Rheumatoid arthritis is a systemic, inflammatory autoimmune disease. A systemic disease means it can affect any part of the body and with RA it can affect organs such as the heart, lungs, eyes and skin. In general, the joints are involved, especially early in the disease.

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Inflammation describes the pin and swelling in  the affected area, and autoimmune means the bodies own immune system recognises the cells and tissues as foreign and therefore attacks them. 

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Remissions and exacerbations of the disease lead to progressive damage of the joints. It often has an insidious onset (causes harm gradually without being aware), and often involves joints on both sides of the body (symmetrical).

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In initially tends to affect the finger joints, spreading to other joints in the wrist, elbows and knee. it can affect joints at the top of the neck and the temporomandibular joint (TMJ) of the jaw.

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The severity of the disease can vary from mild to severe depending on the number of joints involved, how much inflammation is present, and how rapidly the disease progresses.

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Disease Process

1. Abnormal immune response causes the synovial membranes to become inflamed. This causes the joints to become red (due to increased vasodilation of blood capillaries), swollen (as a result of increased permeability of capillary walls causing more fluid to leak into space between the bones) and pain (due to irritation of the nerve endings in the joint).

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2. There is an increase in synovial cells which gradually spread over the hyaline cartilage located on the ends of the bones. This tissue releases enzymes that start to breakdown the hyaline cartilage, resulting an unstable joint.

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3. The tissue that has formed over the ends of the bone becomes fibrotic (fibrous tissue), causing stifness and loss of joint space.

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4. Eventually the joint becomes fixed and deformed.

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5. Due to pain and inflammation the muscles atrophy (waste away) due to disuse of the joint, and this in combination with the stretching of ligaments and tendons the joint becomes even more unstable

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6. With little or no support around the joints, the alignment of the bone shift causing deformities

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7. Movement becomes greatly impaired due to the damaged and deformed joints

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Signs and Symptoms

• Red, swollen and painful joints

• Joint stiffness which eases after movement

• Impaired joint movement due to swelling and pain

• Muscle weakness due to disuse of joints

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Systemic symptoms

• Fatigue 

• Anaemia

• Anorexia

• Mild fever

• Depression

• Generalised aching

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