Rheumatoid arthritis joints affected

by Victoria Ruffing, R.N., C.C.R.P. and Clifton O. Bingham III, M.D.

  • Epidemiology
  • Clinical History
  • Physical Examination
  • Extra-Articular Disease
  • Laboratory Tests
  • Radiographic Findings
  • Clinical Course

Epidemiology

Rheumatoid arthritis has a worldwide distribution with an estimated prevalence of 1 to 2%. Prevalence increases with age, approaching 5% in women over age 55. The average annual incidence in the United States is about 70 per 100,000 annually. Both incidence and prevalence of rheumatoid arthritis are two to three times greater in women than in men. Although rheumatoid arthritis may present at any age, patients most commonly are first affected in the third to sixth decades.

Clinical History

The typical case of rheumatoid arthritis begins insidiously, with the slow development of signs and symptoms over weeks to months. Often the patient first notices stiffness in one or more joints, usually accompanied by pain on movement and by tenderness in the joint. The number of joints involved is highly variable, but almost always the process is eventually polyarticular, involving five or more joints. Occasionally, patients experience an explosive polyarticular onset occurring over 24 to 48 hours. Another pattern is a palindromic presentation, in which patients describe swelling in one or two joints that may last a few days to weeks then completely go away, later to return in the same or other joints, with a pattern increasing over time.

The joints involved most frequently are the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands, the wrists, and small joints of the feet including the metatarsophalangeal (MTP) joints. The shoulders, elbows, knees, and ankles are also affected in many patients. The distal interphalangeal (DIP) joints are generally spared. With the exception of the cervical spine, the spine is unaffected.

Nonspecific systemic symptoms primarily fatigue, malaise, and depression, may commonly precede other symptoms of the disease by weeks to months and be indicators of ongoing disease activity. Fatigue can be an especially troubling feature of the disease for many patients. The pattern of symptoms may wax and wane over the course of a day and even from one day to the next. Sometimes “flares” of RA are experienced as an increase in these systemic symptoms more than discrete joint swelling or tenderness. Fever occasionally occurs and is almost always low grade (37° to 38°C; 99° to 100°F). A higher fever suggests another illness, and infectious causes must be considered, especially in patients who are taking biological therapies and immunosuppressive medications.

Morning stiffness, persisting more than one hour but often lasting several hours, may be a feature of any inflammatory arthritis but is especially characteristic of rheumatoid arthritis. Its duration is a useful gauge of the inflammatory activity of the disease. Similar stiffness can occur after long periods of sitting or inactivity (gel phenomenon). In contrast, patients with degenerative arthritis complain of stiffness lasting but a few minutes.

Physical Examination

Symmetrical joint swelling is characteristic of rheumatoid arthritis that has been persistent for a period of time. However when only a few joints are affected at the beginning of disease, symmetry may not be seen and should not preclude the diagnosis of RA. Careful palpation of the joints can help to distinguish the swelling of joint inflammation from the bony enlargement seen in osteoarthritis, with the swelling often described as being doughy or spongy in RA in contrast to firm knobby enlargement in osteoarthritis. Swelling of the PIP and MCP joints of the hands is a common early finding (Pictured below). Wrists, elbows, knees, ankles and MTP are other joints commonly affected where swelling is easily detected. Pain on passive motion is a sensitive test for joint inflammation as is squeezing across the MCPs and MTPs. Occasionally inflamed joints will feel warm to the touch. Inflammation, structural deformity, or both may limit the range of motion of the joint. Over time, some patients with RA develop deformities in the hands or feet. RA spares the distal joints of the fingers (DIPs) and the spine with the exception of the cervical spine (especially the atlanto-axial joint at C1-C2), which may become involved especially with longer standing disease.

Reprinted from the Clinical Slide Collection on the Rheumatic Diseases, copyright 1991, 1995, 1997. Used by permission of the American College of Rheumatology.

