5 Joints Affected by Rheumatoid Arthritis — and How to Care for Them
Rheumatoid arthritis affects everyone differently, but pain, inflammation, and stiffness often occur in several particular joints. Here’s what you can do to ease symptoms.
Rheumatoid arthritis (RA) affects everyone differently, but certain joints are more often involved in the disease than others. These typically include joints that have a synovial lining, a thin membrane that covers their surfaces and that can thicken when inflamed, explains Michelle J. Ormseth, MD, a rheumatologist at Vanderbilt University Medical Center in Nashville, Tennessee.
“However,” says Dr. Ormseth, “not all joints that have a synovial lining are involved in RA, and it’s unclear why RA follows the pattern of joint involvement that we observe.” One reason the condition can be so hard to live with is that it typically affects the fingers, wrists, knees, ankles, and feet — joints that get a lot of use, explains David Lee, MD, a rheumatologist at Kaiser Permanente Riverside Medical Center in Riverside, California.
In general, you can help limit joint damage by following your medication regimen, not smoking, getting regular exercise, and eating an anti-inflammatory diet. But when it comes to soothing the joints that ache the most, these tips can help.
1. Rheumatoid Arthritis and Your Knees
Where: RA typically affects both sides of the body, so most people feel pain in both knees.
What worsens it: When you’re having a flare, repetitive use and high-impact exercises may make knee pain worse. Being overweight and sedentary increases knee pain and stiffness, whether or not you’re having a flare.
What helps: Maintaining a healthy body weight and exercising regularly can help relieve pain and stiffness. “Physical activity is not known to worsen arthritis in joints; in fact, most people with RA experience stiffness with inactivity and find relief with joint movement,” says Kim Huffman, MD, PhD, an associate professor of medicine in the division of rheumatology and immunology at the Duke Molecular Physiology Institute in Durham, North Carolina. Opt for a mix of lower-impact cardio (swimming or cycling), strength training, and flexibility exercises. Exercise can help you strengthen the muscles in your legs and increase flexibility and mobility. A physical therapist can help you develop an individualized exercise program, according to the American Academy of Orthopaedic Surgeons.
2. RA and the Forefoot
Where: The joints in the toes and the ball of the foot.
What worsens it: As Dr. Huffman notes, “RA begins as a systemic process rather than within the foot or hand itself. In other words, RA foot (and hand) manifestations don’t result from weight-bearing but from a systemic inflammatory process. However, once the inflammation is present in the foot or ankle, poor shoe wear can certainly exacerbate the pain and potential deformities. First and foremost, the foot deformities from RA (bunions, claw toes, and hammertoes) are generally regarded as a sign of disease activity, likely aggravated by poor shoe fit.” Shoes that are tight and squeeze the toes or shift weight onto the ball of the foot, such as high heels, will likely exacerbate symptoms.
Painful bumps and calluses can develop on the ball of the foot because bones in the middle of the foot can be pushed down as the toes deform, according to the American Academy of Orthopaedic Surgeons (AAOS).
What helps: Wear shoes that fit well, provide cushioning, and leave plenty of room for your toes. Specially fitted orthotics, such as inserts for your shoes, can also help relieve pressure on the parts of the feet that are most affected. Remember to stretch and exercise your feet, toes included, to keep joints flexible. And when foot pain strikes, the AAOS recommends icing the most painful part of your foot three to four times a day for 20 minutes at a time.
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3. Caring for Ankle Joints Affected by RA
Where: Both ankles, generally after other joints in the feet.
What worsens it: That’s still under investigation, though ongoing disease activity and subsequent joint damage are the main culprits, notes Huffman. Early signs of ankle involvement include difficulty with ramps and stairs and as the disease progresses, even walking and standing can become painful, notes the AAOS.
What helps: Special orthotics, such as inserts for your shoes, and braces that support the ankle can help lessen pain and make walking easier. When joints ache, stick to low-impact exercises such as swimming and biking. Huffman points out that "the research supporting this focuses on longer term RA that has led to ankle damage (secondary osteoarthritis) where weight-bearing exercise may increase the joint damage.” She suggests her patients do whatever activity they can tolerate — that any is better than none and that “the chance they are doing something to worsen the arthritis is very small.”
4. When RA Causes Pain in Your Wrists
Where: Both wrists, often early in the disease. The pain often affects the joint between the radius and ulna, the bones of the forearm.
What worsens it: “If the wrists are inflamed, more intense activities may be less comfortable, but some activity — especially movement without resistance — is better than none,” says Huffman. And again, the chance that activity increases the RA inflammatory process is small, per Huffman, who encourages general range of motion exercises, as well as contacting a rheumatologist to minimize duration of the flare.
What helps: Medications that help ease inflammation, pain, and stiffness, including oral medications and cortisone injections, can help. Assistive devices such as reachers, grabbers, and jar openers — special tools that make it easier to grip objects — can help lessen strain. Using braces on the wrist and trying gentle exercises recommended by your doctor or a therapist may also help.
5. Finger Joints and Rheumatoid Arthritis
Where: The knuckles in the middle and at the base of the fingers.
What worsens it: Gripping objects or using the fingers repetitively during a flare can worsen symptoms, though Huffman notes that some activity of these joints is better than none.
What helps: “During a severe flare,” says Ormseth, “use of involved joints may need to be limited to protect the joints and reduce pain until the disease is under control again.” Look for assistive devices to help you with tasks like putting on shoes, zipping and buttoning clothes, and grabbing and gripping objects. Consider trying helpful strategies like adding accessories to doorknobs so they can be turned more easily, using Velcro fasteners on clothing, switching to lightweight pots and pans, and adding foam padding to pens and pencils. Cold packs can relieve painful, swollen hands, while heat can reduce stiffness, according to the Cleveland Clinic; apply them for no more than 20 minutes at a time. Finger splints can also help relieve pain in your fingers.
Additional reporting by Deborah Shapiro.