Diagnosed with rheumatoid arthritis later in life: the first months (UK guide)

Name: Rheumatoid Arthritis Later in Life: First Months (UK)
Creator: Louis Maxwell

Written by Louis Maxwell — First Contact Practitioner, HCPC PH128483.

Clinical review status: not yet recorded

Rheumatoid arthritis can start at any age, including in your 60s, 70s or later, and it is treated in the same way as at a younger age. In the first months you can expect blood tests and X-rays, a disease-modifying medicine (DMARD) such as methotrexate started as soon as possible, sometimes with a short course of steroids to help while it starts working, and regular checks — NICE recommends monthly checks of inflammation and disease activity until the arthritis is under control. DMARDs can take up to 12 weeks to work, so keep taking them. Keep moving gently every day, ask for a named contact…

This guide is for people diagnosed with rheumatoid arthritis (RA) later in life, and for the family members and carers supporting them, covering roughly the first 3 to 6 months. For a general starting point, see our newly diagnosed guide. For the medicine most people start on, see methotrexate in later life; for long-term check-ups, see RA monitoring in later life.

A diagnosis later in life is common, and treatable

Many people assume aching, stiff joints in later life are simply wear and tear. RA is different: the immune system attacks the lining of the joints, causing pain, swelling and stiffness, often with tiredness and feeling generally unwell. Being older does not mean you will be offered less. NICE recommends the same treat-to-target approach for every adult with RA: get the inflammation down to remission, or to low activity if remission is not possible, as early as you can, because that protects the joints.

It is normal to feel shocked, relieved, angry or low after a diagnosis — sometimes all in the same week. See feelings after an arthritis diagnosis.

What usually happens in the first weeks

Tests to set a baseline. NICE recommends a blood test for anti-CCP antibodies (if not already done), X-rays of the hands and feet, and a short questionnaire about everyday tasks, so later improvement can be measured. See how arthritis is diagnosed
Starting a DMARD. NICE recommends starting one disease-modifying medicine — methotrexate, leflunomide or sulfasalazine — as soon as possible, ideally within 3 months of persistent symptoms starting. Hydroxychloroquine may be used for milder RA
A short steroid "bridge". Your team may suggest a short course of steroid tablets or an injection to ease symptoms while the DMARD starts working
Safety checks before methotrexate. Blood tests of your blood count, liver and kidneys, and sometimes a chest X-ray and breathing test

Your first rheumatology appointments can feel rushed. Our guide to what to expect at a rheumatology appointment helps you prepare.

The first three months: checks and patience

NICE recommends that people with active RA have their CRP (a blood marker of inflammation) and a disease activity score such as DAS28 checked monthly by the specialist team until the target is reached. If the first medicine is not enough, the dose is usually increased, then another DMARD added. The NHS notes that some people try 2 or 3 medicines before finding the right one — this is normal, not a failure.

DMARDs can take up to 12 weeks to work. Keep taking them, even if you do not feel different yet
You will have regular blood tests to check the medicine is safe. If getting to them is hard, see getting to blood tests
Ask for a named contact (often a specialist nurse) and the advice line number — NICE says everyone with RA should know how to get rapid help for a flare

Your other medicines matter more now

Many people diagnosed later in life already take tablets for blood pressure, the heart, diabetes or bones. Bring a full, up-to-date list to every appointment, including things you buy yourself. Check with a pharmacist before taking any over-the-counter painkiller or supplement, as some interact with RA medicines — see painkillers in later life. If you are prescribed steroids for more than a short time, ask about protecting your bones; see bone protection on steroids. Never stop or change a prescribed medicine yourself.

Staying active from day one

Movement keeps joints mobile and muscles strong, and losing strength in the months around a diagnosis can make it harder to stay independent. The NHS advice for RA is to find a balance: rest inflamed joints when they are hot and swollen, but keep moving, because without movement joints stiffen and muscles weaken.

Try low-impact activity such as walking, swimming, cycling or chair-based exercise, and build up gradually. See chair-based exercise for RA and walking while on DMARDs
The NHS says older adults should also do activities that improve strength, balance and flexibility on at least 2 days a week. Sit-to-stand practice is a good start
If an activity makes your joints warm and swollen or causes severe pain, stop and rest, and try a gentler version next time
NICE says people with RA should have access to specialist physiotherapy, occupational therapy for everyday tasks and hand problems, and podiatry for foot problems. Ask your team for a referral

Tiredness, mood and pacing

Fatigue is one of the hardest parts of RA and often improves as the inflammation comes under control. Pacing — spreading tasks through the day and the week — helps. See managing RA fatigue in later life. If you feel low or anxious most days, tell your team or GP: NICE recommends psychological support to help people adjust to living with RA.

For family and carers

Come to the first few appointments if you can, and write down what is said
Help keep a simple diary of good and bad days, medicines and side effects
Help with transport to blood tests and reviews
Encourage daily movement rather than doing everything for the person — it protects their strength

Support and money

The NHS signposts two free helplines: the National Rheumatoid Arthritis Society (NRAS) on 0800 298 7650 and Arthritis UK (formerly Versus Arthritis) on 0800 5200 520. If you are over State Pension age and need help with personal care, you may be able to claim Attendance Allowance — see GOV.UK. In England, prescriptions are free from age 60.

When to get help

A flare that does not settle: phone your rheumatology advice line — see what to do in a flare
Signs of infection while on DMARDs (high temperature, sore throat, new cough): contact your GP, advice line or NHS 111 the same day
A single hot, very swollen joint with fever, or feeling very unwell: get urgent same-day help from NHS 111
Call 999 for chest pain, difficulty breathing, signs of a serious allergic reaction, or sudden confusion with being very unwell

Frequently asked questions

Is rheumatoid arthritis different when it starts later in life?

The condition and its treatment are the same. What is often different is that you may have other health conditions and medicines to fit around it, so a full medicines list and good communication with your GP matter more.

Am I too old for methotrexate or biologic medicines?

Age alone is not a reason to rule them out. Your team will weigh up your kidneys, liver, lungs, other medicines and preferences with you. Ask them to explain the options in a way that makes sense to you — NICE says they should.

How long until I feel better?

Some people feel steroid relief within days; DMARDs can take up to 12 weeks. Many people find the first few months the hardest, and things improve once the right treatment is found.

Sources and further reading

Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Living With Arthritis is an independent charity and is not part of Arthritis UK (formerly Versus Arthritis) or the NRAS. Everyone's situation is different, so always follow the advice of your own GP, pharmacist, rheumatology nurse or rheumatologist, and never stop or change a prescribed medicine yourself. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.

Continue with related help

Newly diagnosed — a starting point
Methotrexate in later life — blood tests, infections and vaccines
RA monitoring in later life — tests, reviews and what to report
Rheumatology appointments — what to expect
Chair-based exercise for RA — gentle strength
RA fatigue — pacing your energy
Rheumatoid arthritis — condition guide

Last updated 2026-10-22. This is general information, not a substitute for personalised medical advice.