Permanent deformity is an unwanted result of the inflammatory process. Persistent tenosynovitis and synovitis leads to the formation of synovial cysts and to displaced or ruptured tendons. Extensor tendon rupture at the dorsum of the hand is a common and disabling problem.

Reprinted from the Clinical Slide Collection on the Rheumatic Diseases, copyright 1991, 1995, 1997. Used by permission of the American College of Rheumatology.

Advanced changes in RA (shown below) include ulnar deviation of the fingers at the MCP joints, hyperextension or hyperflexion of the MCP and PIP joints, flexion contractures of the elbows, and subluxation of the carpal bones and toes (cocked -up).

Reprinted from the Clinical Slide Collection on the Rheumatic Diseases, copyright 1991, 1995, 1997. Used by permission of the American College of Rheumatology.

Extra-Articular Disease

Although the joints are almost always the principal focus of RA, other organ systems may also be involved. Extra-articular manifestations of RA occur most often in seropositive patients with more severe joint disease. Extra-articular manifestations can develop even in disease when there is little active joint involvement.

Rheumatoid Nodules. The subcutaneous nodule is the most characteristic extra-articular lesion of the disease. Nodules occur in 20 to 30% of cases, almost exclusively in seropositive patients. They are located most commonly on the extensor surfaces of the arms and elbows (shown below)but are also prone to develop at pressure points on the feet and knees. Rarely, nodules may arise in visceral organs, such as the lungs, the heart, or the sclera of the eye. (learn more about rheumatoid nodules in case report #6)

Reprinted from the Clinical Slide Collection on the Rheumatic Diseases, copyright 1991, 1995, 1997. Used by permission of the American College of Rheumatology.

Cardiopulmonary Disease. There are several pulmonary manifestations of rheumatoid arthritis, including pleurisy with or without effusion, intrapulmonary nodules, and diffuse interstitial fibrosis. On pulmonary function testing, there commonly is a restrictive ventilatory defect with reduced lung volumes and a decreased diffusing capacity for carbon monoxide. Although mostly asymptomatic, of greatest concern is distinguishing these manifestations from infection and tumor. (learn more about pulmonary complications in rheumatoid arthritis in case report #6)

Atherosclerosis is the most common cardiovascular manifestation in rheumatoid arthritis. It is also the leading cause of death in the RA patient. Because chronic inflammation may be the cause of atherosclerosis, it is possible that early aggressive treatment of RA may reduce the incidence or severity of heart disease. Pericarditis also seen with RA.

Eye Disease. Keratoconjunctivitis of Sjogren’s syndrome is the most common ocular manifestation of rheumatoid arthritis. Sicca (dry eyes) is a common complaint. Episcleritis occurs occasionally and is manifested by mild pain and intense redness of the affected eye. Scleritis and corneal ulcerations are rare but more serious problems.

Sjogren’s Syndrome. Approximately 10 to 15% of patients with rheumatoid arthritis develop Sjogren’s syndrome, a chronic inflammatory disorder characterized by lymphocytic infiltration of lacrimal and salivary glands. Sjogren’s syndrome is an autoimmune condition that affects exocrine gland function, leading to a reduction in tear production (keratoconjunctivitis sicca), oral dryness (xerostomia) with decreased saliva of poor quality, and reduced vaginal secretions. It is important for patients to be seen regularly by the ophthalmologist and dentist. Additional medications are sometimes required to treat this condition. A polyclonal lymphoproliferative reaction characterized by lymphadenopathy is also seen, and patients have an increased risk of developing lymphoma. Additional information on Sjogren’s syndrome can be found at our Sjogren’s Center website.

Rheumatoid Vasculitis. The most common clinical manifestations of vasculitis are small digital infarcts along the nailbeds. (see picture below) The abrupt onset of an ischemic mononeuropathy (mononeuritis multiplex) or progressive scleritis is typical of rheumatoid vasculitis. The syndrome ordinarily emerges after years of seropositive, persistently active rheumatoid arthritis; however, vasculitis may occur when joints are inactive. Addional information on vasculitis can be found on our Vasculitis Center website.

