Rheumatoid arthritis is a chronic inflammatory disorder of joints, which affects more than one joint symmetrically. Apart from the joints, this systemic disease can affect organs in the body too. Including the heart, and blood vessels; Lungs; Skin; And muscles.
The exact cause of rheumatoid arthritis is not known. However, it is thought to be associated with both genetic factors, and environmental factors, such as smoking and certain infections. These factors together will alter the structure of proteins in the joints, leading to an inappropriate immune response against body’s own tissues, which is known as auto immunity. Here, the immune system starts attacking these proteins, causing excessive proliferation of the synovial cells and formation of a structure called the pannus. Pannus formation will ultimately result in the destruction of joint cartilage, and bone erosion, leading to the symptoms of rheumatoid arthritis. Typically, there is involvement of multiple joints symmetrically. The hallmark symptom of rheumatoid arthritis is, chronic morning stiffness for more than 6 weeks, with an episode lasting for more than one hour, which improves with the use of the joint. Commonly affected joints include the proximal inter phalangeal joint; meta carpophalangeal joint; and the wrists of the hands. Associated symptoms include reduced grip strength; Reduced range of motion; Pain; and swelling. In addition to hands, joints like the hip and knee; and the joints of the foot can also be affected. Involvement of the atlantoaxial joint of the spine can cause neck pain.
It is important to note that rheumatoid arthritis does not usually cause redness and warmth over the affected area, because the inflammatory response is so gradual. Over time, disease progression can lead to deformities due to weakening of the joint capsule. These include, boutonnier and swan neck deformity; claw toe; and ulnar deviation of the hand. Rheumatoid nodules may also present later in the disease.
As already mentioned, rheumatoid arthritis can cause extra articular symptoms, suggestive of systemic involvement. These symptoms may include fever; Anemia of chronic disease; carpal tunnel syndrome; lung fibrosis, which may manifest as shortness of breath; and kidney disease.

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