Rheumatoid arthritis (RA) is one of the most common and serious inflammatory forms of arthritis – affecting approximately 1 percent of the total population. It is an aggressive autoimmune type of arthritis that can dramatically reduce life span if left untreated.
Juvenile rheumatoid arthritis (JRA) is the most common form of childhood arthritis.
RA is a systemic disease that affects the synovial tissue, which lines the joints. The body’s own immune system mistakenly attacks the synovium – which over time can destroy the joint tissues, including cartilage, ligaments, tendons and bone. In the upper body, RA can occur in joints in the fingers, wrist, elbow and shoulder.
RA changes the normal structure and function of cartilage and may increase a patient’s risk of developing osteoarthritis. RA can be a chronic condition, or produce periods of active symptoms (flare ups) and periods of no symptoms (remission).
In RA of the fingers, deformity becomes evident as the disease progresses. The MCP joints of the fingers may begin to point sideways towards the little finger. This is known as the ulnar drift. This drift can cause weakness and pain, making daily activities difficult.
The exact causes for RA, as with other forms of arthritis, are unknown. Though genetics are thought to play a large role. Environmental factors are also thought to play a role in who is diagnosed. Research indicates that RA can be triggered by an infection, possibly a virus or bacterium, in those hereditarily predisposed to the disease.
Signs of RA include joint swelling, limited range of motion, tenderness, pain during motion, and joint “warmth.” If experiencing these symptoms for more than two weeks, a medical consult is advised.
As RA progresses in some patients, small lumps of tissue under the skin may develop. These are called rheumatoid nodules and may form under the skin of the elbow or hands.
Diagnosis
Following an assessment of a patient’s history and a physical examination, a number of tests can be performed to assist in the diagnosis of RA. Blood tests can identify agents indicative of RA. And the appropriate radiographic testing over a period of time can reveal joint damage and progression of the disease.
Treatment
Treatment is determined based on the affect RA has had on a patient’s joints at the time of diagnosis, as well as the type of joint affected. It may involve conservative treatment – including anti-inflammatory medications such as aspirin or ibuprofen, refrain from inflammatory activity, cortisone injections, rehabilitation and occupational therapy (particularly when affecting hands and fingers), as well as special bracing of hands and fingers to help support them – reducing pain and preventing deformity.
In more advanced cases, joint fusion, or arthrodesis, may be indicated in order to eliminate pain by allowing the bones to grow, or fuse, together. While this reduces range of motion, it is successful in eliminating pain and preventing deformity.
Joint replacement, or arthroplasty, is also an option depending on the health of the patient and advanced stage of the disease.
The earlier the diagnosis, the greater the chance of preventing irreversible damage.