Reprinted from the Clinical Slide Collection on the Rheumatic Diseases, copyright 1991, 1995, 1997. Used by permission of the American College of Rheumatology.

Neurologic Disease.

The most common neurologic manifestation of rheumatoid arthritis is a mild, primarily sensory peripheral neuropathy, usually more marked in the lower extremities. Entrapment neuropathies (e.g., carpal tunnel syndrome and tarsal tunnel syndrome) sometimes occur in patients with rheumatoid arthritis because of compression of a peripheral nerve by inflamed edematous tissue. Cervical myelopathy secondary to atlantoaxial subluxation is an uncommon but particularly worrisome complication potentially causing permanent, even fatal neurologic damage.

Felty’s Syndrome

Felty’s syndrome is less commonly encountered than in the past. This is characterized by splenomegaly, and leukopenia – predominantly granulocytopenia. Recurrent bacterial infections and chronic refractory leg ulcers are the major complications.

Clinical Course

The course of rheumatoid arthritis cannot be predicted in a given patient. Several patterns of activity have been described:

  • a spontaneous remission particularly in the seronegative patient within the first 6 months of symptoms (less than 10%)
  • recurrent explosive attacks followed by periods of quiescence most commonly in the early phases
  • the usual pattern of persistent and progressive disease activity that waxes and wanes in intensity.

Disability is higher among patients with rheumatoid arthritis with 60% being unable to work 10 years after the onset of their disease. Recent studies have demonstrated an increased mortality in rheumatoid patients. Median life expectancy was shortened an average of 7 years for men and 3 years for women compared to control populations. In more than 5000 patients with rheumatoid arthritis from four centers, the mortality rate was two times greater than in the control population. Patients at higher risk for shortened survival are those with systemic extra-articular involvement, low functional capacity, low socioeconomic status, low education, and prednisone use. With the advent of therapies to better control inflammation and treatment strategies geared to low disease activity and remission, it is hoped that the statistics concerning disability and mortality will improve.

Laboratory Tests

No laboratory test will definitively confirm a diagnosis of rheumatoid arthritis. However, the information from the following tests contributes to diagnosis and management.

  • Complete blood count (CBC)
  • Comprehensive metabolic panel (CMP)
  • Rheumatoid Factor (RF)
  • Antibodies to citrullinated peptides including anti-CCP
  • Erythrocyte Sedimentation Rate (ESR)
  • C-reactive protein (CRP)

The blood count shows a mild anemia in approximately 25 to 35% of patients with RA. The white cell count is usually normal in patients with rheumatoid arthritis, but can be mildly elevated secondary to inflammation, and can also be very low in a subgroup of patients with Felty’s syndrome. Similarly, the platelet count is usually normal but thrombocytosis occurs in response to inflammation.

Chemistry tests are usually normal in rheumatoid arthritis with the exception of a slight decrease in albumin and increase in total protein reflecting the chronic inflammatory process. Renal and liver function are important to check before beginning treatment and are followed over time with many medications.

A positive rheumatoid factor is present in 70-80% of patients with RA. A positive Anti-CCP is a more specific marker for RA and is found in similar proportions of patients over the course of disease. High levels of Anti-CCP also appear to be linked to a greater severity of the disease.

Measures of inflammation are often, but not always increased in RA. The erythrocyte sedimentation rate (ESR) is usually elevated in patients with RA and in some patients is a helpful adjunct in following the activity of the disease. The C-reactive protein (CRP) is another measure of inflammation that is frequently elevated, and improves with control of disease activity.

Testing for hepatitis B and C and testing for tuberculosis are commonly done as part of an initial evaluation. Baseline X-Rays of the hands, feet, and other affected joints are common at initial evaluation, and sometimes a baseline chest X-Ray is obtained.

