Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune condition that most commonly affects the joints, resulting in pain, swelling and stiffness. Unlike wear-and-tear forms of arthritis, RA arises when the immune system mistakenly attacks the synovial lining of joints, provoking persistent inflammation that can gradually damage cartilage and bone. 

While RA commonly affects joints in the hands and feet, it can involve shoulders, elbows, hips, knees and even internal organs in severe cases. In Singapore, approximately 1 % of the population is estimated to live with RA, with women accounting for about three‑quarters of cases. RA often develops between the ages of 30 and 50, though it can occur at any age. 

What causes rheumatoid arthritis?

The exact trigger for RA remains unknown, but it is understood to involve a complex interplay of the following factors:

• Immune system malfunction – the body’s immune system wrongly attacks the synovial lining, causing chronic inflammation that can erode cartilage and bone over time.
• Genetic factors – certain gene variations appear to increase susceptibility to RA and a family history can raise the risk.
• Environmental triggers – smoking and certain infections may provoke immune responses in people with genetic vulnerability.
• Hormonal influences – RA is more common in women, suggesting that hormonal factors may play a role in influencing its development and severity.

What are the symptoms of rheumatoid arthritis?

Symptoms vary between individuals. It may develop gradually or suddenly, but commonly includes:

• Joint pain and swelling, particularly in small joints, such as the hands, wrists, ankles and feet
• Stiffness in the morning or after periods of rest lasting more than 30 minutes
• Progressive loss of function if inflammation is not controlled
• Warmth and tenderness around the affected joints
• Fatigue or low energy
• Symmetrical involvement, where the same joints on both sides of the body are affected

Who is at risk of rheumatoid arthritis?

Although RA can affect anyone, there are certain factors that are known to increase the likelihood of developing the condition.

Common risk factors are:

• Age – RA commonly begins between the ages of 40 and 60 years old. In younger individuals, particularly children and teenagers, a related condition known as Juvenile Idiopathic Arthritis (JIA) may develop.
• Gender – women are significantly more affected than men, with studies showing they are about two to three times more likely to develop rheumatoid arthritis.
• Genetics – having a close relative with rheumatoid arthritis increases the risk, as certain genetic markers, including HLA-related genes, are associated with immune system dysfunction linked to the disease.
• Early-life influences – exposure to cigarette smoke during childhood or growing up in disadvantaged socioeconomic environments has been linked to a higher risk of rheumatoid arthritis later in adulthood, possibly due to long-term effects on immune regulation.
• Health conditions – certain infections and chronic gum disease have been associated with an increased risk, suggesting a link between immune activation and the development of autoimmune joint conditions.
• Obesity – excess weight places additional stress on joints and is linked to a higher risk of developing rheumatoid arthritis. Obesity may also contribute to more persistent inflammation and reduced response to treatment.
• Tobacco use – cigarette smoking is one of the strongest modifiable risk factors. It not only raises the likelihood of developing rheumatoid arthritis but is also associated with more aggressive disease and poorer treatment outcomes.

How is rheumatoid arthritis diagnosed in Singapore?

Distinguishing RA from other forms of joint pain requires a careful and structured approach, which involves:

• Clinical history – our doctor will explore when symptoms began, which joints are affected and whether stiffness is worse in the morning or after rest. Patterns of swelling, fatigue and systemic symptoms help distinguish rheumatoid arthritis from other joint conditions.
• Physical examination – a detailed joint assessment is performed to look for swelling, warmth, tenderness and reduced range of motion. The involvement of multiple joints on both sides of the body often provides important diagnostic clues.
• Blood tests – laboratory tests may be ordered to look for markers of inflammation and immune activity, such as rheumatoid factor (RF), anti-CCP antibodies, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These help support the diagnosis and assess disease activity.
• Imaging studies – these will help our doctors have a comprehensive understanding of the severity of the condition:
  • X-rays – used to evaluate joint damage in established disease
  • Ultrasound or magnetic resonance imaging (MRI) can detect early inflammation, synovitis and subtle joint changes before permanent damage occurs.

What are the stages of rheumatoid arthritis?

The speed of progression varies from person to person. However, it is commonly described in 4 stages, which are:

How is rheumatoid arthritis treated in Singapore?

There is currently no cure for RA, but timely and tailored treatment can control inflammation, relieve symptoms and slow disease progression.

Medical management

• Lifestyle and activity modification – adopting low-impact exercise, pacing daily activities and protecting affected joints can help minimise stress and flare-ups.
• Weight management – maintaining a healthy weight reduces pressure on inflamed joints and supports mobility.
• Pain coping strategies – heat or cold therapy and ergonomic adjustments may ease discomfort during daily activities.

Conservative treatments

• Platelet-Rich Plasma (PRP) injections – may be considered in selected cases to support joint health and symptom control, particularly when inflammation is localised and other treatments have provided limited relief.
• Disease-modifying antirheumatic drugs (DMARDs) – the foundation of rheumatoid arthritis treatment, aimed at suppressing immune-driven inflammation and protecting joints long term.
• Biologic therapies and targeted synthetic DMARDs – advanced treatments that block specific inflammatory pathways in patients with moderate to severe disease or inadequate response to standard therapy.
• Pain relief and anti-inflammatory medications – used to manage symptoms and flares alongside disease-modifying treatment.

Rehabilitative support

• Physiotherapy – improves joint mobility, strengthens surrounding muscles and enhances functional movement.
• Occupational therapy – helps adapt tasks and environments to protect joints during daily activities.

Book an Appointment

Early care plays a key role in protecting joint health and maintaining long-term mobility. If you are experiencing persistent joint pain, stiffness or swelling, a timely assessment can help identify the cause and guide appropriate treatment.

Book an appointment with Dr James Tan today to take a proactive step towards safeguarding your joints and staying active with confidence.