Rheumatoid Arthritis

by Allan O. Fiesta, PT, DPT, OCS 

What is Rheumatoid Arthritis or RA?

Rheumatoid Arthritis (RA or Rheumatism) is an autoimmune disorder found in about 1 of 100 Americans. Auto-immune disease is a term used to describe a disease where one’s immune or defense system attacks its own cells causing a cascade of inflammatory process in the body. 

Tissues that are most susceptible in RA is the synovium, a connective tissue that lines the inside of the joint capsule. RA is more common in women than men and can go thru many cycles of flaring up and calming down into remission.  Often, RA can cause arthritic hands like in the picture below. 

Rheumatoid Arthritis can cause arthritic handsHands with advanced Rheumatoid Arthritis

What Causes RA or Rheumatoid Arthritis?

The truth is we do not really know.  There is most likely a genetic link but why the immune system turns on and starts the inflammatory cascade is still not really known.  When someone has RA the immune system will start to react to the body’s normal tissue.  

The immune system is what makes antibodies that attack any foreign bodies such as bacteria and viruses that enter your body.  With RA the immune system attacks the body’s own tissue, most commonly, the lining of the joints (synovium), though in severe cases can progress to attack the lining of the heart, lungs and blood vessels. While we do not know what causes RA there have been evidence to suggest that a variety of agents may initiate arthritis such as viral and bacterial infections which include streptococcus, clostridia, diphtheroids and mycoplasmas but no connections have been definitively proven. 

What are the Difference Between Osteoarthritis (OA) and Rheumatoid Arthritis (RA)?

Rheumatoid Arthritis (RA) is classified as an autoimmune disease where the body attacks the lining of joints and at times other tissues of the entire body.  Osteoarthritis or OA (common arthritis) on the other hand is the mechanical wearing out of the cartilage cushion that lines a joint.  RA is a systemic reaction that usually presents in multiple joints and will often be accompanied by other symptoms associated with autoimmune disorders such as fever, fatigue, and body aches while OA will usually present as a single joint pain that is related to weight bearing or activity.  

Rheumatoid Arthritis in the Knee

One of the more common places for RA to first be noticed is in the hands. While OA usually involves the hip, knee and shoulder.  RA usually attacks the large knuckles at the base of the finger (metacarpal phalangeal joint). In RA the fingers will usually wear out on the thumb side of the joint and the fingers drift to the pinky side. OA is usually at the end joint of the finger (distal inter-phalanx joint) or at the base of the thumb can show deformity in a variety of directions.  

Osteoarthritis is different from Rheumatoid Arthritis.

What are the 4 stages of RA or Rheumatoid Arthritis?

  1. Stage 1: Early - Here is where the body starts to attack its own joint tissue but is often only noticed as some early morning stiffness that often resolves with movement.  There may or may not be a positive antibody test at this site.  Most of the time RA goes undiagnosed at this stage
  2. Stage 2: Moderate - Here the inflammation of the joints starts to be detected with testing.  MRI, US and X-rays will start to show subtle changes at some joints and blood tests will now usually show RA
  3. Stage 3: Severe – At this stage there are evidence of cartilage and bone destruction as seen on x-rays, joint deformity, extensive wasting of muscles and swelling can be seen
  4. Stage 4: Terminal – This is the end-stage of RA and is characterized by hardening of the joint and loss of motion and function

What Tissues Does Rheumatoid Arthritis Attack?

Anatomical image of a joint with rheumatoid arthritis with labels on the cells and types of cells involved

In simple terms, RA affects the joints of the body. Specifically, RA targets the synovium, which is the lining of the membranes that surrounds the joint capsule. This membrane is a layer of tissue that covers the joints. This synovium becomes hard from the inflammation process of RA.  This change actually results in the destruction of the cartilage and bone at the joint.

What Parts of the Body Does RA Affect?

In most cases, rheumatoid arthritis affects the joints of the body. Also, RA usually occurs on both sides of the body at once. When RA first starts it usually occurs in the small joints first such as in the fingers and toes.  A physician should determine if you have RA or OA of the joint. Unfortunately, as RA progresses it moves on to the larger joints of the body such as the hip, knee and shoulder. Although patients may present with complaints of pain in the groin, often owing to trochanteric bursitis, the hip is less commonly involved in RA than in other kinds of arthritis. Changes in the hip joint seen on x-rays are evident in about half of all patients with RA.

If you would like to learn more about the larger joints that RA or Rheumatoid Arthritis can affect, watch these VIDEOS on:

How Serious is RA or Rheumatoid Arthritis?

As we have already described, RA is an autoimmune disease which affects the joints of the body. Since this is a “systemic” disease and is considered part of a broader group of rheumatic conditions, it could also involve parts of the body other than the joints such as the skin, eyes, lungs, heart, blood vessels, nerves, kidneys, salivary glands and bone marrow. Thus, it is important not to ignore the tell tale signs of RA and seeking professional medical advice is very important.

What are the Signs and Symptoms of RA?

  • Morning stiffness or chronic pain lasting at least one hour before maximal improvement
  • Arthritis of three or more joint areas
  • Swelling or redness in your joints
  • Arthritis of hand joints
  • Simultaneous involvement of the same joint areas on both sides of the body
  • Nodules under the skin over bony prominences observed by a physician
  • Blood test result showing abnormal amounts of serum rheumatoid factor (Rh factor)
  • X-ray changes typical of RA on hands and wrists
  • Medical management

How is RA treated?

The quick answer is that currently there is no known cure for RA. Joint destruction and irreversible damage are most pronounced in the first years after a diagnosis of RA is made. 

Medical management includes an aggressive approach to stop or delay the disease process as well as to control pain and inflammation. These medications include non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs) and corticosteroids.

Surgical Management represents one of the greatest advances in the management of arthritis in the last  40 years. However, surgery is not appropriate for every individual with RA, and the careful selection of the patient and the timing of the procedure are critical. The primary indication for surgery are pain, loss of function and progression of deformity. Surgical procedures typically performed in the management of RA include synovectomy, osteotomy, arthroplasty and arthrodesis. 

Rehabilitative management or Physical therapy intervention for the management of RA has a lot of benefit and improves the patient’s quality of life. The goals of physical therapy in the management of RA include 

  • decreasing pain
  • increasing or maintaining range of motion of all joints
  • muscle strength
  • joint stability 
  • endurance for all functional activities
  • promote independence in activities of daily living 
  • improve safety and efficiency of gait pattern. 

In a nutshell, regular exercise can cut down on RA pain, strengthen bones as many patients with RA take steroid medication which may weaken bones, and strengthen muscles which help support the joints. Exercises that are low impact and high repetition promote less stress on joints. Designing these types of programs is best left to a physical or occupational therapist. To schedule for therapy at JOI Rehab, please call 904-858-7045.

Related Links:

The Jacksonville Orthopedic Institute offers advanced rehabilitation options to treat Rheumatoid Arthritis with splinting, functional exercise training and adaptive equipment to help you live your best life!  Our Occupational Therapists & Physical Therapists have the tools to get you moving!  Give us a call at 904-858-7045. To schedule an appointment with a JOI Orthopedic Doctor, call 904-JOI-2000, schedule online, or click the link below.


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