Radiographic Findings

Erosions of bone and destruction of cartilage, occur rapidly and may be seen within the first 2 years of the disease, but continue to develop over time (See picture below). These anatomic changes result in limitations in range of motion, flexion contractures, and subluxation (incomplete dislocation) of articulating bones. Typical deformities include ulnar deviation of the fingers at the MCP joints, hyperextension or hyperflexion of the MCP and PIP joints (swan neck and boutonniere deformities), flexion contractures of the elbows, and subluxation of the carpal bones and toes (hammer toes and cock up deformities). Radiological findings early in the disease may show nothing other than soft tissue swelling. Thereafter, periarticular osteopenia may develop. With progression of their disease, narrowing of the joint space is caused by loss of cartilage, and juxta-articular erosions appear, generally at the point of attachment of the synovium. In end-stage disease, large cystic erosions of bone may be seen.

Reprinted from the Clinical Slide Collection on the Rheumatic Diseases, copyright 1991, 1995, 1997. Used by permission of the American College of Rheumatology.

More recently the introduction of ultrasound and MRI imaging has imporved the sensitivity of detecting joint damage earlier in disease. Ultrasound may detect synovitis, effusions, and erosions, in addition to power Doppler providing estimates of ongoing inflammation. MRI may show inflammatory synovitis that enhances with Gadolinium and shows early erosions. The role for these modalities in following patients over time in clinical practice is still not well established, but these methods may improve the ability to detect early disease and confirm a diagnosis.

Next: Pathophysiology of Rheumatoid Arthritis

Hand Pain and Rheumatoid Arthritis (RA)

The hand contains more than 25 joints, and these joints are particularly susceptible to inflammation for people with rheumatoid arthritis (RA). In fact, inflammation, swelling, and stiffness in the knuckles and wrists can be the first signs of this chronic systemic autoimmune disease.

See Rheumatoid Arthritis (RA) Symptoms

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Inflammation, swelling, and stiffness in the knuckles and wrists can be the first signs of RA.

Painful symptoms appear when the immune system mistakenly attacks the joints of the hand. Simple tasks such as opening a jar or turning a key can become difficult.

See Blood Tests to Help Diagnose Rheumatoid Arthritis (RA)

Hand Joints Affected By RA

The disease often appears in one or more of the following joints in the hand:

  • The metacarpophalangeal (MCP) joints, or large knuckles, where the fingers and thumb meet the hand
  • The proximal interphalangeal (PIP) joints, or middle knuckles
  • The joints of the wrist that connect the wrist’s eight carpal bones with each other and the bones of the forearm (the radius and ulna); these joints include the carpometacarpal joint, midcarpal joint, radiocarpal joint, and intercarpal joints

The distal interphalangeal (DIP) joints, or the outermost joint of the fingers and thumb, are affected by rheumatoid arthritis less frequently. When DIP joints are affected, it is typically only after symptoms appear in the MCP or PIP joints. It is more common for DIP joints to be affected by osteoarthritis than by RA.

See Recognizing Osteoarthritis in the Hand

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How Rheumatoid Arthritis Causes Hand Pain

Like many joints in the body, the joints in the hand are synovial joints. These joints are flexible and surrounded by a thin, pliable membrane called synovium. The synovium produces synovial fluid, a thin, clear, viscous substance that normally nourishes and lubricates the joint, enabling movement.

See What Is a Synovial Joint?

In people who have rheumatoid arthritis, however, the joints of the hand can become inflamed when the body’s immune system malfunctions and attacks healthy tissue in the fingers and wrists.

  • The immune system sends white blood cells, called leukocytes, to invade one or more hand joints.
  • The white blood cells trigger inflammation in the hand joints’ synovium. When synovium is inflamed it is called synovitis.
  • The inflamed synovial tissue may continue to react to the white blood cell invasion by adding layers of new synovial cells at a very rapid pace. This new, abnormal tissue is called pannus.
  • The rheumatoid pannus tissue squeezes into the joint space between bones and releases proteins that degrade the hand joints’ articular cartilage and bone.
  • The pannus may create excess fluid that contributes to wrist and knuckle swelling.

The biochemical changes in the joint capsules of the hand cause inflammation that can be seen and felt. Changes can also occur in parts of the hand and wrist, including the tendons.

