Rheumatoid arthritis (RA) is an autoimmune disease that causes swelling, pain, stiffness, and loss of function in the joints.
- In autoimmune disease, a person’s immune system, which normally helps protect the body against infection and disease, instead attacks the body
- In rheumatoid arthritis, the white blood cells of the immune system attack the lining of the capsule around the joints known as the synovium, making this normally thin tissue thick and causing swelling.
This results in ongoing inflammation of the tissues lining the joint; a breakdown of cartilage and the bone surrounding the joint; and the loosening of the ligaments and tendons supporting the joint. In turn, this can lead to limited mobility, impaired function, and deformity of the joints.
Deformities of the hand and wrist caused by rheumatoid arthritis include:
- Changes in the tissues around the finger joints, causing abnormal bending or straightening
- Swelling of the joints can push the supporting tendons and ligaments out of position, causing the fingers to bend toward the little finger.
- Ruptured tendons, which make it impossible to straighten or bend the finger, depending on which tendon ruptures
In the elbow and shoulder, rheumatoid arthritis can cause severe pain, limited range of motion and a feeling of grinding.
Causes and risk factors
Although scientists still don't know the precise cause of autoimmune disorder and rheumatoid arthritis, there is strong evidence that it may be inherited. Other possible risk factors include environmental and hormonal influences that trigger the autoimmune response.
Gender is a known risk factor in rheumatoid arthritis, affecting 2 to 3 times as many women than men.
Symptoms
- Painful, swollen, tender, stiff joints
- Morning stiffness
- Nodules (bumps) that form on pressure points such as the elbows or knuckles
- Fatigue; general feeling of being ill
- Mild fever
Diagnosis
In addition to performing a physical exam, evaluating your symptoms and taking a family history, your physician may perform some or all of the following:
- Joint fluid analysis
- X-ray
- Blood test for determining rheumatoid factor (RF) and other indicators of autoimmune disease
Treatment options
Studies have shown that damage to joints occurs in the majority of people with rheumatoid arthritis within two years. Irreversible joint damage, chronic pain, and long-term disability can occur if rheumatoid arthritis is not diagnosed and aggressively treated early.
Initial treatment can include:
- Use of assistive devices to reduce strain on your joints, such as special door knobs or kitchen tools
- Physical therapy or exercises to improve mobility and function
- Keeping the affected joint warm with use of heating pads, electric blankets, immersing in warm water, or, in the case of the hands, soaking in warm wax baths
- A balance of rest and exercise, since rest helps reduce active inflammation and prevent fatigue, while exercise can help maintain mobility and flexibility.
Medications that can slow or even help prevent joint destruction are also recommended early in the course of the disease. These medications are known as disease-modifying anti-rheumatic drugs (DMARDs). DMARDs are also called immunosuppressive drugs or slow-acting anti-rheumatic drugs (SAARDs).
Newer drugs known as biologic response modifiers are also being used to help reduce inflammation and structural damage to the joints by blocking the action of cytokines, the substance in the immune system that triggers inflammation during normal immune responses.
Surgical options
In cases that do not respond to early treatments, and that are causing severe pain, loss of function and/or joint deformity, surgery is an option. The primary purpose of surgery is to reduce pain, improve the affected joint’s function, and improve the patient’s ability to perform daily activities.
At UCSD, our orthopedic surgeons offer several surgical treatments for rheumatoid arthritis. Although there is no cure for rheumatoid arthritis, our team is at the forefront of leading edge treatment technologies to provide relief of symptoms and improve function.
Arthroscopy: in this procedure, tiny incisions are used to insert an instrument for viewing the inside of the joint for diagnostic purposes. Surgery may be performed at the same time, using instruments to remove debris or inflamed tissue, or to repair damage. Arthroscopy is less invasive than open surgery since it requires much smaller incisions.
Synovectomy: The removal of inflamed tissues lining the inside of the joint, which may be performed using arthroscopic procedures.
Tendon reconstruction: During this surgery, which is used most frequently on the hands, damaged tendons are repaired by attaching them to healthy, intact tendons. This procedure may also be done arthroscopically.
Arthrodesis (fusion of the joints): This procedure, often used for the wrist and elbow, permanently immobilizes the affected joint to provide stability and relieve pain.
Arthroplasty (total joint replacement): Can be used for the fingers, elbow and shoulder when the joints are too damaged to be repaired.
Shoulder replacement surgery includes two methods:
- Conventional shoulder replacement, in which the damaged cartilage is removed and a metal and plastic ball-and-socket implant is placed in the shoulder. This is an excellent option to relieve pain associated with severe shoulder arthritis.
- Reverse shoulder replacement, in which the ball and socket are reversed. The ball is placed on the shoulder blade and the socket is placed on the top of the arm bone. This reverse technique allows better function when the patient has a non-functioning rotator cuff.
To schedule an appointment
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