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Rheumatoid arthritis is an autoimmune disease that is characterized by chronic inflammation of the joints. It eventually affects the fingers first since they are smaller joints but can eventually spread to larger joints such as knees or hips. This disease is very painful for patients because it can cause deformities in their joints, such as their fingers. Ulnar drift is a hallmark sign of RA and that is when the fingers position and point away from the thumb.

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This is a quick video explaining how the immune system is involved in rheumatoid arthritis.

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This link is a series on patient education videos by John Hopkins.

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This series of five videos was designed to help you learn more about Rheumatoid Arthritis (RA). You will learn how the diagnosis of RA is made, what happens to your joints, what treatments are available, what is happening in the immune system and what other conditions are associated with RA.

Learning more about your condition will allow you to take a more active role in your care. The information in these videos should not take the place of any advice you receive from your rheumatologist.

Rheumatoid Arthritis: Disease Overview

Rheumatoid Arthritis: Signs & Symptoms

Rheumatoid Arthritis: Gaining Control - Diagnosis

Rheumatoid Arthritis: Treatment

Rheumatoid Arthritis: Lifestyle Options

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Rheumatoid Arthritis Patient Eduction Video Series | Johns Hopkins

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This series of five videos was designed to help you learn more about Rheumatoid Arthritis (RA). You will learn how the diagnosis of RA is made, what happens to your joints, what treatments are available, what is happening in the immune system and what other conditions are associated with RA.

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Sex: development is more likely in women than men

Age: occurs at any age, but more likely to begin in middle age

Family history: may increase risk

Smoking: can increase risk of development and develop greater severity

Excessive weight

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Rheumatoid arthritis - Symptoms and causes

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This chronic inflammatory disorder can affect more than just your joints. It can also damage your skin, eyes, lungs, heart and blood vessels.

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New England Journal on Rheumatoid Arthritis 

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New England Journal on Rheumatoid Arthritis 

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Rheumatoid Arthritis does conform to the definition of hypersensitivity because there is an immunologic response to an antigen. That response results in a disease or damage to the host. Type III hypersensitivity is caused by an antigen-antibody or immune complex formed in circulation that is later deposited into vessel walls or tissues. This relates to rheumatoid arthritis (RA) as these responses can aggregate in the joints, which as we know is the main place of RA. The immune complex can change during the progression of a disease, like RA it can go from joint inflammation to inflaming tissues of the heart, lungs, etc. Therefore, progressing the disease and making it much worse.

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Rheumatoid arthritis - causes, symptoms, diagnosis, treatment, pathology

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Müller-Ladner, U., Pap, T., Gay, R. et al. Mechanisms of Disease: the molecular and cellular basis of joint destruction in rheumatoid arthritis. Nat Rev Rheumatol 1, 102–110 (2005). https://doi.org/10.1038/ncprheum0047

This image is a broad overview of how rheumatoid arthritis acts on the cellular level.

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This image compares a "normal" hand to one with rheumatoid arthritis. In this image bone displacement and bone erosion can be seen, which indicates later stages.

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Medications:
NSAIDs: relieve pain and reduce inflammation
Steroids: reduce inflammation and slow joint damage
Disease-modifying antirheumatic drugs: slow progression of rheumatoid arthritis and save joints/tissues from permanent damage

Physical/occupational therapy:
Help keep your joints flexible
Develop new ways to do daily activities to make it easier on joints
Assistive devices can be used to reduce stress on joints

Surgery: last resort
removal of inflamed joint
tendon repair from joint damage
joint fusion to stabilize joint for pain relief
joint replacement

Lifestyle modifications:
Physical activity
Maintain range of motion in joints
Stop smoking
Maintain healthy weight to reduce stress on  inflamed joints
Changes in diet can reduce inflammation

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Rheumatoid Arthritis (RA): Causes, Symptoms & Treatment FAQs

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Rheumatoid arthritis is a type of arthritis where your immune system attacks the tissue lining your joints. It affects the joints on both sides of your body.

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This article goes in depth on the causes of rheumatoid arthritis including genetic and environmental factors.

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Tobias C. Messemaker, Tom W. Huizinga and Fina Kurreeman

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This article from UpToDate gives great information for the patient to educate themselves on rheumatoid arthritis

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Patient education: Rheumatoid arthritis treatment (Beyond the Basics) - UpToDate

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Rheumatoid arthritis (RA) is a chronic inflammatory condition. It can affect many different parts of the body but most commonly affects the joints, causing pain

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Rheumatoid arthritis (RA) causes joint inflammation and pain. It happens when the immune system doesn't work properly and attacks the lining of the joints, called the synovium. The disease commonly affects the hands, knees or ankles, and usually the same joint on both sides of the body, such as both hands or both knees. But sometimes RA causes problems in other parts of the body as well, such as the eyes, heart and circulatory system and/or the lungs.

