires at least four of the following seven criteria to confirm the diagnosis:

• Morning stiffness around the joint that lasts at least 1 hour
• Arthritis of three or more joints for at least 6 weeks
• Arthritis of hand joints for at least 6 weeks 
• Arthritis on both sides of the body for at least 6 weeks 
• Rheumatoid nodules under the skin 
• Rheumatoid factor present in blood testing 
• Evidence of rheumatoid arthritis on X-rays