Rheumatoid arthritis (RA) is a condition that is classified as autoimmune, which means that it is a result of the body producing antibodies against itself. These antibodies react with the body's own cells and cause symptoms. Some of the manifestations of RA occur in internal organs and are hard to quantify without laboratory tests or imaging studies but others, such as nodules and joint damage, are simple to examine.
Spine
The spine is not very susceptible to RA, however the cervical region is vulnerable to its effects, according to "Kelley's Textbook of Rheumatology." This can result in a significant structural displacement, known as subluxation, which can be dangerous. You many notice numbness in the hands, problems with limb movement, and tingling in the shoulders and arms when you move your head. These effects can be attributed to instability of the spine.
Jaw
The jaw, or temporomandibular, joint is commonly involved in RA, according to "Kelley's Textbook of Rheumatology." This can include an overbite, erosion of the joint, pain, inability to close the mouth and crepitus (a crackling sound when you move your jaw).
Hearing Loss
Hearing loss can begin with problems hearing high-pitched sounds, and can progress to include the majority of sounds as the disease worsens. This happens as the bones in the middle ear shorten and erode, which decreases the ability to hear properly.
Shoulder Problems
Many different parts of the shoulder can be affected, and symptoms include pain, and rotator cuff problems (tears and weakness). The shoulder pain often results in sleep problems as it is difficult to find a comfortable position in which to sleep without pain.
Hand and Wrist Signs
The hand and wrist joint are primary targets of damage in RA, according to "Kelley's Textbook of Rheumatology." Decreased range of movement and pain are a result of damage to the joints. The wrist can become distorted and twisted due to inflammation and weakness of the extensor carpi ulnaris muscle. In the hands, a "swan neck" or "boutonniere" deformity may affect the fingers with varying extension and flexion of the finger bones (phalanges). Sometimes, the fingers may become shortened of the fingers, due to breakdown of the bone in the hand. The knuckles may develop nodules, locking the finger into painful flexed positions. The overall result is jand weakness and pain, usually a result of an inflammation of the sheath that surrounds the muscle (tendonstenosynovitis).
Knee Signs
The knees are also a primary joint affected by RA, according to "Kelley's Textbook of Rheumatology." The quadriceps muscle may shrink, and you may have have trouble fully extending your knee. In addition, your knees can deviate inwards or outwards, usually due to the knee misalignment that can result from RA. Sometimes, patients will notice an outpouching of tissue in the back of the knee, called a Baker's cyst. It is due to fluid buildup that causes the outpouching, and can be quite painful.
Muscle
Muscle weakness is common in RA patients, according to "Kelley's Textbook of Rheumatology." It is not thought be directly a result of RA, rather a problem caused by the weak joints, pain from movement and effects of anti-RA medications. The weakening is usually gradual in most patients, but can develop rapidly in others for unknown reasons, according to "Kelley's Textbook of Rheumatology." Patient's can also expect morning stiffness in the muscles that can last for less than an hour and this is a cardinal symptom that begins even before the pain.
Skin Lesions
Skin problems can include nodule development, altered skin pigmentation and texture due to vasculitis (inflammation of vessels) within in the skin. The nodules are a result of inflammation and they can vary from a soft mass to a hard, rubbery mass. Skin changes can include reddened palms, a dusky purple discoloration, shallow ulcers, areas of discoloration that resemble bruising and "liver spots" that are usually seen in the elderly.
Eye
RA affects the eyes in a variety of ways. Symptoms include inflammation of the tear ducts causing dry eyes, and inflammation of various components in the eye, resulting in altered or blurry vision, and pain. An ophthalmic examination may reveal ulceration and nodules on the eyes.
References
- "Kelley's Textbook of Rheumatology, 8th Edition;" Firestein; 2008
- "American Journal of Medicine;" Diagnosis and Management of Rheumatoid Arthritis; P. Kaushik, R. Kaushik; Jun. 2008
- "Rheumatic Diseases Clinics of North America;" Rheumatic Disease in the Elderly: Rheumatoid Arthritis; Z. Tutuncu, A. Kavanaugh; Feb. 2007