For unknown reasons, more women than men get RA, and it usually develops in middle age. Having a family member with RA increases the odds of developing RA.

Causes

In a healthy person, the immune system fights invaders, such as bacteria and viruses. With an autoimmune disease like RA, the immune system mistakes the body's cells for foreign invaders and releases inflammatory chemicals that attack those cells. Tn RA, it attacks the synovium, the tissue lining around a joint that produces a fluid to help the joint move smoothly. The inflamed synovium gets thicker and makes the joint area feel painful and tender and look red and swollen, and moving the joint may be difficult.

Researchers aren't sure why people develop RA. They believe these individuals may have certain genes that are activated by a trigger in the environment, such as a virus or bacteria, physical or emotional stress or some other external factor.

Symptoms

In the early stages, people with RA may not see redness or swelling in the joints, but they may experience tenderness and pain.
These symptoms are clues to RA:

Joint pain, tenderness, swelling or stiffness that lasts for six weeks or longer.

Morning stiffness that lasts for 30 minutes or longer.

More than one joint is affected.

Small joints (wrists, certain joints in the hands and feet) are typically affected first.

The same joints on both sides of the body are affected.

Many people with RA get very tired (fatigue) and some may have a low-grade fever. RA symptoms may come and go. Having a lot of inflammation and other symptoms is called a flare. A flare can last for days or months.

Health Effects

Eyes. Dryness, pain, inflammation, redness, sensitivity to light and trouble seeing properly.

Mouth. Dryness and gum inflammation, irritation or infection.

Skin. Rheumatoid nodules - small lumps under the skin over bony areas.

Lungs. Inflammation and scarring that can lead to shortness of breath and lung disease.

Blood vessels. Inflammation of blood vessels that can lead to damage in the nerves, skin and other organs.

Blood. A lower than normal number of red blood cells.

Heart. Inflammation can damage the heart muscle and the surrounding areas.

Painful joints also make it hard to exercise, leading to weight gain. Being overweight may make people with RA more likely to develop high cholesterol, diabetes, heart disease and high blood pressure.

Diagnosis

Getting an accurate diagnosis as soon as possible is the first step to treating RA effectively. A doctor with specialized training in treating arthritis (called a rheumatologist) is the best person to make a correct diagnosis, using medical history, a physical examination and lab tests.

Medical history. The doctor will ask about joint symptoms (pain, tenderness, stiffness, difficulty moving), when they started, if they come and go, how severe they are, what actions make them better or worse and whether family members have RA or another autoimmune disease.
Physical examination. The doctor will look for joint tenderness, swelling, warmth and painful or limited movement, bumps under the skin or a low-grade fever.
Blood tests. The blood tests look for inflammation and blood proteins (antibodies) that are linked to RA:

Erythrocyte sedimentation rate (ESR, or "sed rate") and C-reactive protein (CRP) levels are markers for inflammation. A high ESR or CRP combined with other clues to RA helps make the diagnosis.

Rheumatoid factor (RF) is an antibody found (eventually) in about 80 percent of people with RA. Antibodies to cyclic citrullinated peptide (CCP) are found in 60 to 70 percent of people with RA. However, they are also found in people without RA.

Imaging tests. RA can cause the ends of the bones within a joint to wear down (erosions). An X-ray, ultrasound, or MRI (magnetic resonance imaging) scan can look for erosions. But if they don't show up on the first tests that could mean RA is in an early stage and hasn't damaged bone yet. Imaging results can also show how well treatment is working.

Treatment

The goals of RA treatment are to:

Stop inflammation or reduce it to the lowest possible level (put disease in remission).

Relieve symptoms.

Prevent joint and organ damage.

Improve function and overall well-being.

Reduce long-term complications.

To meet these goals, the doctor will follow these strategies:

Early, aggressive treatment to reduce or stop inflammation as quickly as possible.

Targeting remission or another goal (called "treat-to-target") to work toward few or no signs or symptoms of active inflammation.

Tight control to keep inflammation at the lowest level possible.

Search arthritis.org to learn about medications your doctor prescribes for your rheumatoid arthritis.

Self-Care

Working with your doctor to ensure you get appropriate medical treatment is essential, but you can also take measures on your own to manage your RA and ease pain and fatigue. Diet, exercise, smoking cessation and mental health are all key to good health overall and controlling RA. Get help setting health goals and managing pain with the our pain resources.

