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.


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.


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.


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