bone, joint, and muscle disorders
Rheumatoid Arthritis (RA)
Symptoms of Rheumatoid Arthritis
People with rheumatoid arthritis may have Relatively mild symptoms Occasional flare-ups with long periods of remission (in which the disease is inactive) A severe, steadily progressive disease, which may be slow or rapid Rheumatoid arthritis may start suddenly, with many joints becoming inflamed at the same time. More often, it starts subtly, gradually affecting different joints. Usually, the inflammation is symmetric, with joints on both sides of the body affected about equally. Rheumatoid arthritis can affect any joint, but most often the first inflamed are the small joints in the Hands Wrists Fingers Feet Toes Other commonly affected joints include the Knees Shoulders Elbows Ankles Hips Rheumatoid arthritis can also affect the neck. The lower spine and the joints at the tips of the fingers are not affected. The inflamed joints are usually painful and often stiff, especially just after awakening (such stiffness generally lasts for more than 60 minutes) or after prolonged inactivity. Some people feel tired and weak, especially in the early afternoon. Rheumatoid arthritis may cause a loss of appetite with weight loss and a low-grade fever. Affected joints are often tender, warm, and enlarged because of swelling of the soft tissue lining the joint (synovitis) and sometimes fluid within the joint (synovial fluid). Joints can quickly become deformed. Joints may freeze in one position so that they cannot bend or open fully, which leads to a limited range of motion. The fingers may tend to dislocate slightly from their normal position toward the little finger on each hand, causing tendons in the fingers to slip out of place, or may develop other deformities (see Swan-Neck Deformity and Some disorders, such as rheumatoid arthritis, and injuries can cause the fingers to bend abnormally. In swan-neck deformity, the joint at the base of the finger bends in (flexes), the middle joint straightens out (extends), and the outermost joint bends in (flexes). In boutonnière deformity, the middle finger joint is bent inward (toward the palm), and the outermost finger joint is bent outward (away from the palm). Swollen wrists can pinch a nerve and result in numbness or tingling due to Carpal Tunnel Syndrome . Cysts, which may develop behind affected knees, can rupture, causing pain and swelling in the lower legs. Up to 30% of people with rheumatoid arthritis have hard bumps just under the skin (called rheumatoid nodules), usually near sites of pressure (such as the back of the forearm near the elbow). Rarely, rheumatoid arthritis causes an inflammation of blood vessels ( Overview of Vasculitis ). Vasculitis reduces the blood supply to tissues and may cause nerve damage or leg sores (ulcers). Inflammation of the membranes that cover the lungs (pleura) or of the sac surrounding the heart (pericardium) or inflammation and scarring of the lungs or heart can lead to chest pain or shortness of breath. Some people develop swollen lymph nodes (lymphadenopathy), Felty syndrome (a low white blood cell count and an enlarged spleen), Rheumatoid arthritis can also affect the neck, making the bones unstable and increasing the risk of the bones Compression of the Spinal Cord . Neck involvement is common in longstanding, active rheumatoid arthritis and usually causes headaches and pain and stiffness, sometimes with pain that radiates down the arms or legs. People with rheumatoid arthritis are at increased risk for early and bone disease, such as In swan-neck deformity, the finger takes on a curved shape, like the neck of a swan. SCIENCE PHOTO LIBRARY This photo shows a boutonnière (buttonhole) deformity of the ring finger. © Springer Science+Business Media This photo shows multiple boutonnière deformities of the fingers and thumbs in this person with advanced rheumatoid arthritis. By permission of the publisher. From Matteson E, Mason T: Atlas of Rheumatology. Edited by G Hunder. Philadelphia,Current Medicine, 2005. This photo shows bumps (rheumatoid nodules) on the sole of the foot in a person who has rheumatoid arthritis. DR P. MARAZZI/SCIENCE PHOTO LIBRARY This photo shows a hard bump under the skin (rheumatoid nodule) over the joint in the hand of a person who has rheumatoid arthritis. DR P. MARAZZI/SCIENCE PHOTO LIBRARY 