Rheumatoid Arthritis (RA) is an autoimmune disease from unknown reasons resulting in chronic inflammation affecting synovial joints in the fingers, hands, and feet. Larger joints in the knee and shoulder can also be affected and conditions will vary among individuals. The inflammation is often found in multiple joints, usually, yet not always occurring in a symmetrical pattern involving the destruction of bone and cartilage. Inflammation can create swollen, tender, stiff and often permanently deformed joints resulting in decreased movement and even loss of function. Fingers can exhibit a deviated, unnatural shape spanning towards the little finger (Figure 5). Typically, after waking, an increased stiffness can occur, identified as a prominent feature lasting as long as one hour.41
RA has been classified as a systemic disorder meaning the immune system attacks the body’s tissues leading to destruction and inflammation spreading to systems and tissues known as extra-articular conditions or “outside the joints” existing in approximately 15% of those diagnosed with RA.42 Lymph nodes may become inflamed, and in aggressive systemic conditions nodules can occur under the skin and around joints, which are associated with a poor prognosis. It has been reported approximately 40% with RA also suffer with pericarditis affected by the inflammatory process.43 According to the European League Against Rheumatism in Paris, those with RA had a doubled risk of suffering a stroke or heart attack.27 Over one-third of deaths with RA were attributed to a cardiovascular condition identifying cardiovascular disease as a major factor in the increased mortality among those with RA.41
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