Rheumatoid arthritis – assessment and treatment at Charlottenlund Private Hospital

What is rheumatoid arthritis?



Rheumatoid arthritis is the most common autoimmune inflammatory arthritis. The immune system attacks the synovium, the thin membrane lining the joints, causing it to swell and produce fluid and, over time, to break down cartilage and bone. The disease typically affects many joints at once, often the same joints on both sides of the body. According to the Danish Society for Rheumatology’s national treatment guidelines, around 36,000 people in Denmark are estimated to have rheumatoid arthritis, with approximately 2,000 new diagnoses each year.

Rheumatoid arthritis is not osteoarthritis. Osteoarthritis is caused by cartilage wear and tear and causes pain with activity, while rheumatoid arthritis is caused by inflammation and causes pain at rest, swelling and pronounced morning stiffness. The two conditions are often confused in everyday conversation, but assessment, treatment and disease course are completely different – one of the most important reasons to get an accurate diagnosis.

What are the symptoms of rheumatoid arthritis?

Early signs include swollen, tender and warm joints – most often the middle and base joints of the fingers, wrists and balls of the feet – and morning stiffness lasting more than an hour. Symptoms typically develop gradually over weeks to months and often affect both hands or both feet at the same time. Many people describe pain when shaking hands, being unable to remove rings, or feeling as though they are walking on pebbles under the balls of their feet. Fatigue, a mild fever and reduced appetite may also occur, particularly in the early stage of the disease.

Over time, larger joints such as the knees, elbows, shoulders and ankles may also be affected. The end joints of the fingers are usually spared – one of the features that distinguishes rheumatoid arthritis from osteoarthritis and psoriatic arthritis [link: /reumatologi/psoriasisgigt]. Some people develop nodules under the skin near the elbows, dry eyes and mouth, or symptoms affecting the lungs and blood vessels.

What causes rheumatoid arthritis?

The exact cause is not fully known. According to the treatment guidelines, the disease develops through an interaction between genetic predisposition and environmental factors, with smoking being the best-documented. Smoking increases both the risk of developing rheumatoid arthritis and the risk of a more severe course. The disease is not directly inherited, but is more common in families with rheumatoid arthritis or another autoimmune disease. Rheumatoid arthritis is not caused by physical strain, diet or cold.

How is rheumatoid arthritis assessed?

The assessment starts with your medical history – which joints are affected, for how long, at what time of day, and whether there is swelling and morning stiffness – followed by a clinical examination of all joints for swelling, warmth, tenderness and range of motion. The pattern of affected joints often points to the diagnosis: small joints in the hands and feet, symmetrically affected, with symptoms lasting more than six weeks.

Blood tests include inflammatory markers (CRP and ESR) and rheumatoid factor and anti-CCP. Anti-CCP is particularly important because it is more specific to rheumatoid arthritis and can be positive before symptoms become pronounced. However, rheumatoid arthritis tests may be negative in some patients with the disease, and a positive test without symptoms does not mean a diagnosis. Ultrasound scans of the hands and feet can show inflammation in the synovium and tendon sheaths and detect early bone changes that are not visible on a routine examination. The diagnosis is based on the overall picture, using the international ACR and EULAR classification criteria (2010), which take into account the number and type of affected joints, test results, inflammatory markers and symptom duration.

How is rheumatoid arthritis treated?

Treatment has one goal: to bring the inflammation under control and preserve the joints. According to the treatment guidelines, disease-modifying antirheumatic medication should be started as soon as the diagnosis is made, and treatment adjusted regularly according to disease activity until the target is reached. In the initial phase, inflammation can be reduced with corticosteroids – as tablets or as an ultrasound-guided injection into the most swollen joints. If disease activity remains high despite disease-modifying medication, the next step is biologic medication, which under current Danish regulations is administered in a hospital setting.

At Charlottenlund Private Hospital, assessment and diagnosis are provided. If rheumatoid arthritis is confirmed, the patient is referred for disease-modifying treatment in a hospital setting, together with the completed assessment, so treatment can begin without delay. Advice on quitting smoking, exercise and joint protection is also provided. If the assessment or course of the disease indicates a need for biologic treatment, the patient is referred with the completed assessment so care can continue without delay.

When should I see a rheumatologist?

A rheumatology assessment is recommended when one or more joints have been swollen for more than six weeks without a known injury, when swelling affects the hands or feet symmetrically, when morning stiffness lasts for more than an hour, or when your GP has found elevated inflammatory markers or a positive rheumatoid factor or anti-CCP test. The earlier the inflammation is treated, the better the chance of preventing permanent joint changes – so don’t wait months to have swollen joints assessed.

Assessment at Charlottenlund Private Hospital

Assessment and treatment are provided by specialists in rheumatology and take place on an outpatient basis. The initial consultation typically lasts 20–30 minutes; blood tests and ultrasound scans of the hands and feet can often be done on the same day. If the diagnosis is confirmed, a referral is sent with the completed assessment, and the specialist will provide the patient with the results and an explanation.

Most patients come through health insurance; insurers typically require a referral from your GP and prior authorisation before an appointment can be booked. Self-paying patients do not need a referral, and prices are listed on the price list. Appointments can be booked online 24/7 or by calling 44 98 19 21 Monday–Friday, 08:00–14:00. Outside phone hours, the digital telephone assistant Anna can book, cancel and reschedule appointments.