Some symptoms of rheumatoid arthritis (RA) may be internal. Visible symptoms may also affect parts of the body such as the skin, hands, and feet.
Rheumatoid arthritis (RA) is an autoimmune condition that causes chronic inflammation.
With RA, your immune system attacks your body’s tissues and causes painful swelling of the joints. Without treatment, RA can severely damage the joints.
There are many ways that RA can appear, but some of the most recognizable symptoms affect the hands and feet. However, RA can affect many different joints, with varying levels of severity.
RA can also affect other areas of the body, including the skin, lungs, and blood vessels. People with RA may experience fatigue and general weakness as well.
One of RA’s first noticeable features can be seen in the hands. Swelling of the knuckle joints and wrists leads to severe pain and stiffness, especially in the morning.
Chronic inflammation can cause the fingers to twist in an outward direction. This can take a toll on fine motor skills. In advanced cases of RA, the hands can permanently change shape and interfere with your quality of life.
With proper treatment, you can manage your RA symptoms. Treatments focus on reducing the inflammation in order to prevent joint damage.
For hands and fingers, these treatments may include oral medications and splinting. Splinting helps support the joints, but splints shouldn’t be worn for too long because this may lead to muscle deterioration.
Certain injections may help too. A doctor may recommend a combination of steroids to reduce inflammation and anesthetics to help ease associated pain.
The effects of steroid injections can last for several months, but a doctor may exercise caution in repeating these treatments because of possible side effects. Side effects include:
- skin color changes
- weakened ligaments or tendons
You may need surgery if other RA treatments don’t work.
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These symptoms can lead to pain and mobility difficulties.
Ankle and heel
Inflammation causes damage to the ligaments and tissues that support your bones. This damage can then cause the ankle and back of the foot to move out of alignment.
If the ankle and heel can’t move properly, it can be difficult to walk, especially on hills, stairs, and uneven surfaces. Inflammation of the ankle and heel can result in malalignment, causing pain on the outside of the foot.
In addition to your regular RA treatment, you can also get custom shoe inserts (orthotics) to minimize pressure or use an ankle brace to support your joints.
Middle of the foot
Over time, the ligaments and cartilage of the foot can deteriorate, leading to the collapse of the foot’s arch. With a flat foot, the shape of the entire foot begins to shift.
Some people with RA develop large, bony bumps, corns, or calluses on the ball of the foot. These can be painful and make it very difficult to find comfortable footwear. Special shoe inserts can help improve the arch. Learn more about midfoot arthritis.
Front of the foot
When the arch falls, it puts pressure on the toes and the front of the foot starts to point outward. Toes become twisted and may cross over each other, especially the big toe.
Many people with RA develop calluses, claw toes, or bunions. A combination of problems from the ankle to the toes can cause pain throughout the foot.
Over time, foot pain may cause people with RA to avoid standing or walking. In severe cases, surgery can help by fusing the affected bones.
If inflammation isn’t properly managed, severe joint damage can cause the toes to take the shape of claws. The small toes take on a prominent appearance as they bend upward and then point downward at the middle joints. Sometimes, toes curl under the foot.
Added pressure on the toes can cause calluses and skin ulcers. In time, claw toes can become stuck in position, leaving you unable to flex your toes inside a shoe.
In the early stages, you can wear soft shoes and stretch your toes into a normal position. Toe exercises, such as using your toes to pick up marbles, may help. If your toes are fixed in position, try using special shoes or a pad to accommodate them.
Surgery may be required to help correct your toes if other treatments don’t work.
When your big toe bends toward the second toe, it causes a bump to form on the joint at the base of the big toe. This is known as a bunion.
Because the foot must carry the body’s weight when you walk, bunions can be very painful.
A bunion can also form on the outside of the little toe. This is called a tailor’s bunion or bunionette.
The misshapen area in front of the foot makes it difficult to find shoes that are wide enough at the front. You can ease the discomfort by:
- wearing bunion pads
- wearing wider shoes
- avoiding high heels
- applying ice packs to reduce swelling
Cortisone injections, oral anti-inflammatory drugs, and physical therapy may help treat bunions. In severe cases, surgery may be needed.
RA can also attack the knee joints, causing inflammation. This makes it difficult to bend or straighten the knee. Doctors use imaging tests, such as MRI and X-ray exams, to visualize possible joint damage and erosion.
Having RA may increase the risk of inflammation in the synovial membrane that covers your knee joint, resulting in pain and stiffness. Additionally, unlike other types of arthritis, RA may occur in both knees at the same time.
There’s typically a loss of joint space due to damaged cartilage. In advanced cases, bones can grow together and fuse.
Treating knee arthritis involves a combination of medications and lifestyle modifications, such as:
- steroid injections
- oral anti-inflammatory drugs
- physical therapy
- assistive devices like a cane or knee sleeve
A severe case could warrant a surgical procedure, such as a knee replacement.
Any joint in the body can be affected by RA. Other sites where inflammation can arise, leading to pain, deformity, and dysfunction, include the:
If you’re diagnosed with RA, mention any focus of pain to a doctor so that you can begin appropriate treatment.
Rheumatoid nodules are small, firm lumps that develop under the skin, usually near inflamed joints. Twenty percent of people with RA develop nodules. They’re sometimes associated with unmanaged or more advanced disease.
The nodules can be small or as large as a walnut. They’re usually painless and pose no risk.
Treatment isn’t required, but certain medications can help reduce the size of larger, bothersome nodules. In some cases, nodules can be surgically removed.
While the most obvious symptoms of RA are seen in the joints, the condition can cause inflammation in other parts of the body too.
The following complications are less common and are more likely to be seen in very advanced cases. Additionally, some RA medications such as disease modifying antirheumatic drugs (DMARDs) may help slow down RA’s effects and reduce such complications.
Rheumatoid arthritis and the eyes
In some cases, inflammation from RA can make the whites of your eyes red and swollen, which may indicate a condition called scleritis. Scleritis can cause symptoms such as pain, light sensitivity, and blurry vision.
Uveitis is another eye condition associated with RA. It causes inflammation between the whites of your eyes and the retina.
Both scleritis and uveitis can lead to permanent eye damage if left untreated.
RA may also increase your risk of dry eye and glaucoma.
It’s also possible to develop Sjögren’s disease, an autoimmune condition that causes inflammation in the tear-producing glands of the eyes. Artificial tears may help treat dry eye associated with Sjögren’s.
Rheumatoid arthritis and the teeth
RA-related inflammation may affect your mouth, resulting in dry mouth. If left untreated, dry mouth may lead to gum disease and tooth decay. You may notice red or tender gums.
A dentist may recommend treatments for dry mouth, such as rinses or prescription medications, to help increase saliva production.
Did you know?
Rheumatoid vasculitis is a rare complication involving the blood vessels. It’s associated with more serious or advanced cases of rheumatoid arthritis. It can cause rashes on areas such as the legs.
RA can affect each person differently, so you may not have all of these symptoms. If you have RA, you may even experience remission, or periods where your symptoms stop.
In addition to medications, there are lifestyle changes that can have a positive impact on your condition. If you’ve received an RA diagnosis, talk with a doctor about the following strategies:
- dietary interventions
- exercise to help boost your energy and preserve joint mobility
- stress management techniques, which may include yoga, deep breathing, or tai chi
- mental health support from a counselor, therapist, or support group