Rheumatoid Arthritis

What is Rheumatoid Arthritis?

Rheumatoid Arthritis and Osteoarthritis are the two most common types of arthritis that affect the hand. While both may cause destruction, deformity, and disability of the hand joints, the mechanism by which the damage occurs is completely different. Osteoarthritis of the hand is caused by mechanical wear and tear on the joints, while Rheumatoid Arthritis of the hand is an autoimmune disease. Autoimmune disease occurs when the body’s immune system mistakenly identifies a native protein as foreign and attempts to destroy it. In Rheumatoid Arthritis a protein found in the synovial lining of the joints is erroneously targeted. The synovium lines the inside surface of the joint capsule and secretes synovial fluid, essential for lubricating and cushioning the joint. When the immune system attacks the synovium, inflammation ensues, an excess of synovial fluid is produced, and the joint swells. The injured synovial lining allows seepage of inflammatory cells into the cartilage and bone beneath it. These inflammatory cells then erode and destroy the cartilage and bone. Degradation of the synovium also weakens the joint capsule, contributing to instability in the already painful and inflamed joint.


What causes Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is believed to be caused by a combination of genetic and environmental factors. Researchers are currently trying to determine which genes are associated with RA. Several genes have been implicated, but not all individuals who have these genes develop RA. The current belief is that an environmental factor triggers an immune response and turns on the genes for RA in genetically susceptible individuals. There may also be a role for hormones as 70% of cases in RA occur in women. Obesity and smoking have also been shown to increase the risk for developing RA.


What are the symptoms of Rheumatoid Arthritis?

In contrast to the symptoms of Osteoarthritis, Rheumatoid Arthritis is a polyarticular arthrititis. In RA the synovial linings of the entire body are under attack and joint pain is noted in multiple joints at the same time, often to varying degrees. The joints of the hands are usually among the first joints affected.

In the early stages of RA, fatigue, malaise, mild joint stiffness, and swelling are noted. As the immune response ramps up, increased synovial fluid in the joint causes warmth, more pronounced swelling, and limitation of motion. As the bones and cartilage become affected, soft tissue swelling, subcutaneous nodules, and deformity of the joint may occur. Swan neck deformity, boutonniere deformity, and carpal tunnel syndrome can result from joint deformity in RA of the hands.

The progression of symptoms is highly variable. Some individuals may progress slowly and gradually. Others may have sporadic episodes of joint pain, swelling, and inflammation with periods of remission in between. Still others may have aggressive, fast paced progression to joint destruction. Rheumatoid Arthritis can also affect other organ systems in the body including the skin, eye, lungs, circulatory system and nervous system.


How is Rheumatoid Arthritis Diagnosed?

A careful history and thorough physical exam along with laboratory examinations are the cornerstones of diagnosis in Rheumatoid Arthritis. The latest guidelines for diagnosis take into account the number and size of joints affected, the duration of the symptoms, and the results of key blood tests. Blood levels of Rheumatoid Factor, Anti-Citrullinated Protein Antibodies, C-Reactive Protein, and Erythrocyte Sedimentation Rate are noted. Based on this constellation of findings, the diagnosis can be made. X rays and MRI are often utilized to stage the disease once diagnosis has been made.


How is Rheumatoid Arthritis Treated?

There are both nonsurgical and surgical options for the treatment of Rheumatoid Arthritis.

Non-Surgical

Although there is currently no cure for RA, non surgical treatment aims to control symptoms, slow progression of the disease, and ensure quality of life. Non Steroidal Anti-inflammatory drugs (NSAIDs) are useful in the early stages of RA to reduce pain and inflammation. Steroids have a role in suppressing the immune response and are generally used in the short term to calm a flare. Steroids are used in both oral and injectable forms. Disease Modifying Anti Rheumatic Drugs (DMARDs) and Biologics are two categories of medications proven to halt the progression of the disease. Exercise, Physical Therapy, and Occupational Therapy are essential components of a comprehensive approach to managing RA.

