A synonym for this disease is chronic polyarthritis (CP). It typically affects middle-aged women, but also children (juvenile chronic polyarthritis) and men of any age. It is an inflammation and destruction of, among other things, joints, usually involving more than one site. It is assumed that antibodies are formed which attack the synovial membrane around the joints as well as the paratenon, which is synovial material between the tendon and its sheath. Rheumatoid factor will possibly be traceable in the blood but also other specific blood values such as anti-CCP.
In the joints there is an increased growth in the synovial membrane and increased secretion of synovial fluid. In advanced stages of the disease, the underlying cartilage, bones and tendons are attacked, leading to deformation and swelling of the joints and destruction of the tendons. The destruction will often involve other organs, above all the eyes, kidneys, heart and lungs. As the entire body can be affected, it is necessary to commence systematic medicinal treatment. Therefore, if rheumatoid arthritis is suspected, examinations should be carried out by a rheumatologist and additional x-rays taken (feet, cervical spine in order to confirm the diagnosis and ascertain its stage of development.
According to the American Rheumatism Association (ARA), a patient is classified as RA if four of the seven criteria below are satisfied. Criteria 1-4 must have been present for at least 6 weeks.
- Morning stiffness in affected joint for more than 1 hour
- Swelling of 3 or more joints
- Arthritis on at least one hand or finger joint
- Simultaneous involvement of the same joint areas on both sides of the body
- Rheumatoid nodules
- Rheumatoid factors in blood
- Visible rheumatic bone changes on x-ray
On the hand, rheumatoid arthritis mainly affects the wrist as well as the basal and middle joints of the fingers. The disease often actually begins with swelling and pain in the wrist. Through the damage to the joint surfaces and usually also the ligaments and tendons, typical displacement of the fingers towards the little finger occurs (so-called ulnar deviation). To compensate, the wrist often shifts direction towards the radius (so-called radialduction). Further effects of the disease are also described under buttonhole deformity and swan neck deformity.
Surgical intervention involving removal of the diseased synovial tissue in the early stages of the disease can delay joint destruction. The synovial membrane regenerates replacement tissue within a few weeks. This replacement tissue is usually not affected by the disease again, or affected extremely gradually, so an early synovialectomy can effectively cease or delay progressive destruction.
In principle, the goal of all surgical interventions is to delay the progression of joint and tendon destruction. Should this fail, for example if the patient already has signs of significant bone destruction, then only secondary operative measures remain in order to recover lost function or maintain what is left as far as possible. Reconstructive measures include implanting silicone rubber spacers and prostheses, tendon transfer or salvage surgeries to maintain remaining function such as, for example, arthrodesis, in other words surgical fusion of the joints.
Rheumatoid arthritis (chronic polyarthritis) is not to be mistaken for osteoarthritis.