How Rheumatoid Arthritis Affects Each Part of the Body

Rheumatoid arthritis is a chronic, inflammatory, autoimmune disease that affects the joints in ways that can be both felt and, in some cases, seen. The disease also may have systemic effects, affecting other organs of the body.

This is due to inflammation of the synovial lining (membrane lining the joints). This can cause the disease's characteristic swelling, pain, limited range of motion, and decreased function, but also joint damage and deformity as the synovium begins to thicken and inflamed cells release enzymes that digest bone and cartilage.

RA typically has a symmetrical pattern of joint damage. For example, both of your knees are usually affected rather than just one. Signs and symptoms can differ slightly depending on the part of the body that's affected.

Hands and Wrists

X-ray showing rheumatoid arthritis in hands (Colour Enhanced)
RNHRD NHS Trust / Getty Images

Rheumatoid arthritis most commonly begins in the small joints of the fingers, hands, and wrists. It can damage joints and cause several kinds of hand deformity, such as:

  • Rheumatoid nodules: Firm lumps under the skin near joints
  • Joint effusion: Abnormal accumulation of fluid in the soft tissues around joints
  • Joint stiffness: Difficulty moving or impaired range of motion
  • Ulnar drift/ulnar deviation: A characteristic deformity in which the fingers appear to lean toward the little finger
  • Contractures: Shortening or hardening of muscles and connective tissues, leading to deformity and rigid joints
  • Wrist subluxation: Partial dislocation

Elbows

Studies say the elbows are involved in between 20% and 65% of rheumatoid arthritis cases. Elbow symptoms you may experience include:

  • Pain
  • Swelling
  • Joint instability

If drug treatments and other approaches are unsuccessful at managing elbow symptoms, surgical procedures may be considered.

The first surgery is typically arthroscopic synovectomy, in which much of the synovium is removed. If that's unsuccessful, elbow-replacement surgery may be considered.

Shoulder Joint

The ball-and-socket of the shoulder may be an early joint for RA to hit. Research suggests that shoulder impairment may be significant in the first 18 months of disease activity.

Symptoms specific to RA in the shoulder include:

  • Lowered shoulder muscle strength
  • Impaired shoulder and arm movement
  • Shoulder pain

These symptoms can have a big impact on your activity level and ability to perform daily activities.

Hip Joint

Hip joint pain
MedicalRF.com / Getty Images

RA can impact any joint and the more aggressive it is, the more joints it affects. When it strikes your weight-bearing joints—the hips, knees, and ankles—it can have a huge impact on your mobility.

Symptoms specific to RA in the hips include:

  • Aching pain in the groin, buttocks, outer thigh, or knee
  • Pain in the hip joint that's severe enough to make walking difficult
  • Pain that's worse after sitting or sleeping but improves with activity

Hip replacement surgery can reduce pain, restore function, and correct joint damage and deformity in people with RA.

Joint replacements exist for other joints too, such as the shoulder, wrist, and ankle, but the most common ones are for hips and knees. About 435,000 Americans have a hip or knee replaced each year.

Knee Joint

Arthritic knees
MEDICAL PHOTO NHS LOTHIAN/SCIENCE PHOTO LIBRARY / Getty Images

The knee joint is the largest and strongest one in the body. It's formed by the femur (thighbone), tibia (shinbone), and patella (kneecap) coming together. In a healthy knee, these are cushioned by wedge-shaped pieces of cartilage (called the menisci).

When this area is damaged by RA, the pain, swelling, and stiffness may be severe, especially after you've been inactive for several hours. Other symptoms may include:

  • Difficulty bending and/or straightening the knee
  • The knee "locking" while you walk
  • A grinding, snapping, or creaking noise when you walk
  • Weakness or buckling

Joint damage and deformity can be repaired by knee replacement surgery, which can also reduce pain and restore function.

Ankles and Feet

An estimated 90% of people with RA will have symptoms in their feet and ankles at some point, and these are among the smaller joints that may be impacted early in the disease progression. Pain and functional limitations in the feet and ankles can lead to a severe loss of mobility, and deformities can make it difficult not only to walk but to even wear shoes.

The specific problems attributed to foot and ankle RA depends on the joints involved:

  • Ankle: An early symptom of ankle involvement is pain while walking up or down ramps, slopes, or stairs.
  • Hindfoot (heel area): The first symptom of RA in the hindfoot is difficulty walking on irregular surfaces, such as rough terrain or gravel. Pain is most common on the outside of the foot. Later on, bone movement can lead to a deformity called flatfoot that includes pain in the arch, inside of the ankle, or outside of the ankle.
  • Midfoot (top of foot): Ligaments that support your arch can be weakened by RA, which can lead the arch to collapse. This often causes the toes to point outward and may also lead to a large bump in the arch.
  • Forefoot (ball of foot, toes): Complications of RA in the toes and ball of your foot include bunions (painful swelling at the base of the big toe) and permanently curved toes, which are called hammertoes or claw toes. While many joints can dislocate due to RA, toes are among the more common to dislocate. Damage to the toes and feet from repeated dislocations can be severely debilitating.

Joint Dislocation

Joint erosion, which is visible on X-ray, can be severe and limiting to your mobility and function. As the joint becomes eroded and cartilage is damaged, bone-on-bone contact can be the painful end result.

Severe damage to cartilage, tendons, ligaments, and bone can cause joints to become not only deformed but unstable as the disease progresses. Joint instability can lead to subluxation or, less often, dislocation.

People who've had RA for more than a decade are at risk of developing a condition called cervical myelopathy, in which joints of the spine can dislocate and put pressure on the brain stem, spinal cord, and spinal nerve roots. This is an uncommon but serious problem that needs to be corrected with surgery to avoid permanent damage.

Systemic Disease

Senior African American man rubbing his shoulder
Terry Vine / Getty Images

Rheumatoid arthritis doesn't only affect the joints. It's a disease of systemic inflammation that may also affect other parts of you body including:

  • Skin
  • Lungs
  • Heart
  • Nerves
  • Kidneys (rarely)

Rheumatoid lung disease is most common in men who are positive for rheumatoid factor, have subcutaneous nodules, and a long disease course.

People with RA also have a higher risk of coronary heart disease than those in the general population.

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Article Sources
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Additional Reading
  • Penn State Hershey: Milton S. Hershey Medical Center. Rheumatoid arthritis. Updated April 23, 2018.