🦴 Men's Health

Rheumatoid Arthritis (Nigeria Guide)

Understanding and managing autoimmune joint disease — early treatment prevents disability

Rheumatoid arthritis (RA) is an autoimmune disease in which the immune system attacks the joints, causing chronic inflammation, pain, and — if untreated — permanent joint destruction. It affects women three times more than men and can occur at any age. In Nigeria, RA is often diagnosed late because joint pain is attributed to 'rheumatism', spiritual causes, or treated only with analgesics. Early diagnosis and disease-modifying therapy (DMARDs) can prevent disability.

Signs and Symptoms

✓ Symmetrical joint pain and swelling — both hands, wrists, or knees affected equally

✓ Morning stiffness lasting more than 1 hour — a hallmark distinguishing RA from osteoarthritis

✓ Warm, swollen, tender small joints — metacarpophalangeal (knuckle) joints, wrists, ankles

✓ Fatigue and general malaise — often severe, mistaken for anaemia

✓ Rheumatoid nodules — firm lumps under the skin near the elbows

✓ Eye redness and pain — episcleritis or scleritis

✓ Shortness of breath — rare lung involvement (interstitial lung disease)

✓ Fever and weight loss in active disease

Risk Factors

Female sex — three times more common in women
Age 30–60 years — peak onset, though any age can be affected
Family history of RA or other autoimmune disease
Smoking — a major modifiable risk factor; doubles RA risk
Obesity — increases systemic inflammation
Previous joint trauma or infection
Hormonal factors — RA often improves in pregnancy, flares postpartum
Low socioeconomic status — associated with worse outcomes due to delayed diagnosis

When to Seek Help

UrgentJoint pain with sudden redness, heat, and fever — rule out septic arthritis, a surgical emergency

Within 1 weekSymmetrical small joint swelling lasting more than 6 weeks — early rheumatology assessment changes outcomes dramatically

SoonMorning stiffness over 1 hour, fatigue, and joint swelling — begin investigation for RA

Book appointmentKnown RA with increasing joint pain or new symptoms — disease may be flaring, medication review needed

Urgent referralEye pain or redness in a patient with RA — ophthalmology assessment required

RoutineChest symptoms (breathlessness, dry cough) in RA patient on methotrexate — drug-related lung toxicity possible

Tests & Diagnosis

🧪 Rheumatoid factor (RF)

Positive in 70–80% of RA cases. Also positive in other conditions — not specific alone. High RF titre associated with more severe disease

🧪 Anti-CCP antibodies (ACPA)

More specific than RF. Positive years before symptoms — very useful for early diagnosis. Available at major Nigerian laboratories

🧪 Full blood count

Normocytic anaemia of chronic disease, raised platelet count in active disease

🧪 ESR and CRP

Inflammatory markers — elevated in active RA. Used to monitor disease activity and treatment response

🧪 X-ray of hands and feet

Shows joint space narrowing and periarticular erosions — early changes may be absent; MRI is more sensitive

🧪 Liver and renal function tests

Baseline before starting methotrexate. Must be monitored regularly during treatment

Treatment Options

DMARDs — disease-modifying antirheumatic drugs (first-line)

Methotrexate is the anchor drug. Started as soon as RA is confirmed. Reduces joint damage, not just pain. Taken weekly (7.5–25 mg). Must be taken with folic acid 5 mg daily (on non-methotrexate days) to reduce side effects. Available in Nigerian hospitals

Hydroxychloroquine (Plaquenil)

Often combined with methotrexate for mild-moderate RA. Also used alone for early disease. Eye check every 12 months required — rare retinopathy risk. Available widely in Nigeria

Sulfasalazine

Used in combination or when methotrexate is contraindicated. Monitor blood count and liver function

Prednisolone (short-term 'bridge')

Oral steroids reduce inflammation rapidly while DMARDs take effect (2–3 months to work). Use lowest dose for shortest time — long-term steroid use causes significant side effects

Biologic therapies (for refractory RA)

TNF inhibitors (etanercept, adalimumab), IL-6 inhibitors (tocilizumab) — for RA not responding to conventional DMARDs. Expensive and not widely available in Nigeria, but available at LUTH and some private centres. Screen for TB before starting

NSAIDs for symptom control

Ibuprofen, diclofenac, or celecoxib for pain and stiffness while DMARDs take effect. Celecoxib preferred in older patients (less GI risk). Not a substitute for DMARDs — they treat symptoms, not the underlying disease

Physiotherapy and occupational therapy

Joint protection techniques, splinting, assistive devices. Regular exercise — swimming, cycling — maintains joint function and reduces cardiovascular risk. Do not rest a joint into deformity

Monitoring on methotrexate

Full blood count and liver function every 3 months. Chest X-ray at baseline. Avoid alcohol. Stop immediately if mouth ulcers, persistent cough, or abnormal LFTs develop. Methotrexate is teratogenic — use contraception in women of childbearing age

Vaccinations

Before starting DMARDs or biologics: pneumococcal, influenza, hepatitis B, varicella. Avoid live vaccines once on immunosuppression

Treat comorbidities

Cardiovascular risk is doubled in RA — manage hypertension, hyperlipidaemia, and diabetes aggressively. Screen for osteoporosis — RA and steroids both cause bone loss; calcium and vitamin D supplements recommended

Frequently Asked Questions

Is rheumatoid arthritis the same as 'rheumatism'?

No. 'Rheumatism' is a non-specific term used for any joint pain. Rheumatoid arthritis is a specific autoimmune disease with diagnostic criteria and targeted treatment. Many Nigerians with RA are told they have 'rheumatism' and given only pain relief — this delays the DMARDs that prevent joint destruction.

Can RA be cured?

Not currently cured, but it can be controlled. With early diagnosis and consistent DMARD therapy, most patients achieve remission — where there is little or no disease activity and joint damage is prevented. The goal is remission or low disease activity.

Is methotrexate safe for long-term use?

Yes, with proper monitoring. It has been used for over 40 years for RA. The key is regular blood tests every 3 months and avoiding alcohol. Liver toxicity is rare with monitoring. It is teratogenic — women must use effective contraception and stop 3 months before trying to conceive.

Can I exercise with rheumatoid arthritis?

Yes — exercise is important. Low-impact activities (swimming, cycling, walking) maintain joint range of motion and reduce cardiovascular risk. Exercise during remission should be regular. During flares, reduce intensity but don't stop entirely. Work with a physiotherapist for a safe programme.

Is RA worse during rainy season in Nigeria?

Many patients report increased joint stiffness in cold, damp weather — there is some evidence that barometric pressure changes affect joint symptoms. However, disease activity is driven by inflammation, not weather. Consistent medication is more important than climate.