Healthy Eating. A balanced, nutritious diet consisting of the recommended amounts of all the food groups helps promote wellness and makes it easier to maintain a healthy weight.

Daily movement. Even when you don't have time to exercise, try to make movement part of your everyday routine. Use the stairs instead of taking the elevator. Park in a spot that makes you walk a bit to enter a building. Take the longer way to a meeting in your office.

Balancing activity with rest. It's important to try to stay physically active even during a flare, but rest is also especially important when RA is active and joints feel painful, swollen or stiff. Rest helps reduce inflammation and fatigue that can come with a flare. Taking breaks throughout the day protects joints and preserves energy.

Hot and cold treatments. Heat treatments, such as heat pads or warm baths, tend to work best for soothing stiff joints and tired muscles. Cold is best for acute pain and swollen joints. It can numb painful areas and reduce inflammation.

Topical products. These creams, gels or stick-on patches can ease the pain in a joint or muscle. Some contain the medicine that you can get in a pill, and others use ingredients that irritate your nerves to distract from pain.

Stress Reduction and Complementary Therapies. There are different ways to relax and stop focusing on pain. They include meditation, deep breathing, and thinking about images in your mind that make you feel happy. Massage can help reduce pain, relax sore muscles and ease stress or anxiety. Acupuncture involves inserting fine needles into the body along special points to relieve pain. If you don't like needles, acupressure uses firm pressure instead.

Supplements. Studies show that curcumin/turmeric and omega-3 fish oil supplements may help with rheumatoid arthritis pain and morning stiffness. However, talk with a doctor before taking any supplement to discuss side effects and how it may affect other medicines you are taking.

Positive Attitude and Support System. Cultivate a network of friends, family members and co-workers who can help provide emotional support. Take time to do things that you enjoy to lift your mood, which can help relieve pain.

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Rheumatoid Arthritis: Symptoms, Diagnosis, and Treatment | Arthritis Foundation

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Rheumatoid arthritis is an inflammatory, autoimmune condition that can affect the joints and organs. Read important information about rheumatoid arthritis.

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The synovial membrane is destroyed and this lines the joint cavity. Cytokines and inflammatory enzymes (interleukins, B cells, collagenase) contribute to an immune response that results in leukocyte infiltration in the synovium. Infiltration develops into synovitis, and the synovium of the joint becomes inflamed which can result in joint damage. This inflammation then can spread to articular cartilage, fibrous joint capsules that surround ligaments and tendons. When this occurs it causes pain, deformity, and loss of function. Tissues of the heart, lungs, kidneys, and skin can be affected by this inflammation.

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Events for Rheumatoid Arthritis are mediated by inflammatory cytokines and antibodies against self-antigens. These inflammatory cytokines are mainly CD4+ T cells that promote inflammation. Tissue injury is promoted by T cells that produce cytokines, which produce other inflammatory responses. In inflammation arginine, an amino acid can be modified into another amino acid; citrulline. When this modification occurs the structure and function of the protein are changed and these proteins may act as antigens. Rheumatoid factors (altered antibodies in RA) consist of IgM and IgG antibodies; occasionally IgA. RFs bind with self antigens and synovial membrane to form an immune complex.

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People with RA can present with the symptoms:

pain/aching in more than one joint

soreness/stiffness in more than one joint

weight loss

fatigue

fever

weakness

It's important to note that the symptoms happen on both sides of the body and not just one.

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Stages of RA picture:
Donvito, T. (2018, November 14). The 4 stages of rheumatoid arthritis progression. CreakyJoints. https://creakyjoints.org/about-arthritis/rheumatoid-arthritis/ra-overview/rheumatoid-arthritis-stages-progression/

Centers for Disease Control and Prevention. (2020, July 27). Rheumatoid arthritis (RA). Centers for Disease Control and Prevention. Retrieved October 11, 2022, from https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html

Mayo Foundation for Medical Education and Research. (2021, May 18). Rheumatoid arthritis. Mayo Clinic. Retrieved October 11, 2022, from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648

Rheumatoid arthritis: Signs & treatment: The hand society. Signs & Treatment | The Hand Society. (n.d.). Retrieved October 11, 2022, from https://www.assh.org/handcare/condition/rheumatoid-arthritis

U.S. National Library of Medicine. (n.d.). Rheumatoid arthritis: Medlineplus medical encyclopedia. MedlinePlus. Retrieved October 11, 2022, from https://medlineplus.gov/ency/article/000431.htm

Textbook:
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby.