Joint Damage Pain Deformities Loss Of Function: Late
It is important for people with these symptoms to be diagnosed as soon as possible, because if RA isnt diagnosed and treated early the synovial lining can become so inflamed that it damages and erodes the cartilage this makes bone loss more likely.
Moving joints becomes more difficult, and flare-ups can occur with greater frequency. These joint changes are called erosions, and they can lead to deformities of the bone, such as crooked fingers, says Daniel Solomon, MD, MPH, chief of the section of clinical sciences in the division of rheumatology at Brigham and Womens Hospital in Boston. In severe cases, bones may eventually fuse together. All of this further contributes to pain and loss of function.
Should I See A Doctor
Its common to have aches and pains in your muscles and joints from time to time. This may especially be true if you take part in unusual or strenuous physical activities.
So, how can you tell the difference between the early signs of arthritis and normal pain and stiffness? And, how do you know when you should see a doctor about your symptoms?
If you have swelling or stiffness that you cant explain and that doesn’t go away in a few days, or if it becomes painful to touch your joints, you should see a doctor. The earlier you get a diagnosis and start the right type of treatment, the better the outcome will be.
Here are some other things to think about that might help you decide whether you need to see a doctor:
Gout And Calcium Crystal Diseases
Gout is a type of inflammatory arthritis that can cause painful swelling in joints. It typically affects the big toe, but it can also affect other joints in the body.
Joints affected by gout can become red and hot. The skin may also look shiny and can peel.
Its caused by having too much urate, otherwise known as uric acid, in the body. We all have a certain amount of urate in our body.
However, being overweight or eating and drinking too much of certain types of food and alcoholic drinks can cause some people to have more urate in their bodies. The genes you inherit can make you more likely to develop gout.
If it reaches a high level, urate can form into crystals that remain in and around the joint. They can be there for a while without causing any problems and even without the person realising they are there.
A knock to a part of the body or having a fever can lead to the crystals falling into the soft part of the joint. This will cause pain and swelling.
There are drugs that can reduce the amount of urate in the body and prevent gout attacks. Examples are allopurinol and . If youre having a gout attack, youll also need short-term pain relief. Non-steroidal anti-inflammatory drugs as well as paracetamol can be good drugs to try first.
Men can get gout from their mid-20s, and in women its more common after the menopause. Taking water tablets can increase the risk of gout.
There are also conditions that cause calcium crystals to form in and around joints.
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What Are The Early Warning Signs
Joint pain and morning stiffness are the most common early warning signs of RA. The joint pain of RA has some unique characteristics that separate it from joint pain due to other causes. The characteristics of joint pain caused by RA are:
Multiple joints are affected at once .
Symmetric joints are affected .
Smaller joints are more commonly affected than larger joints .
Morning stiffness of these joints that lasts more than 30 minutes can occur.
Joint pain improves with activity.
Joint pain is worse after resting.
Small Joint Inflammation: Symptoms In The Fingers Wrists Toes And Ankles
For more than half of RA patients, the first symptoms will occur in one or more of the small joints of the fingers , the wrists, the toes , or the ankles. Symptoms can begin slowly and subtly over a period of weeks or months, worsening over time.
In the majority of patients, this swelling and pain is symmetrical, meaning the same joints are affected on both sides of the body.
But this is not always the case. Its important not to wait to treat until the disease becomes symmetric. Early diagnosis and treatment are key to prevent joint damage even if only one joint on one side of the body is affected, notes Rebecca Manno, MD, a rheumatologist and adjunct assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore.
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Rheumatoid Arthritis Can Impact A Large Number Of Other Organs
RA can significantly affect a number of other organs as it progresses, especially if the disease is not controlled with medications, including:
- The Eyes Episcleritis, an inflammation of the episclera a tissue in the white part of the eye can occur.
- The Lungs Lungs can show scarring or develop interstitial lung disease, which can cause difficulty breathing, breathlessness, or a mild cough. Usually this is seen as the disease progresses, but it can show up in some early-stage patients, says Mannon.
- The Skin Some patients may develop blisters or nodules under the skin that are caused by inflamed blood vessels. Rashes and skin ulcers can erupt as well.
- The Mouth People with RA are twice as likely to have gum disease as those without RA. Research suggests that underlying gum disease may be a trigger for developing RA, and that getting treated for gum disease can improve joint symptoms.
- The HeartHeart failure is twice as common in people with RA, and theyre also 50 percent more likely to have a heart attack.
- The Kidneys RA can also damage the kidneys, especially when RA is not well controlled.
Neck Joints Are Not Spared Ra Joint Pain And Damage
- The Neck Someone with RA can also experience inflammation and pain in the neck. This can cause stiffness, weakness, and loss of motion. If not treated, severe inflammation in the neck can lead to instability of the cervical spine.
- The Throat Although rare, the cricoarytenoid joint near the windpipe may also swell from the disease, affecting breathing.
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What Type Of Hand Surgery Is Most Commonly Performed On The Specific Joints Affected By Arthritis
- Base of the thumb: Where your thumb and wrist join. Common surgical options include removing part or all of one of the trapezium bone , tendon transfer or joint fusion.
- Knuckles : Joint replacement is almost always considered for this repair. Rheumatoid arthritis can cause serious damage and disability to your knuckles.
- Second joint of your finger : Osteoarthritis commonly causes stiffness and loss of motion. Joint replacement or fusion are considered for these joints. Because you use these joints frequently, there is a chance your implant could wear out. In this case, your provider may recommend further surgery.
- Top of finger joint : Joint fusion is commonly used to treat arthritis in this joint.
How Arthritis In The Back Is Diagnosed
Diagnosing arthritis in the back begins with taking your medical history and doing a physical exam of your back and legs to assess your mobility/flexibility and make sure your nerves are working properly. The doctor will ask questions about:
- Where the pain is occurring
- How long the pain has lasted
- What the pain feels like/how severe it is
- What situations/activities make the pain feel better or worse
- How the pain is affecting/limiting your daily function
Imaging tests are usually needed to help confirm a diagnosis of arthritis. X-rays are typically the first imaging test ordered. They can joint damage/bone spurs, but cannot show damage to soft tissues such as muscles, ligaments, or bulging discs. Other tests may be ordered to look for changes or damage that is not visible on X-rays. These may include MRI, CT, ultrasound, bone scans, or other tests as needed. The gold standard to diagnose arthritis in the back is actually an injection called a medial branch block, but its not often necessary, says Dr. Kirschner.
Other blood tests may look for genetic markers associated with axial spondyloarthritis, such as HLA-B27, or antibodies associated with rheumatoid arthritis .
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Lifestyle Changes That Help Ease Ra Symptoms
In addition to treatment with drugs, the following remedies and lifestyle approaches can help alleviate symptoms at any stage of RA:
Occupational or Physical Therapy Rheumatologists frequently refer patients to occupational or physical therapy practitioners to help patients find ways of moving that are less painful, and that strengthen muscles, says Manno. Decreased movement can cause muscles to atrophy and can reduce a persons cardiovascular fitness.
Arthritis In The Heel And Ankle
Several types of arthritis, including OA, RA, AS, and PsA, can affect the heels and the ankles.
Symptoms of arthritis in the heel might include:
- Stiffness upon awakening in the morning
- Recurring pain in the heel
- Swelling of the heel
- Limited movement
- Skin changes, including rashes and growths
Inflammation at the heel from RA, AS, or PsA can lead to conditions that cause heel pain. This might include Achilles tendonitis, plantar fasciitis, or retrocalcaneal bursitis, a condition in which the bursa becomes inflamed, causing pain and swelling.
The ankle is not affected by arthritis as often as other joints, but it can be a source of severe pain and instability when it is affected. Additional symptoms of ankle arthritis include swelling and stiffness of the ankle and problems with mobility. Ankle arthritis will eventually affect gaitthe way a person walks.
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Early Rheumatoid Arthritis Symptoms
Rheumatoid arthritis also causes pain and swelling in the joints. Usually the small joints of the fingers and toes are affected first. The most common symptom is stiffness, and it takes a long time to get the joints moving, especially in the morning.
The disease is symmetrical, meaning that if your left index finger is swollen and painful, youll usually have the same symptoms in the right index finger.
Rheumatoid arthritis can be systemic, meaning it can develop to the point that it affects the whole body.
Other non-joint symptoms can include:
- shortness of breath
Coping With Arthritic Feet
- Steroid medications to be injected into the affected joints
- Custom-made shoes, shoe inserts, or arch supports to support your ankles and feet
- Physical therapy that includes foot exercises and stretches
Your doctor might recommend surgery if other treatments dont work to manage foot and ankle arthritis. Surgical options might include:
- Arthrodesis: Also called fusion surgery, this involves fusing bones together with rods, pins, screws, or plates. When bones heal, the bones will stay joined.
- Joint replacement surgery: Also called arthroplasty, this surgery is used only in severe cases. The surgeon will take out damaged bones and cartilage and replace them with metal and plastic.
Home remedies you can try to help you cope with arthritic feet include:
- Creams containing capsaicin or menthol: These creams may stop the nerves from sending out pain signals.
- Hot or cold packs in the affected areas
- Gentle exercises, including yoga and tai chi
- Foot massage
Making changes to your lifestyle can also help you to feel better and keep arthritis in your feet from getting worse. Lifestyle changes might include choosing low-impact exercises like swimming rather than high-impact ones , maintaining a healthy weight to keep stress off joints, and reducing or avoiding activities that trigger symptoms in the feet and ankles.
