How Rheumatoid Arthritis Affects Each Part of the Body

Hands and Wrists

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 inside the joint
• 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 (see below)

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.

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 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.

Deformities can make it difficult not only to walk but to wear shoes.

Shoulder Joint

The ball-and-socket joint 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.

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.

Hip Joint

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.

Knee Joint

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.

Joint Subluxation and Dislocation

Joint erosions, which are visible on X-ray, are associated with limited joint 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 unstable. Joint instability can lead to subluxation or, less often, dislocation.

While many joints can become deformed or subluxed due to RA, toes are among the more common ones. The associated pain, damage, and functional limitations often lead to a loss of mobility.

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.

Rheumatoid Arthritis Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

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Systemic Disease

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)
• Jaw

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.