Rheumatoid Arthritis
Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune inflammatory condition that commonly causes joint swelling, prolonged morning stiffness, pain and fatigue. Medical treatment helps control the disease, while physiotherapy can support strength, mobility, exercise, joint protection and day-to-day function.
If you want care that considers your joints, fitness and daily demands, see our rheumatology physiotherapy service page and our broader arthritis overview.
Common pattern
Joint swelling, prolonged morning stiffness, fatigue and periods of increased symptoms or flare-ups.
Common joints
Fingers, wrists, hands and the joints around the front of the feet are often affected.
Medical care
Your GP and rheumatologist guide diagnosis, medication and disease management.
Physiotherapy
Physiotherapy can support exercise, mobility, strength, pacing, joint protection and daily function.
When to seek review
Persistent swelling, warmth, prolonged morning stiffness or declining function should be medically assessed.
What is rheumatoid arthritis?
Rheumatoid arthritis is an inflammatory autoimmune condition. It commonly affects smaller joints such as the fingers and wrists, as well as joints in the feet. Other joints can also be involved.
The inflammation occurs within the synovium, which is the tissue lining the joint. When this tissue becomes inflamed, a joint can feel swollen, warm, tender and stiff.
Over time, poorly controlled inflammation may contribute to joint damage and changes in function. For this reason, medical treatment aimed at controlling the disease is an important part of rheumatoid arthritis care.
For a plain-English medical overview of symptoms, diagnosis and treatment options, see the MedlinePlus rheumatoid arthritis guide.
Why does rheumatoid arthritis hurt?
Pain can occur because inflammation changes how the tissues within and around the joint behave. Swelling may increase pressure within the joint and make normal movement feel stiff or sore.
- Inflammation can increase sensitivity around the joint.
- Swelling can stretch the joint capsule and restrict comfortable movement.
- Muscles around painful joints may become less active or guarded.
- Reduced activity during flare-ups can contribute to loss of strength and confidence.
What are the symptoms of rheumatoid arthritis?
Symptoms vary between people. Many people experience periods when symptoms are relatively settled and other periods when symptoms increase.
- joint pain and swelling, often affecting the fingers, wrists or feet
- morning stiffness that may last longer than 30 minutes
- fatigue or reduced energy
- reduced grip strength or hand function
- a general feeling of being unwell during active inflammation
- rheumatoid nodules, which are firm lumps that can occur beneath the skin
Rheumatoid arthritis often affects joints on both sides of the body, although individual patterns vary.
Rheumatoid arthritis compared with osteoarthritis
Rheumatoid arthritis and osteoarthritis can both cause joint pain and stiffness, but the underlying processes differ.
Rheumatoid arthritis
An autoimmune inflammatory condition that often affects several joints and may also cause fatigue and prolonged morning stiffness.
Osteoarthritis
A joint condition involving changes in cartilage, bone and other joint tissues, often influenced by age, loading, previous injury and other factors.
Why the distinction matters
Rheumatoid arthritis usually requires medical management aimed at controlling inflammation, while rehabilitation helps maintain movement, strength and function.
How is rheumatoid arthritis diagnosed?
Rheumatoid arthritis can take time to diagnose because symptoms may develop gradually and overlap with other conditions. Your doctor considers your symptom pattern, physical examination and results from blood tests or imaging.
Blood tests may include inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), along with other tests used when rheumatoid arthritis is suspected.
Your GP may refer you to a rheumatologist, who is a medical specialist in inflammatory and autoimmune joint conditions.
How is rheumatoid arthritis treated?
There is currently no cure for rheumatoid arthritis. However, modern medical treatment can help control inflammation and reduce the risk of ongoing joint damage.
Early medical treatment helps control the disease, while appropriately prescribed exercise and physiotherapy can help maintain strength, mobility, fitness and day-to-day function.
Management may include:
- medications prescribed and monitored by your GP or rheumatologist
- physiotherapy to support strength, mobility and function
- exercise that is adjusted according to symptoms and disease activity
- joint protection and pacing strategies
- procedures or surgery in selected situations
How can physiotherapy help rheumatoid arthritis?
Physiotherapy usually focuses on helping you remain active while adapting exercise and daily activity around sensitive or swollen joints.
Your plan may consider your flare pattern, fitness, work demands, general health and which joints are most affected.
