Rheumatoid arthritis is an autoimmune condition in which the body attacks itself. The parts of the body most affected are the joints. In rheumatoid arthritis the body forms antibodies against antigens of the synovium. The synovium is a cellular coating that lines joint spaces. It normally secretes lubricants and helps ensure the integrity of the joint. However, when auto-antibodies bind to it the result is inflammation.
The inflammatory process gets out of control damaging not only the synovium, but also adjacent structures like cartilage and bone. After years of inflammatory changes the joints involved become deformed.
Clinically, rheumatoid arthritis typically begins as vague non-specific joint pain. In its earliest form it can be difficult to diagnose. Patients will often complain of other non-specific symptoms like fatigue and fever. The inflammatory response typically begins in the hands and feet. In the hands the metacarpophalangeal joints (ie: the first "knuckle") and proximal interphalangeal joints (ie: the second "knuckle") are most commonly involved. Interestingly, the distal interphalangeal joint (ie: the last "knuckle") is not commonly involved in rheumatoid arthritis.
After years of wear and tear on these joints several deformities occur. The two commonly seen ones are Boutonniere and Swan Neck deformities of the hands. In addition, "ulnar deviation" of the fingers can occur.
Symptoms may wax and wane, or disappear entirely for periods of time. Unfortunately, they almost always return. Eventually the wrists, ankles, elbows, and knees can also become involved. The disease is considered progressive. Treatment is designed to slow both the inflammatory process and joint destruction.
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