Rheumatoid Arthritis

Overview

Is a systematic autoimmune disease leading to joint destruction
Usually caused by a combination of genetic and environmental factors

What Happens in the Body

Is thought to occur in those who are born with certain genes, along with those who have certain risk factors
- Cigarette smoking (strongest risk factor), diet/nutrition (high calories, low in fiber), high body mass index
The body produces autoantibodies that attack normal joint proteins
- The body's immune system mistakenly attacks its own tissues
The immune system attacks the synovium (joint lining) which leads lead to:
- Inflammation and the break down of cartilage and bone, leading to joint space narrowing, deformity, stiffness, and pain
Smaller joints in the hands (and feet) usually get affected first
Is a chronic and progressive disease that can lead to permanent joint damage without treatment
Can cause hand deformities that lead to a loss of function

Pain & Spine Specialists. “Rheumatoid Arthritis” illustration. In “The Causes and Treatments for Rheumatoid Arthritis.” Pain and Spine Specialists, 2024. Retrieved from painandspinespecialists.com

Symptoms

Joint pain
Edema/swelling
Joint stiffness that is usually worse in the morning
Joint warmth/erythema when palpating
Symptoms usually last over periods or "flare-ups" for a few weeks to months
Advanced cases may involve:
- Boutonniere deformity
- Swan neck deformity
- Ulnar drift of the metacarpophalangeal joints
- Reduced joint range of motion

Who Gets It?

Risk factors - cigarette smoking (strongest risk factor), diet/nutrition (high calories, low in fiber), high body mass index
More common in women
More common in middle and late adulthood

Prognosis/Timeline

Without treatment, rhematoid arthritis leads to joint damage, disability, and an increased mortality rate
Treatment within 6 months of symptom onset can improve joint function and reduce symptoms
Around 40% of patients will develop functional disability within 10 years of their diagnosis
- Can impact ADLs, self-care, and ability to work
Early surgical intervention results in better outcomes and preservation of hand function
Common surgeries include:
- Synovectomy/tenosynovectomy: Removal of inflamed synovial tissue to reduce pain, swelling, and prevent joint and tendon damage
- Metacarpophalangeal joint arthroplasty: Replacement of MCP joints using sillicone or other materials to combat ulnar drift finger deformity and improve pain and function
- Tendon reconstruction or tendon transfer: Repair damaged tendons to restore function to muscles after a tendon is ruptured or damaged from chronic inflammation

Treatment Ideas

Patient education on adaptive equipment and activity modification

AROM and gentle strengthening

AROM

Quiz Questions

1. What type of disease is rheumatoid arthritis (RA)?

A. Genetic-only disorder

B. Localized infection

C. Systemic autoimmune disease

D. Degenerative bone disease

2. What is the strongest known environmental risk factor for developing RA?

A. Cigarette smoking

B. Alcohol use

C. Cannabis smoking

D. Cold climates

3. Which joints are typically affected first in RA?

A. Larger joints such as knees and hips

B. Small joints in the hands and feet

C. Shoulders and elbows

D. Joints of the spine

4. In RA, what structure is primarily attacked by the immune system?

A. The tendons

B. The muscles

C. The synovium

D. The bone marrow

5. What are the two main contributors to the development of RA?

A. Only bacterial infections

B. Repetitive overuse and aging

C. Vitamin deficiencies

D. Genetic predisposition and environmental factors

6. What is a flare-up in RA?

A. A period of joint healing

B. A sudden allergic reaction to medication

C. A period when symptoms worsen

D. A period when symptoms improve

Quiz Answers

References

Bobos, P., Nazari, G., Szekeres, M., Lalone, E. A., Ferreira, L., & MacDermid, J. C. (2019). The effectiveness of joint-protection programs on pain, hand function, and grip strength levels in patients with hand arthritis: A systematic review and meta-analysis. Journal of Hand Therapy, 32(2), 194–211. https://doi.org/10.1016/j.jht.2018.09.012

Chauhan, K., Jandu, J. S., Brent, L. H., & Al-Dhahir, M. A. (2025). Rheumatoid arthritis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK441999/

Hand therapies for rheumatoid arthritis. (2021). Arthritis Foundation. https://www.arthritis.org/diseases/more-about/hand-therapies-for-rheumatoid-arthritis

Neumeister, M., & Molnar, J. A. (2023). Hand and Wrist Surgery in Rheumatoid Arthritis. Medscape. https://emedicine.medscape.com/article/1287449-overview#a1

Page updated

Google Sites

Report abuse