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Pay Attention To Joint Pain Swelling And Other Early Symptoms
As the person experiencing symptoms, you are on the front line for early diagnosis. Be sure to see a rheumatologist if you have swelling, redness, and stiffness in the small joints of your hands, feet, wrists, and ankles. Also, Dr. Niewold says, This tends to be symmetric. Its not a perfect symmetry, but usually you will get symptoms in both hands or both feet. Feeling very stiff in the morning is another symptom.
A rheumatologist may use the following to diagnose you:
- A physical exam of your joints
- Blood tests, which will show if there is an inflammation in the body
- X-rays, MRIs, or other imaging tests, to see how severely the joints are affected
Very Early Therapy Within The First 3 Months Of Symptoms
The first 12 weeks of symptoms represents a potentially important therapeutic window in patients with very early synovitis destined to develop RA. However, treating patients within this phase presents three challenges: getting patients with symptoms of such short duration to clinic predicting which patients with very early synovitis will develop RA and thus require treatment determining how such patients should be treated.
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Some People Experience Fatigue And Other Flu
Up to a third of patients have more systemic symptoms before or along with joint pain and inflammation. This can include fatigue, muscle pain, mood changes, and low-grade fever. As the digital arthritis community CreakyJoints puts it, “Some patients describe the symptoms of RA as being ‘flu-like’ that general yucky feeling you get when you are on the verge of getting sick.”
Although these symptoms can be an early sign of RA, because they overlap with other illnesses, RA usually isn’t the first thing the doctor considers, especially without joint pain.
Other symptoms many don’t realize can also indicate RA include rashes, easily bruising, itchy and dry eyes, and sharp chest pain brought on my irritation of the costosternal joints, which connect the ribs to the breastbone.
What Does Early Arthritis Feel Like
In general, the first sign of arthritis is pain, also called arthralgia. This can feel like a dull ache or a burning sensation. Often, pain starts after youve used the joint a lot, for example, if youve been gardening or if you just walked up a flight of stairs. Some people feel soreness first thing in the morning.
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Other Causes Of Joint Pain
Joint pain can also result from abnormal pain processing, which occurs in conditions such as fibromyalgia.
Because joint pain and swelling can have many different causes, she stresses that obtaining the correct diagnosis is the most important part. You have to learn the cause of the joint pain and swelling in order to treat it correctly. Treatment options can vary widely, so it’s important that you don’t try to fix your joint pain or swelling on your own.
How Long Does It Take To Recover From Hand Surgery
Recovery time depends on many factors, including the severity of your condition, type of surgery you had, the skill of your surgeon and your compliance with therapy. Most people can return to their activities about three months after joint reconstruction surgery. Your team of caregivers can give you the best estimate of your particular recovery time.
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Surgery For Back Arthritis
Surgery is a last resort when it comes to arthritis in the back. Know that 95 percent of people with back pain will not need surgery, and 75 percent will fully recover within three months, says Dr. Tiso.
Doctors recommend that you try medications, physical therapy, and weight loss before considering surgery, says Dr. Kilian. The best surgical outcomes often occur in patients who are actively involved in physical therapy and have a healthy body weight, he says.
The type of surgery depends on the type of arthritis and region of the back that is affected. Depending on the procedure performed, surgery aims to decompress any pinched nerves and free up the nerve roots from bone spurs and other tissues that may be pressing on them.
The Treatment Of Early Ra
The time frames within which the effects of therapy have been studied in most trials of early intervention in RA have been somewhat arbitrarily defined and have been based on the principle of the earlier the better .
Most trials of early therapy have chosen a maximum symptom duration of 2 years. Therapeutic approaches studied to date have included intra-articular and systemic steroid, DMARD monotherapy, DMARD combination therapy and anti-TNF- therapy these approaches in each case were compared with less aggressive approaches to treatment.
Those studies that have shown benefit from early combination therapy have used steroids, albeit in different regimens.,, Steroids certainly allow a more rapid control of synovitis than conventional DMARDs, explaining their incorporation in step-down regimes. The use of steroid in the medium to long-term, however, remains controversial. Several studies suggest that oral steroids reduce the risk of development of erosions in patients with early RA, and there is a clear biological rationale for this. However, data from the WOSERACT study does not support this clinical benefit.
Therefore, even with potent regimens it appears unlikely that permanent drug-free remission can be induced in patients with established RA once symptoms have been present for more than 3 months.
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Heart Disease Risk Increases With Ra
One of the most concerning conditions that can evolve in people with RA is cardiovascular disease, especially ischemic heart disease, in which there’s a reduced blood supply in the heart.
Its crucial that people with RA continue to be monitored for heart disease risks by their general practitioner or cardiologist. In a review of preventative measures for people with RA, published in June 2020 in the journal Nature Reviews Rheumatology, the authors noted that catching risk factors early, such as high blood pressure or high blood lipids, is especially important for preventing a serious cardiac event.
In addition, people with RA are more likely to develop type 2 diabetes another cardiovascular risk factor as those without RA, possibly because the inflammation of RA affects blood sugar levels and insulin resistance.