See How Do Synovial Joints Work?

In This Article:

  • Hand Pain and Rheumatoid Arthritis (RA)
  • Hand Rheumatoid Arthritis (RA) Signs and Symptoms
  • Treatments for Rheumatoid Arthritis (RA) in Hands
  • Hand Rheumatoid Arthritis Video

Tenosynovitis in the Hands

In addition to encapsulating joints, synovial tissue surrounds most tendons, structures that connect muscles to bones. Rheumatoid arthritis can cause a tendon’s synovial sheath to become inflamed, a condition called tenosynovitis. The inflammation is not always painful but can lead to tendon damage.

See Conditions Related to Degenerative Arthritis

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Hand tenosynovitis from rhuematoid arthritis. Read Trigger Finger (Stenosing Tenosynovitis)

Tenosynovitis of flexor tendons in the hand is called trigger finger. Flexor tendons in the hand allow a person to bend his or her fingers, such as when making a fist. When a flexor tendon is inflamed it can cause “triggering” of that finger—the PIP joint gets stuck in a bent position, as if pulling the trigger of a gun.

See Nonsurgical Treatment for Trigger Finger

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At least one study suggests that tenosynovitis of flexor tendons is a strong predictor of rheumatoid arthritis.1

See Trigger Finger Release: Percutaneous and Open Surgery

Over time, damage to joints, tendons, and ligaments (which connect bone to bone) can cause bones to become malaligned, resulting in hand deformities.

  • 1.Eshed I, Feist E, Althoff CE, et al. Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis Rheumatology (2009) 48 (8): 887-891 first published online May 27, 2009 doi:10.1093/rheumatology/kep136.

Tetsuji Sawada1, Susumu Nishiyama2, Mayu Tago3, Koichiro Tahara3, Eri Kato1, Hiroaki Mori3, Haeru Hayashi3, Toshihiro Matsui4, Jinju Nishino5 and Shigeto Tohma6, 1Rheumatology, Tokyo Medical University, Shinjuku Tokyo, Japan, 2Rheumatic Disease Center, Kurashiki Medical Center, Okayama, Japan, 3Rheumatology, Tokyo Medical University, Tokyo, Japan, 4National Hospital Organization Sagamihara l Hospital, Clinical Research Center for Allergy and Rheumatology, Kanagawa, Japan, 5Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan, 6National Hospital Organization Tokyo National Hospital, Kiyose, Japan

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Rheumatoid arthritis (RA)

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Session Information

Date: Sunday, October 21, 2018

Session Title: Epidemiology and Public Health Poster I: Rheumatoid Arthritis

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Distal interphalangeal (DIP) joint arthropathy is characteristic of both psoriatic arthritis and osteoarthritis, but it has long been pointed out that DIP joints can also be affected in rheumatoid arthritis (RA) since the report by McCarty et al. (Arthritis Rheum 9(2):325,1966). However, the clinical significance of DIP joint involvement in RA has yet to be elucidated in detail. The aim of this study was to examine the frequency of DIP joint involvement in RA, and its relationship with RA disease activity, using the National Database of Rheumatic Diseases in Japan (NinJa).

Methods: We used data of patients with adult-onset RA registered in NinJa in 2016 whose affected joint distribution data were available (n=12413). The relationship between DIP joint involvement and age, sex, age at RA onset, disease duration, stage, class, pain visual analog scale (VAS) score, tender joint count (TJC), swollen joint count (SJC), disease activity scorein 28 joints-C-reactive protein level (DAS28-CRP), modified Health Assessment Questionnaire (mHAQ), rheumatoid factor, and anti-cyclic citrullinated peptide (anti-CCP) antibody were analyzed.

