Rheumatoid arthritis is a chronic disease in which the body's immune system attacks the joints. The inflammation can become severe, impacting function and appearance of the hands, as well as other parts of the body. In the hand, rheumatoid arthritis may cause deformities in the joints of the fingers, making movement difficult. Lumps, known as rheumatoid nodules, may form over small joints in the hands and the wrist.
Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger that causes inflammation and stiffness of joints for more than six weeks. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow JRA. However, the disease can affect bone development in growing children.
Causes and Risk Factors
The exact cause of rheumatoid arthritis is not known. Rheumatoid arthritis is an autoimmune disorder, which means the body's immune system attacks its own healthy cells and tissues. The response of the body causes inflammation in and around the joints, which then may lead to a destruction of the skeletal system. Rheumatoid arthritis may also have devastating effects on other organs, such as the heart and lungs. Researchers believe certain factors, including heredity, as well as smoking, may contribute to the onset of the disease.
Rheumatoid arthritis affects more women than men — 70 percent of those with rheumatoid arthritis are women. The disease most often occurs between the ages of 30 and 50, but is becoming more prevalent in older individuals.
The joints most commonly affected by rheumatoid arthritis are in the hands, wrists, feet, ankles, knees, shoulders and elbows. The disease typically causes inflammation symmetrically in the body, meaning the same joints are affected on both sides of the body, but there are many exceptions. Symptoms of rheumatoid arthritis may begin suddenly or gradually. People experience symptoms differently, but the following are the most common symptoms of rheumatoid arthritis in the hands:
- Morning stiffness that lasts longer than one hour for at least six weeks
- Three or more joints that are inflamed for at least six weeks
- Decreased movement
- Pain that is worse with movement of the joints
- Bumps may appearover the small joints
- Difficulty performing activities of daily living (ADLs), such as tying shoes, opening jars or buttoning shirts
- Decreased ability to grasp or pinch
The symptoms of rheumatoid arthritis may resemble other medical conditions or problems. Consult your physician for a diagnosis.
At UC San Diego Health we have board-certified rheumatologists who can provide a thorough examination, as well as any needed testing to determine whether or not you have rheumatoid arthritis.
Diagnosis of rheumatoid arthritis may be difficult in the early stages, because symptoms may be very subtle and go undetected on X-rays or blood tests. In addition to a complete physical examination and discussion of your medical history, diagnostic procedures for rheumatoid arthritis may include the following:
- Ultrasound or MRI of the swollen joint
- Joint aspiration — involves a removal of fluid from the swollen bursa to determine whether infection or gout could be possible causes
- Biopsy (of nodules tissue) — tissue samples are taken (with a needle or during surgery) and are examined under a microscope to determine if cancer or other abnormal cells are present
- Blood tests — these screen for certain antibodies, such as rheumatoid factor, anti-CCP antibody and other indicators of rheumatoid arthritis
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 treated aggressively early on.
Initial treatment options 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, soaking in warm water or, in the case of the hands, soaking in warm wax baths
- Balancing rest with 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 very important early in the course of the disease. These medications are known as disease-modifying antirheumatic drugs (DMARDs). These medications can treat the arthritis itself and not only improve symptoms, but also slow or stop progression of the arthritis.
- 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.
Our compassionate, patient-centered joint team provides customized joint replacement and resurfacing using the latest proven components and surgical techniques. 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.
Learn more about joint replacement and resurfacing at UC San Diego Health.