Surgical

If the pain and loss of motion of RA becomes disabling in a particular joint, surgery may be indicated to relieve the symptoms. Surgical techniques include joint replacement or joint fusion. In the fingers, it is often possible to replace the diseased joint with an implant, allowing the restoration of motion. The procedure is followed by Hand or Occupational Therapy to ensure full recovery.


How can Dr. Knight help you with Rheumatoid Arthritis?

Over the years, Dr. Knight has seen in many patients the painful effects of Rheumatoid arthritis, and understands how important it is for you to be relieved of that pain. Through careful study of your case, Dr. Knight will determine which solution is the best option for you, with the ultimate goal of restoring your hands to as much use as medically possible, so that you can get back to your life and work.

Come visit Dr. Knight, one of the most accomplished hand specialists in Dallas, Texas. See him at the Southlake office or Dallas hand and wrist center.


Rheumatoid Arthritis Fact Sheet

Is Rheumatoid Arthitis different from normal arthritis?Rheumatoid arthritis is an autoimmunedisease that is caused by a mixture of genetic and environmental factors. Essentially, the joints don't produce enough fluid to lubricate themselves so they begin to wear away, leading to swelling and pain. This is different from Osteoarthritis, because in the case of osteoarthritis, the fluid is absent due to age or injury, and not specifically the autoimmune condition underlying rheumatoid arthritis.
What kinds of things can I do to treat Rheumatoid Arthritis short of contacting a doctor?As an autoimmune disorder, Rheumatoid Arthritis cannot be treated except through medical intervention. That being said, not all medical treatment need be purely clinical. Studies have shown that acupuncture and magnet therapy can be effective in treating the early onset of the disease,
What sorts of medication can help me deal with my Rheumatoid Arthritis?Rheumatoid Arthritis is an inflammatory condition, so anti-infmallatory medication is key in reducing the major symptoms of the condition. Pain relief is also important once the condition begins to progress. As above, acupunture is acommonly used non-western practice of pain relief that has had some success.
Can Rheumatoid Arthritis be cured?Unfortunately, due to its autoimmune nature, once Rheumatoid Arthritis has begun to manifest, it can only be treated, and not cured or reversed.
What is Dr. Knight's preferred plan of treatment for Rheumatoid Arthritis?Conservative treatment is preferred, but if the condition progresses then surgery sometimes including total joint replacement, may be necessary. These are always a last resort, however, and is is important to explore all options in treatment prtior to settling on a final decision of surgery.

Frequently Asked Questions:

Is Rheumatoid Arthritis genetic?
Rheumatoid arthritis IS genetic, but it is NOT hereditary. This is confusing, but basically means that there are certain genetic propensities that make one more susceptible to developing the condition, but just because someone in your family suffers from the condition does not mean that you will inherit it. The precise mechanisms are poorly understood, but a specific combination of genes are required in order to trigger the development of Rheumatoid Arthritis, and it is difficult to predict when and how this might occur.

What are the first signs of Rheumatoid Arthritis?
Like many inflammatory conditions, Rheumatoid Arthritis comes on slowly, but the signs are noticeable: swelling, pain, stiffness, redness, unusual warmth, loss of flexibility and decreased range of motion. Fatigue, depression, and anxiety can also be associated with the development of the condition, as autoimmune conditions often have non-physical symptoms as well.

What causes Rheumatoid Arthritis?
Unlike standard arthritis, which is usually the result of overuse and wear-and-tear on the joints over time, rheumatoid arthritis is an autoimmune disorder that causes the body to fight against itself, and leads to the deterioration of the joint lining and the synovial fluid that lubricates them.

Can certain foods make Rheumatoid Arthritis worse?
Yes, some foods are known to exacerbate the symptoms of rheumatoid and other arthritises. As an inflammatory illness, it can be affected by foods that act as inflammatory, or are known to inflame tissues and fluids. These foods include fatty foods, fried foods, gluten, alcohol, and processed foods, which are often high in fat and salt, both inflammatory.


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HandAndWristInstitute.com does not offer medical advice. The information presented here is offered for informational purposes only. Read Disclaimer

Dr. John Knight
Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.