Rheumatoid arthritis (RA) is an autoimmune disease that can cause pain and stiffness in multiple joints.  RA is one type of inflammatory arthritis that most often starts in the small joints of the hands and feet and often will affect joints on both sides of the body – both hands or both feet. 

The exact cause of RA is unknown, but it is not an inherited disease.  Women are 2-3 times more likely to develop RA than men and although symptoms usually develop between the ages of 30 and 60, children may also be affected.  In children the disease may appear similar, but it is caused by an auto-immune disorder and is now known as juvenile idiopathic arthritis (JIA). 

RA is the result of immune cells releasing substances that inflame the synovium, causing thickening and swelling.  What causes the immune cells to behave this way is the unknown, but doctors suspect a chemical or environmental trigger causing an incorrect immune system response.  Instead of protecting the body, the immune system attacks healthy tissue.  Infection and smoking are two likely triggers. 

Symptoms of RA are different in different people and range from mild to severe.  Many patients have chronic mild symptoms with occasional painful flare-ups of their symptoms.  

The most common symptoms of RA are: 

1. Pain 

1. Fatigue 

1. Stiffness, especially morning stiffness, which may last hours. 

1. Swelling in more than one joint; the joints can ache even at rest 

Other RA symptoms include: 

• A feeling of warmth around the joint 
• Symptoms throughout the body, such as fever, loss of appetite, and decreased energy 
• Weakness due to a low red blood cell count (anemia) Nodules, or lumps, especially around the elbow 

• Deformities and contractures of the joint (with long-lasting disease) 
• Foot pain, bunions, and hammer toes (with long-lasting disease) 

 If left untreated, over time RA causes joint damage that can result in serious disability.   

While there is no cure, new medications can modify the course of the disease, frequently preventing the progression of joint damage, so early detection and treatment can help prevent joint destruction and other complications. 

NONSURGICAL TREATMENT

• Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation

• Corticosteroids such as prednisone are potent anti-inflammatories which can be taken orally in pill form or injected directly into the affected area(s).
• Disease-modifying anti-rheumatic drugs (DMARDs) help slow the progress of RA by decreasing the body’s overactive immune response. They reduce inflammation, joint damage, and other painful symptoms. DMARDs carry significant risk of side effects, including:

• High blood pressure
• Liver damage
• Nausea

• Increased risk of serious infection

• Physical therapy is an important part of any RA treatment program. Balanced exercise guided by a physical therapist and your physician will help strengthen muscles around affected joints without stressing the joints.
• You may benefit from braces or splints to help reduce the stress on your joints and help prevent joint deformity.

SURGICAL TREATMENT

Depending on the extent of joint damage and your response to nonsurgical treatments, your doctor may recommend orthopedic surgery. The surgery recommended will depend on the type of joint damage.

1. Synovectomy is the removal of damaged synovial joint lining to reduce pain and swelling.

1. Tendon surgery repairs ruptured tendons to restore function.

1. Joint rebalancing can be effective in early stages of RA as small joints may become loose and unbalanced, causing deformities and contractures. A surgeon may release tight structures or tighten loose joints to correct deformities and restore function.

1. Fusion is a common surgery performed for RA. Fusing the bones that form a joint make one bone that is no longer mobile. Fusions are mainly performed in the joints of the hand and foot because they can relieve symptoms while still allowing excellent function.

1. Joint replacement surgery is used for the larger joints required for mobility, such as the shoulder, hip, and knee. The damaged bone ends are removed and replaced by metal and plastic components. Joint replacement surgery can mean the difference between disability and an active life.

Source: https://orthoinfo.org/