❓What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a condition in which the immune system, which normally fights germs, mistakenly attacks your own joints. The lining inside the joint (the synovium) becomes inflamed, causing lasting swelling and pain.
It usually starts in the small joints of the hands and feet, and typically swells on both sides of the body in the same places. Left untreated, the cartilage and bone can be damaged, leading to joint deformity.
The most important thing to know: you can have RA even when rheumatoid factor (RF) and anti-CCP antibodies come back negative. This is called seronegative rheumatoid arthritis, and reports suggest it accounts for roughly 20-30% of people with RA (figures vary between studies).
So please do not conclude "my blood work was all normal, so it cannot be rheumatoid arthritis." If your symptoms continue, come and have your joints examined.

⚙️Why Does It Happen?

The immune system mistakes your joints for an enemy

An inherited tendency combined with triggers such as smoking is thought to upset how the immune system works

The joint lining becomes inflamed (synovitis)

The synovium thickens and joint fluid builds up, giving a soft, puffy swelling

The inflamed lining eats away at cartilage and bone

Small pits called erosions appear on the bone surface, and damaged cartilage and bone do not grow back

Joint damage moves fastest in the first two years

This early period is often called the window of opportunity, when treatment tends to make the biggest difference

Some types leave no trace in the blood

The joints are inflamed, yet RF, anti-CCP antibodies, CRP and ESR can all sit in the normal range

👩 More common in women 🎂 Often starts in the 30s-50s 🧬 Family history 🚬 Smoking 🦷 Gum disease 🤱 After childbirth

🔍Watch for These Symptoms

⏰

Morning stiffness lasting 30 minutes to an hour or more, with fingers hard to move on waking

🖐️

Swelling in the middle and base knuckles (PIP and MCP joints); the fingertip joints are usually spared

↔️

The same joints swell on both the right and left sides

📅

Joint swelling or pain that has lasted six weeks or longer

🫙

Weaker grip, such as trouble opening a bottle cap or wringing out a towel

🌡️

Feeling generally tired or run down, a slight fever, poor appetite, or weight loss

🚩

Even with normal blood tests, ongoing symptoms like these do not rule out rheumatoid arthritis. If a joint stays swollen, please come in without waiting the full six weeks

💊Treatment

🔬

Blood Tests

We check rheumatoid factor (RF), anti-CCP antibodies, CRP and ESR. RF and anti-CCP are positive in about 70-80% of people with RA, but a negative result does not rule the condition out. RF can also be positive in healthy people or with liver disease, so numbers alone never make the diagnosis

🩻

X-ray & Joint Ultrasound

These are the imaging tests we can perform here. Ultrasound shows a thickened joint lining, extra joint fluid, and the increased blood flow that comes with inflammation (power Doppler). It can pick up signs of inflammation even when blood tests are negative

🧲

MRI

MRI can show synovitis and early bone changes before they appear on X-ray. We do not have an MRI scanner on site, so when one is needed we arrange the appointment at a partner facility

💊

Antirheumatic Drugs (DMARDs)

Methotrexate (MTX) and other DMARDs are the mainstay, aiming to calm inflammation and slow joint damage. We handle diagnosis and antirheumatic drug treatment, including MTX, here at the clinic. MTX cannot be used during pregnancy or breastfeeding — tell your doctor beforehand if you are planning a pregnancy. Because it can cause infection, bone marrow suppression (low blood counts) and interstitial lung disease, it is taken together with folic acid and monitored with regular blood tests

💉

Biologics & JAK Inhibitors

Considered when DMARDs do not bring the inflammation under control. These injections or tablets block specific inflammation signals, and because they raise the risk of infection they are started carefully under a rheumatologist

🧴

Steroids

Mainly a supporting role, to get through periods of severe pain and swelling. Long-term use carries risks such as infection, osteoporosis and raised blood sugar, so we keep the dose low and the course short

🤝

Working with Specialists

When the diagnosis or treatment plan is difficult, or when specialised drug therapy such as a biologic is needed, we refer you to a rheumatology or clinical immunology specialist. We stay in touch with them and remain involved in your follow-up afterwards

🏥

If Surgery Becomes Necessary

Once a joint is badly deformed, an operation such as a joint replacement may be considered. We do not perform surgery here, so we refer you to a partner hospital

🧘

Rehabilitation & Joint Care

We practise ways of moving that put relatively less strain on the joints, so you keep your strength and range of motion. Everyday tweaks help too — thicker handles on tools, carrying heavy things with both hands

📈Outlook & Recovery

🌿

Finding it early and starting treatment matters for protecting your joints

Treatment for rheumatoid arthritis has advanced a great deal. When treatment starts early and the inflammation is brought under control, many people keep their pain and swelling settled (remission) and carry on with the life they had before.
At the same time, cartilage and bone that have already been destroyed do not grow back. That is why the first few years after symptoms begin are so important. Rather than waiting and watching because a blood test came back normal, have your joints looked at early if symptoms persist.

🔎

How it differs from osteoarthritis (such as Heberden's nodes)
In finger osteoarthritis, the fingertip joints (DIP) swell and harden, and the pain gets worse the more you use the hand. Any morning stiffness usually eases within a few minutes.
In rheumatoid arthritis, the middle and base knuckles (PIP and MCP) swell softly on both sides, and the first movements of the day are the hardest, often easing a little as you keep moving. The stiffness lasts 30 minutes to an hour or more.
The two can also occur together, and they cannot be told apart by looks alone. We decide based on the examination together with X-ray and ultrasound.

🏠If You Are Unsure Whether to Come In

💡 Five Things Worth Remembering

Normal blood tests (RF, anti-CCP, CRP, ESR) do not mean rheumatoid arthritis has been ruled out
Morning stiffness lasting over 30 minutes, or finger joints swelling on both sides — if these keep up, it is time to be seen
The imaging we can do here is X-ray and ultrasound. If an MRI is needed, we arrange the appointment at a partner facility
Once treatment has started, do not stop your medication on your own. If side effects worry you, speak with your doctor first
Waiting and watching because "the blood test was normal" can allow joint damage to progress. If something concerns you, please come in early

Rheumatoid Arthritis

Finding it early and starting treatment matters for protecting your joints

💡 Five Things Worth Remembering

🩻 Gotokuji Orthopedic Clinic