Question

I’ve always had occasional joint pains since developing ME/CFS three years ago but they are definitely getting more frequent and painful. As both my mum and aunt have rheumatoid arthritis, I’m worried that I may also be developing arthritis. My GP isn’t too concerned as there isn’t any swelling or signs of inflammation, but I’m still not happy. What is the difference between joint pains in ME/CFS and true arthritic joint pain?

Answer

You are right to be concerned in view of the family connection. However, as rheumatoid arthritis (RA) has some characteristic symptoms and signs, and blood test abnormalities, it’s a diagnosis that can normally be made with a reasonable degree of certainty. Unlike ME/CFS, joint pain in RA often affects the small joints in the hands and feet – especially to start with – but it can go on to affect any joint. It also causes joint stiffness early in the morning – or after any period of inactivity.

The pain tends to be throbbing and the joints are often visibly swollen with signs of inflammation – being hot and red. In addition, there may be characteristic non-joint symptoms such as dry eyes, loss of appetite and weight. Blood tests help to confirm the diagnosis in most cases. People with rheumatoid arthritis often have an elevated level of the erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) – both of which are markers of an active inflammatory process taking place in the body.

There may be mild anaemia as well. More specific blood tests look for the presence of rheumatoid factor (an immune system marker that attacks the joint tissues) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. If your joint problems worsen, or there is still uncertainty as to whether you might have RA, your GP can refer you to a rheumatology clinic for further assessment. Early diagnosis of RA is important because drug treatment can reduce the chances of long-term complications.

The NHS: Rheumatoid Arthritis

Overview, Symptoms, Causes, Diagnosis, Treatment, Living With, and, Complications | August 2019

Rheumatoid arthritis is an autoimmune disease. This means your immune system (which usually fights infection) attacks the cells that line your joints by mistake, making the joints swollen, stiff and painful. Over time, this can damage the joints, cartilage and nearby bone. It's not clear what triggers this problem with the immune system, although you're at an increased risk if:

• • you are a woman,
  • you have a family history of rheumatoid arthritis,
  • you smoke.

There's no cure for rheumatoid arthritis. However, early diagnosis and appropriate treatment enables many people with the condition to have periods of months or even years between flares. This can help them to lead full lives and continue regular employment.

See also: Functional Limitations, Joint Pain.

More information

• The NICE Clinical Guideline: Rheumatoid Arthritis in Adults: Management Recommendations | July 2018 (updated October 2020).