Rheumatoid arthritis most often affects specific joints with varying rates of occurrence:
- Knuckles (90-95%)
- Wrists (80-90%)
- Fingers (65-90%)
- Knees (60-80%)
- Toes (50-90%)
- Shoulders (50-60%)
- Ankles (50-80%)
- Neck (40-50%)
- Hips (40-50%)
- Elbows (40-50%)
- Jaws (20-30%)
How it begins
RA usually begins insidiously, presenting with painful swelling and stiffness in a few joints, especially in the smallest joints (knuckles, fingers, wrists and toes); larger joints may be affected over subsequent months.
In a minority of patients (approximately 20%), the onset of rheumatoid arthritis can be slow (subacute) following a similar pattern of inflammation, but instead over a course of weeks to months.
Only a small number (10% or less) of RA sufferers experience an acute onset, with severe symptoms arising in just a few days across many joints, progressing almost immediately to persistent disease.
Visible physical deformities
The most commonly visible physical deformities are those appearing in the hands, which include a tapering or spindle-shaped appearance of the lower fingers, bent or ‘swan-necked’ appearance of the fingers at various points, and the appearance of a ‘piano key’ springing effect when the fingers are pressed down. These may appear months to years after active disease, and are due to damage to the joints and ligaments.
Additionally, deformities in the feet are common, as inflammation in the toe and ankle joints tend to partially dislocate the toes, creating new pressure points and friction when patients attempt to put on their shoes, or walk. The result is often the development of callouses, or ulceration (skin breakage); the resultant pain is such that patients often feel as if they are walking on pebbles or stones. When the heel and ankle joints are involved, the arch of the foot will often flatten.
Rheumatoid arthritis can rarely lead to a wide variety of secondary symptoms that, while unrelated to the joints themselves, are by-products of the inflammation and the course of the disease itself.
These manifestations are uncommon and generally only seen in patients with active, severe rheumatoid arthritis; studies show that male patients, smokers and those who have tested RF- and CCP positive are at greatest risk to experience these manifestations of the disease, and should actively pursue appropriate courses of treatment and ongoing disease management.
Patients should be aware that involvement of other joints, specifically the along the length of the spine, the sacroiliac (where the spine meets the pelvis), or the tips of the fingers, are rarely indicative of rheumatoid arthritis, and should be further investigated with your physician.
Examples of secondary symptoms
- Weight loss
- Swollen lymph nodes
- Dry eyes and dry mouth (Sjögren’s syndrome)
- Dermatological (skin) changes
- Ocular (eye) changes, including swelling, redness, pain and nodule growth
- Pulmonary (lung) inflammation, tissue and blood vessel hardening, and disease
- Cardiac (heart) disease
- Neuromuscular (nervous and muscular system) disease
- Hematologic (blood) disease