Rheumatoid Arthritis

What Happens

The course of rheumatoid arthritis is difficult to predict because it may progress slowly or quickly. If the disease progresses, joint pain can restrict simple movements, such as your ability to grip, and daily activities, such as climbing stairs. Rheumatoid arthritis is a common cause of permanent disability. Early treatment may significantly control the course of the disease.

In rare cases, you may get better on your own with no remaining signs or symptoms. This is called spontaneous remission. Partial remission is more common. It involves the relief of some, but not all, symptoms. Although a minority of people with rheumatoid arthritis will achieve a complete remission with treatment, the majority will have improvement in their symptoms.

Rheumatoid arthritis usually progresses gradually.¹

• Up to 65% of rheumatoid arthritis cases begin slowly, over weeks to months.
• In 8% to 15% of rheumatoid arthritis cases, symptoms come on rapidly, within days.

Progression of the disease is more likely when:

• A rheumatoid factor blood test is positive.
• The disease fails to respond to therapy.
• Bumps (nodules) develop rapidly.
• Many joints are affected.
• X-rays show early loss of bone or cartilage.

In most cases, rheumatoid arthritis does not affect a woman's ability to become pregnant and have a healthy baby. Pregnancy often improves rheumatoid arthritis symptoms, especially from the end of the first trimester on. More than 75% of women have remission of disease activity during pregnancy; however, approximately 80% experience a flare of disease symptoms in the weeks after delivery.²

Other organ involvement may occur later in the course of the disease. In a small number of severe cases, rheumatoid arthritis may cause damage to the heart, lungs, skin, blood vessels, nerves, and eyes. It is common for people with rheumatoid arthritis to have some degree of depression, which may be caused by pain and progressive disability.

Some people with rheumatoid arthritis cannot keep working because of the symptoms. But experts hope that the newer treatments for rheumatoid arthritis will help more people stay active and be able to work.

Studies have shown that damage to joints occurs in 60% of people with rheumatoid arthritis within 2 years.³ Because irreversible joint damage, chronic pain, and long-term disability can occur if rheumatoid arthritis is not diagnosed and treated early, it is now recommended that a person with rheumatoid arthritis see a specialist in joint disease (rheumatologist) within the first 3 months after symptoms appear.³ As soon as rheumatoid arthritis is diagnosed, early treatment includes medications known as disease-modifying antirheumatic drugs (DMARDs).

Joint destruction

The pain, stiffness, and whole-body (systemic) symptoms associated with rheumatoid arthritis can be disabling. Over time, rheumatoid arthritis can cause significant joint destruction, leading to deformity and difficulty with daily activities. Specific joint problems may also occur later in the course of the disease.

Hands and wrists are the most common location for deformities caused by rheumatoid arthritis.⁴

• Swan-neck and boutonniere deformities: Changes in the tissues around the finger joints cause abnormal bending or straightening.
• Swelling of the joints can push the supporting tendons and ligaments out of position, causing the fingers to bend toward the little finger (ulnar drift).
• The tendons may break (rupture), making it impossible to straighten or bend the finger, depending on which tendon ruptures. Tendon loosening is very common in rheumatoid arthritis, due to inflammation of the joints.
• Inflammation in the wrist can limit the ability to bend the wrist up or down.

The feet are a common site of rheumatoid-arthritis-caused deformities that affect more than one-third of people with this disease.¹

• Hammer toes: Changes in the tissues around the toe joints cause abnormal bending (flexion).
• Hallux valgus/bunion: Changes in the tissues around the big toe joint cause it to bend toward the little toe and develop a bony enlargement.
• Movement of the joints between the toes and foot (metatarsophalangeal subluxation): The ball joints loosen, and the bones press down to the ground.
• Pes planus: The arch joint of the middle foot loosens, which causes a painful flat foot.
• Valgus hind foot: The joint below the ankle loosens, which causes the foot to bend outward.

Inflammation of the knees, if not controlled by treatment, can cause erosion of cartilage and can eventually lead to the need for knee replacement surgery.

X-rays of the neck joints show some damage in 15% of people with rheumatoid arthritis.⁵ This damage can limit how easily you can move your neck. In rare cases, the damage can pinch a nerve or affect the spinal cord and cause numbness, pain, or weakness in the arms or legs.

More information How does rheumatoid arthritis develop in my body? What is my prognosis with rheumatoid arthritis?

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Author:	Robin Parks, MS	Last Updated: August 23, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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