Morning stiffness, swollen fingers, painful wrists or difficulty getting out of bed are often dismissed as signs of ageing or ordinary arthritis.
But when such symptoms persist, they could be pointing to rheumatoid arthritis (RA), an autoimmune disease in which the body's immune system attacks the lining of the joints.
And with RA, waiting for the pain to become severe can come at a cost. A new review published in JAMA has reinforced the importance of recognising the disease early and starting disease-modifying treatment promptly.
The review, led by Josef S Smolen of the Medical University of Vienna and involving researchers from Vienna and Stanford University, analysed 15,886 scientific publications and included 120 studies after detailed assessment. The evidence covered 43 randomised clinical trials, 28 cohort studies, systematic reviews and international treatment guidelines.
One of its key messages is straightforward: the earlier RA is diagnosed and treated, the greater the opportunity to prevent permanent joint damage.
RA is different from the wear-and-tear arthritis that becomes more common with age. It is a systemic autoimmune disease that can cause persistent inflammation in the joints and damage cartilage and bone.
According to the review, diagnosis ideally within about six weeks of the onset of symptoms allows treatment with disease-modifying antirheumatic drugs (DMARDs) to begin at an early stage, when they can be particularly effective.
This matters because painkillers may make a person feel better without stopping the underlying disease process.
DMARDs, on the other hand, are designed to control the immune-driven inflammation and slow or prevent disease progression.
“Treating symptoms is not the same as treating the disease,” is the message patients need to understand, particularly when joint pain keeps returning, said the authors of the study.
The Indian picture makes the issue particularly relevant.
A 2025 study using Global Burden of Disease 2021 data found that the incidence, prevalence and disability-adjusted life-year rates associated with RA in India increased between 1990 and 2021. The burden was consistently higher among women than men.
The study also found considerable regional variations, with the highest prevalence among women reported in Tamil Nadu and among men in Uttarakhand.
India, however, does not have a single recent nationwide population-based survey that can provide a definitive estimate of how many people currently live with RA. Earlier Indian studies have reported widely varying estimates, reflecting differences in geography, diagnostic criteria and study methods.
A 2016 review of Indian RA literature found that many studies were based on relatively small samples, cross-sectional designs or hospital populations and cautioned against extrapolating their findings to the entire country.
An older large rural survey near Delhi, involving more than 44,000 adults, reported an RA prevalence of 0.75%. A WHO-ILAR COPCORD study from rural western India reported a prevalence of 0.5%.
These figures should not be treated as a current national prevalence estimate, but they show that RA is not a rare problem in India.
The symptoms can be deceptively ordinary.
Unlike osteoarthritis, which typically worsens with use, inflammatory arthritis can produce considerable stiffness after periods of rest, particularly in the morning.
There is no single blood test that by itself confirms or rules out RA. Doctors generally combine the clinical history and examination with tests such as rheumatoid factor and anti-CCP antibodies, inflammatory markers including ESR and CRP, and imaging where required.
This is one reason self-diagnosis can be misleading.
The latest JAMA review too says the initial aim should include at least a 50% reduction in disease activity within three months and remission or low disease activity by six months. If that target is not achieved, treatment should be reassessed and adjusted.
International guidelines similarly recommend regular monitoring and modification of treatment when the desired target is not reached.
