X-Ray image of Left hand showing Rheumatoid Arthritis.
The slide shows every metacarpal joint (MCP) to be affected.
There are also ligament abnormalities.
X-Ray of both hands showing Rheumatoid Arthritis
Deviations of the carpus(1) and the fingers give the
hand it’s characteristic shape.
X-Rays of Right and Left Foot showing affected metatarsophalangeal (MTP joints)
in a 49 year old woman presenting with Rheumatoid Arthritis (RA)
Rheumatoid Arthritis is an auto-immune inflammatory disease that primarily affects the joints but it can also involve the lungs, heart, eyes and subcutaneous tissue. It is a chronic and typically progressive illness that eventually causes deformation and destruction of the small joints resulting in pain and lack of function. Rheumatoid Arthritis is a disease in which there are periods of flare-ups or ‘flares’ characterised by episodes of severe symptoms (in which the disease is active) and remissions (in which the disease is inactive). As can be seen in the X-Rays above, Rheumatoid Arthritis affects the same joints equally on both sides of the body, so the disease process could be said to be ‘symmetrical’ this is an important factor in diagnosis.
Rheumatoid Arthritis is characterised by an inflammatory process, which is a normal bodily reaction to injury trauma or infection, but in this case the inflammatory response affects healthy cartilage and bones and can also harm organs. The disease process usually begins with inflammation of the synovium, a protective capsule or sac surrounding a joint. The synovium is filled with fluid (synovial fluid) which acts as a cushion or shock absorber and supplies oxygen and essential nutrients to the cartilage. In a healthy joint the synovium membrane is very thin but in rheumatoid arthritis white blood cells and small blood vessels permeate the synovium and the membrane becomes thickened and inflamed which results in the development of unwanted fibrous tissue called pannus. The pannus then produces more harmful enzymes that damage nearby cartilage, irritating the area and attracting more white cells and inflammation, thereby continuing and exacerbating the process.
It is estimated that at least 1.3 million U.S adults have Rheumatoid Arthritis which is the most common form of autoimmune arthritis. Although Rheumatoid Arthritis is one of the more debilitating forms of arthritis the outlook has improved greatly for a lot of newly diagnosed people. One of the keys to reducing symptoms and the inflammatory process in general is early diagnosis and treatment.
Seek medical advice if you experience any, or a combination of, the following symptoms:- Tender swollen joints (especially of the hands or feet) or joints that feel stiff in the morning even after being awake for some time. This tenderness can often be experienced as heat or a burning sensation. You may experience extreme tiredness (fatigue), low-grade fever and/or weight loss. You may also notice small firm ‘bumps’ under the skin of your arms, called ‘Rheumatoid Nodules’ and/or itchy, dry eyes. These symptoms can come and go so there is a tendency to ignore them making early diagnosis and treatment more difficult. If you are experiencing, or have experienced, any of these symptoms please go to your family doctor and get checked out.
There is no cure for rheumatoid arthritis at the moment but therapy programmes have greatly improved over the last 30 years. The aim of rheumatoid arthritis treatment is to control a patient’s signs and symptoms, to prevent joint damage, and to maintain the patient’s quality of life and ability to function(3) The medications prescribed are primarily aimed at reducing inflammation in the joints (anti-inflammatories) and slowing down or stopping the auto-immune response (immunosuppression). Drug therapies are designed to ease the symptoms of the disease and prevent joint and bone damage and long term disability. Occupational and physical therapy can also help.
1. Carpus The carpus is the sole cluster of bones in the wrist between the radius and ulna and the metacarpus (Wikipedia)
2. American College of Rheumatology
3. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 Update. Arthritis Rheum 2002; 46:328.