Results: The number of RA patients who presented with DIP joint involvement (tenderness or swelling in the second to fourth DIP joints) was 257 (2.0%). The number (mean ±standard deviation) of affected DIP joints was 2.6 ±2.3 with median of 1. DIP involvement was not related to age, age at RA onset, disease duration, stage III-IV, class 3-4, mHAQ, presence of rheumatoid factor or that of anti-CCP antibody. On the other hand, DIP involvement was significantly more frequent in women than in men (91.0% versus 80.1%, p<0.01). Furthermore, pain VAS, TJC, SJC, and DAS28-CRP were significantly higher in RA patients with DIP involvement than in those without it, indicating the association of DIP involvement with high RA disease activity. Categorizing RA disease activity based on DAS28-CRP scores also revealed that DIP involvement was significantly associated with higher frequency of moderate and high disease activity and with lower frequency of remission status. Regarding the involvement of other joints in the hand, the number of affected DIP joints was significantly correlated with those of the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints with correlation coefficients of 0.24 and 0.14, respectively (p<0.01).

Conclusion: We have demonstrated that DIP involvement was significantly associated with high disease activity in RA. It would thus be necessary to pay more attention to DIP joint involvement, albeit being observed infrequently, when evaluating disease activity in RA patients.

Disclosure: T. Sawada, None; S. Nishiyama, None; M. Tago, None; K. Tahara, None; E. Kato, None; H. Mori, None; H. Hayashi, None; T. Matsui, None; J. Nishino, None; S. Tohma, None.

To cite this abstract in AMA style:

Sawada T, Nishiyama S, Tago M, Tahara K, Kato E, Mori H, Hayashi H, Matsui T, Nishino J, Tohma S. Distal Interphalangeal Joint Involvement and Its Association with Disease Activity in Rheumatoid Arthritis (RA): Analysis Based on a Nationwide RA Database in Japan . Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/distal-interphalangeal-joint-involvement-and-its-association-with-disease-activity-in-rheumatoid-arthritis-ra-analysis-based-on-a-nationwide-ra-database-in-japan/. Accessed February 2, 2020. Favorite Save to PDF

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Rheumatoid arthritis

What will happen to me?

With early diagnosis and the right treatment, most people with RA can lead full and active lives. However the course of RA varies and no two cases are exactly the same. Many people with RA experience ‘flares’, periods when joints become more inflamed and painful. These can happen with no obvious cause. ‘Flares’ are commonly followed by months or even years when there is little inflammation. RA can cause permanent joint damage and deformity, especially in the first few years of the disease. The good news is that early diagnosis and treatment is shown to limit this type of joint damage.

Is there a cure for RA?

Currently there is no cure for RA. However treatment has improved dramatically over the past 20 years, with new medicines now extremely helpful for people in the early stages of RA. Be wary of any products or therapies that claim to cure RA.

What treatments are there for RA?

Your rheumatologist will tailor your treatment to your symptoms and the severity of your condition. There is no way of predicting exactly which treatment will work best for you. Your doctor may need to trial several different treatments before finding the one that is right for you and may include:

  • medicines, such as
    • non-steroidal anti-inflammatory drugs (NSAIDs)
    • corticosteroid medicines or injections
    • disease-modifying anti-rheumatic drugs (DMARDs)
    • biological DMARDs.
  • exercise, to keep the joints flexible and muscles strong.

What can I do?

  1. See a rheumatologist as early as possible. A rheumatologist can diagnose RA and make sure you get the right treatment. If you have RA and have not seen a rheumatologist, ask your doctor about a referral.
  2. Learn about RA and play an active role in your treatment. Not all information you read or hear about is trustworthy so always talk to your doctor or healthcare team about treatments you are thinking about trying. Reliable sources of further information are also listed in the section below. Self management courses aim to help you develop skills to be actively involved in your healthcare. Contact your local Arthritis Office for details of these courses.
  3. Learn ways to manage pain.
  4. Live a healthy life. Stay physically active, eat a healthy diet, stop smoking and reduce stress to help your overall health and wellbeing.
  5. Learn how to protect your joints and cope with tiredness.
  6. Acknowledge your feelings and seek support. As there is currently no cure for RA and it can affect many parts of your life, it is natural to feel scared, frustrated, sad and sometimes angry. Be aware of these feelings and get help if they start affecting your daily life.

