Rheumatoid Arthritis

Overview

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that primarily affects the joints but can also affect other parts of the body. In RA, the immune system mistakenly attacks healthy tissues, especially the synovium, which is the lining of the joints. This leads to inflammation, pain, swelling, and stiffness in the affected joints. Over time, the inflammation can cause damage to the joint and surrounding tissues, leading to deformity, loss of function, and disability. RA is a systemic disease, meaning it can also affect other organs, such as the lungs, heart, and eyes. The exact cause of RA is unknown, but it is believed to be a combination of genetic, environmental, and hormonal factors.

For joints that are severely affected by rheumatoid arthritis despite medical management, there are orthopaedic procedures that can greatly improve function, mobility, and overall quality of life.

Types of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation and damage to various joints in the body. While it primarily affects the joints of the hands, wrists, and feet, RA can affect any joint in the body.

In RA, the immune system mistakenly attacks the body’s own tissues, resulting in inflammation and damage to the joints, cartilage, and surrounding tissues. This inflammation can lead to joint pain, stiffness, and swelling, and over time, can cause irreversible joint damage and disability. The joints most commonly affected by RA are those in the hands, wrists, and feet. In the hands, RA typically affects the small joints in the fingers and thumbs, as well as the wrist and knuckle joints. In the feet, RA often affects the joints in the toes and ankles. However, RA can also affect other joints in the body, including the shoulders, elbows, hips, and knees. In some cases, RA can even affect the joints in the neck and jaw, making it difficult to move the head or chew. 

One of the distinguishing features of RA is its symmetrical pattern of joint involvement. This means that if a joint on one side of the body is affected, the corresponding joint on the other side of the body is usually affected as well. For example, if the right hand is affected, the left hand is likely to be affected too.

Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis can manifest in different ways, and the severity of symptoms can vary from person to person. Some individuals may experience mild symptoms that persist over time, while others may experience more severe symptoms that flare up intermittently.

Common symptoms of rheumatoid arthritis include pain, fatigue, stiffness, and swelling in multiple joints, which can cause discomfort even when at rest. Other symptoms that may occur include a sensation of warmth around the joint, general symptoms throughout the body like fever, loss of appetite, and weakness due to anemia, as well as the development of nodules or lumps, particularly around the elbow. In cases of long-lasting disease, the patient may develop deformities and contractures of the joint, as well as foot pain, bunions, and hammer toes.

People with severe rheumatoid arthritis often experience joint pain in the hands, arms, legs, and feet, with the neck joints also possibly affected. Rheumatoid arthritis is a complex disease, and patients may exhibit a wide range of symptoms that require careful management and treatment.

Causes of Rheumatoid Arthritis

While the exact reason behind the development of RA is not clear, it is not considered to be a hereditary condition. Scientists believe that certain individuals may have genes that increase their susceptibility to the disease. It is believed that an environmental or chemical “trigger” is required to activate the disease in those individuals who have these genes. Once the trigger is encountered, the immune system responds inappropriately. Infection and smoking are believed to be potential triggers.

Diagnostics of Rheumatoid Arthritis

Early diagnosis and treatment of RA is important to prevent or minimize joint damage and disability. Treatment typically involves a combination of medication, physical therapy, and lifestyle changes. While there is currently no cure for RA, early and effective treatment can help to control symptoms, slow the progression of the disease, and improve overall quality of life.

Doctors use a combination of a patient’s medical history, physical examination, and laboratory tests to diagnose rheumatoid arthritis because there is no single test that can confirm the condition. Symptoms of rheumatoid arthritis can develop slowly, making it challenging to diagnose in the early stages. During the physical exam, the doctor will look for signs of RA, including swollen or tender joints, limitation of joint motions, and early deformity, as well as signs of inflamed tendon sheaths in the hands or wrists and tendon ruptures. Blood tests, such as rheumatoid factor, anti-CCP antibodies, and ESR or CRP, are also commonly used to diagnose RA. X-rays are not very useful in detecting RA in the early stages, but they can help rule out other possible diagnoses and monitor the progression of the disease. Specific criteria have been developed to help diagnose early-stage RA. If RA is suspected, the patient may be referred to a rheumatologist to determine the specific diagnosis.