- therapeutic exercise to improve strength and physical capacity
- walking, cycling, swimming or other suitable aerobic exercise
- strategies for painful or stiff hands and wrists
- education about pacing and activity modification
- joint protection and support strategies where appropriate
- graded return to activity after a flare-up
- hydrotherapy when water-based exercise offers a more comfortable starting point
Should you exercise during a rheumatoid arthritis flare?
Complete rest is rarely the best long-term strategy. However, exercise usually needs to change when a joint becomes unusually swollen, hot or painful.
Settled
Gradually build strength, walking, cycling, pool exercise or other appropriate activity.
Mildly irritated
Reduce resistance, range, speed or session duration until symptoms settle.
Hot or swollen
Use comfortable movement and reduce loading. Seek medical or clinical guidance if swelling persists or is unusual for you.
Exercising between flare-ups
When symptoms are more settled, exercise can gradually become more challenging. The aim is to improve physical capacity without creating an unnecessary spike in joint symptoms.
A program may include strengthening, aerobic exercise, mobility work, balance and activity-specific training. Progression should match your health, current fitness and treatment plan.
What can you do day to day?
Learn your symptom patterns
Pay attention to changes in swelling, stiffness, fatigue and activity tolerance. A simple record can help you identify when workloads need adjustment.
Keep moving within tolerance
Regular movement helps maintain strength, fitness and confidence. During a flare, modify the dose rather than automatically stopping all activity for prolonged periods.
Use heat or cold for comfort
Some people find warmth useful for stiffness, while cold may feel more comfortable when a joint feels hot or swollen. Protect your skin and use either option for comfort rather than as a substitute for medical treatment.
Protect sensitive joints
Changing how you grip, lift, carry or complete repetitive tasks may reduce unnecessary stress on painful joints. A physiotherapist or occupational therapist can help with strategies that match your daily activities.
Plan around fatigue
Rheumatoid arthritis can cause significant fatigue. Spacing heavier tasks, allowing recovery time and matching demanding activities to your better periods can make daily activity more manageable.
Related rheumatoid and arthritis information
What to do next
If you have ongoing joint swelling, prolonged morning stiffness or symptoms that suggest inflammatory arthritis, arrange medical review. If rheumatoid arthritis has already been diagnosed, physiotherapy can help you adapt exercise, maintain strength and work towards practical activity goals alongside your medical care.
Choose your clinic and appointment pathway
Select a PhysioWorks clinic to continue to live booking, an appointment request or reception assistance.
References
- Peter WF, Swart NM, Meerhoff GA, Vliet Vlieland TPM. Clinical Practice Guideline for Physical Therapist Management of People With Rheumatoid Arthritis. Physical Therapy. 2021;101(8):pzab127. doi:10.1093/ptj/pzab127
- Sobue Y, Kojima T, Ito H, et al. Does exercise therapy improve patient-reported outcomes in rheumatoid arthritis? A systematic review and meta-analysis. Modern Rheumatology. 2022;32(1):96-104. doi:10.1080/14397595.2021.1886653
- Niedermann K, de Oliveira BI, Fransen J, et al. 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. Annals of the Rheumatic Diseases. 2023;82(1):48-56.
Rheumatoid Arthritis FAQs
Can physiotherapy help rheumatoid arthritis?
Physiotherapy may help maintain strength, mobility, fitness and day-to-day function. Exercise and activity can be adjusted during flare-ups and progressed again as symptoms settle.
What joints does rheumatoid arthritis commonly affect?
Rheumatoid arthritis commonly affects smaller joints such as the fingers, wrists and feet. It can also affect larger joints, and the pattern varies between people.
How long should morning stiffness last before I get checked?
Persistent morning stiffness, particularly when combined with joint swelling, warmth or declining function, is worth discussing with your GP. Rheumatoid arthritis cannot be diagnosed from stiffness duration alone.
Should I exercise during a rheumatoid arthritis flare-up?
Gentle movement may still be appropriate during a flare-up, but resistance, range, speed or exercise duration may need to decrease. Seek guidance if a joint becomes persistently swollen, hot or unusually painful.
Is hydrotherapy useful for rheumatoid arthritis?
Hydrotherapy may provide a comfortable way to exercise because water supports body weight and can reduce the loading felt during some movements. Suitability depends on your symptoms, health and exercise goals.