CONTACT YOUR LOCAL ARTHRITIS OFFICE FOR MORE INFORMATION AND SUPPORT SERVICES.Patient Action Plan

Arthritis: how osteoarthritis and rheumatoid arthritis affect joints

Arthritis – joint inflammation – is very common, and typically causes pain and stiffness in the affected joints.

Osteoarthritis and rheumatoid arthritis are 2 of the most common types of arthritis and they affect the joints differently. View the 3 diagrams of joints below to see the differences between:

  • a normal, healthy joint;
  • a joint affected by osteoarthritis; and
  • a joint with rheumatoid arthritis.

Normal joint

A joint is a place where bones meet. The muscles surrounding a joint make the bones move by contracting and relaxing. The muscle is joined to the bone by a fibrous cord known as a tendon.

The ends of most bones have a layer of cartilage covering them. The cartilage is smooth and slippery and forms a cushion that absorbs shock and also prevents bones from rubbing against each other.

The joint is surrounded by a membrane called the synovium or synovial membrane. This produces a thick fluid called synovial fluid that protects and lubricates the joint.

The synovium is enclosed by the capsule which holds the joint together with its fibrous bands called ligaments.

Joint affected by osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis. Often associated with ageing, the exact cause of osteoarthritis is not known. However, factors that are known to increase your risk of OA include a family history of osteoarthritis, excessive wear on joints, and injury.

You may have several joints affected by OA, just a few or only one osteoarthritic joint.

What happens to joints in osteoarthritis?

When you have osteoarthritis, it affects the entire joint, including the bones, cartilage, joint capsule, synovial membrane, synovial fluid, tendons, ligaments and muscles.

Osteoarthritis involves the breakdown of the protective cushion of cartilage surrounding the ends of the bones where 2 bones meet to form a joint. A healthy joint has a lining of smooth cartilage and is lubricated by synovial fluid.

In osteoarthritis, the cartilage becomes flaky and rough and small pieces break off to form loose bodies in the synovial fluid. This causes irritation and inflammation of the synovial membrane. The loss of cartilage leaves bones unprotected and vulnerable to damage.

As the roughened cartilage becomes thinner, the bone underneath thickens and swells. The smooth functioning of the joint is lost and the bone can lose shape and bony spurs (osteophytes) may form on the bone end. Microfractures may also occur in the ends of the bones.

The joint capsule and ligaments stretch, and may thicken slowly to try to stabilise the joint as it changes shape. The tissue around the joint can also become inflamed. OA can also result in deterioration and weakness of the tendons, ligaments and muscles around the joint.

Which joints are affected by osteoarthritis?

The joints most commonly affected by osteoarthritis include the:

  • knees;
  • hips;
  • neck;
  • lower back; and
  • hands.

Joint affected by rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease, meaning that your immune system attacks the tissues in the joints, resulting in inflammation. The exact cause of rheumatoid arthritis is not known, but it is thought that genetic factors may be involved, and that infection may trigger the development of RA in some people.

What happens to joints affected by rheumatoid arthritis?

Rheumatoid arthritis (RA) results in inflammation of the joints and, in particular, the synovial membrane that covers them (synovitis). An overproduction of synovial fluid occurs, which causes joints to swell and the capsule to stretch, causing pain.

The inflammation in the joints causes damage to the cartilage and sometimes to the bone ends. If this process is not halted, the cartilage damage can result in deformities or destruction of the joint. The tendons may also be inflamed and worn down. This is why taking medicines to suppress inflammation early on in the course of the disease is very important in RA.

Which joints are affected by rheumatoid arthritis?

Rheumatoid arthritis is usually symmetrical – affecting joints on both sides of the body at the same time. The joints most commonly affected are the:

  • wrists;
  • hands;
  • fingers;
  • ankles;
  • toes;
  • shoulders; and
  • knees.

The elbows, hips and the spinal joints in the neck are less commonly affected.

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Last Reviewed: 28/06/2017

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