Complications of Rheumatoid Arthritis

If left untreated, rheumatoid arthritis (RA) can lead to a number of complications that can significantly impact a person’s quality of life. These complications can include:

  • Joint Damage: Over time, RA can cause joint damage and deformity, leading to chronic pain and loss of function.
  • Reduced mobility and disability: As the disease progresses, people with RA may find it increasingly difficult to carry out daily activities such as dressing, cooking, or cleaning. Eventually, joint damage can lead to significant disability.
  • Increased risk of infections: RA can weaken the immune system, increasing the risk of infections such as pneumonia and urinary tract infections.
  • Cardiovascular disease: RA is associated with an increased risk of heart disease and stroke.
  • Lung disease: RA can cause inflammation and scarring in the lungs, leading to shortness of breath and other respiratory problems.
  • Eye problems: In some cases, RA can cause inflammation in the eyes, leading to dryness, redness, and discomfort.
  • Increased risk of cancer: People with RA may have a slightly increased risk of developing certain types of cancer, such as lymphoma. This is likely caused by chronic inflammatory stimulation of the immune system.

It’s important to note that with proper medical treatment, the risk of these complications can be reduced. If you suspect that you may have RA or any other type of arthritis, it’s important to seek medical attention as soon as possible to get an accurate diagnosis and start treatment.

Nonsurgical Treatment of Rheumatoid Arthritis

While there is currently no cure for rheumatoid arthritis, there are various treatment options available that can provide relief from joint pain and improve overall functioning.

Medical treatment is an important aspect of managing the disease and surgery may be necessary for individuals with severe joint damage or tendon ruptures. A team of healthcare professionals, including family doctors, orthopaedic surgeons, rheumatologists, physical and occupational therapists, social workers, and rehabilitation specialists, often work together to provide comprehensive care.

Physical therapy and exercise are crucial components of treatment. Patients may work with their doctor and physical therapist to create an exercise regimen that strengthens the muscles around affected joints while avoiding unnecessary stress.

In certain cases, braces or splints may be recommended by a doctor to reduce stress on specific joints and prevent deformity.

Surgical Treatment of Rheumatoid Arthritis

Depending on the severity of cartilage damage and the response to nonsurgical treatments, your physician may recommend orthopedic surgery.

Synovectomy: A synovectomy involves removing the synovial lining of the joint affected by rheumatoid arthritis to reduce pain and swelling. This procedure is usually used in the early stages of the disease when it is limited to the joint lining and has not yet severely affected the articular cartilage. However, synovitis can recur without ongoing medical management, though synovectomy is now required less frequently due to newer treatments.

Tendon Surgery: If tendons rupture, reconstructive surgery may be necessary to restore function. This may involve tendon repairs or transfers, which can be highly successful in the hand. Trigger fingers and tenosynovitis in the hand and wrist may require partial release of tight tunnels, partial flexor tendon excision in the finger, and tenosynovectomy to prevent tendon ruptures.

Joint Rebalancing: In the early stages of rheumatoid arthritis, joints can become loose and unbalanced, leading to deformities and contractures that interfere with function. If the cartilage is still intact, a surgeon can perform procedures to release tight structures, transfer tendons, and tighten loose ligaments to rebalance the joint alignment and improve function.

Fusion: Fusion of affected joints is the most common type of surgery for RA. During fusion, the bones that form a joint are fused together, eliminating motion in the joint. This is mainly used in joints of the foot and hand and relieves symptoms while allowing good function. Fusion surgery eliminates pain and improves function, but patients may notice a lack of motion.

Joint Replacement Surgery: Joint replacement surgery can be effective in restoring painless joint movement. This procedure involves removing the damaged cartilage and bone and positioning new metal or plastic joint surfaces to restore function. It is especially effective in the hand, and a combination of specific small joint fusions and/or joint replacement improves function significantly. For larger joints such as the elbow, shoulder, hip, and knee, joint replacement surgery can be the difference between disability and an active life.