Rheumatoid arthritis

Rheumatoid arthritis (RA) is an inflammatory condition that causes joint pain, stiffness, and/or swelling.  Normally symptoms affect the entire body, sometimes they may affect one joint. This may be the wrist, knee, hip, ankle, or shoulder.

Pain and swelling of the affected joints is often determined by exam. Tenderness with pressure applied to a joint is a key feature. Normally the joints affected are furthest away from the body, including those in the hands, feet, or the neck. Changes in the knuckles are common. There may be swelling in the hands, reduced grip strength, or symptoms of carpal tunnel syndrome. When the feet are affected, a person may feel heel pain, tenderness of the toe joints, or they may have difficulty standing on the heels or extending the toes.

Lab tests may show white blood cells in the fluid of a swollen joint, a positive RF test, and sometimes antinuclear antibodies.  Xray results show bony erosions in the affected joints.  Bony erosion of the 3d, 4th of 5th MTP (the toe joint with the foot) is a helpful clue for RA, as most other conditions do not cause these.

Treatment for RA

RA can be treated by methotrexate (MTX), prednisone, hydroxychloroquine, sulfasalazine, and TNF-alpha inhibitors (etanercept, infliximab, adalimumab, golimumab).  The choice of medication relies on the disease severity, whether there are other medical conditions, the cost and patient preference.