12 July 2021

Rheumatoid arthritis: symptoms, causes, treatment

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Symptoms, causes, diagnosis and treatment of rheumatoid arthritis

Rheumatoid arthritis, the most severe osteoarticular disease, is a chronic inflammatory pathology affecting the joints.  It is an autoimmune disease and, like in all other autoimmune diseases, the immune system, which has the role to protect the body, attacks healthy tissues, in this case the synovial membrane that covers the joint capsule. Inflammation leads to an increased membrane volume, causing the formation of the so-called “synovial pannus”, which expands until the cartilage is destroyed. Inflammation can also involve blood vessels, heart, lungs, kidneys, central and peripheral nervous system, and the visual system. More frequently rheumatoid arthritis affects individuals between 40 and 60 years of age, although cases in childhood and senile age are not excluded, and it involves more women than men.


In the early stages, this disorder affects the small joints (hands, wrists, ankles, feet) and extends over time to the larger joints (elbows, shoulders, knees, hips, etc.).  It manifests itself with pain, swelling, feeling of heat and stiffness in the affected joints. These symptoms may be associated with general malaise, loss of appetite, fatigue.  Joint stiffness and motion limitation are usually present in the morning and can last for hours.  Over time, this can cause loss of function and joint deformity.

Causes of rheumatoid arthritis

A fully known cause for rheumatoid arthritis has not been identified, but studies have identified several genetic and environmental risk factors. In people with a genetic predisposition to this disease, an environmental event can trigger an abnormal activation of the immune system that attacks the joints, resulting in chronic inflammation and joint damage.  Non-genetic causes may include:

  • Gender and age
  • Viral infections
  • Smoking
  • Obesity
  • Hormonal factors


The first symptoms of rheumatoid arthritis are similar to those of other rheumatic diseases, so it is not always easy to diagnose it early. Swollen joints, pain and morning stiffness are the first signs to look out for. To carry out an accurate diagnosis the following may be necessary:

  • Laboratory tests: to detect rheumatoid factor, CCP antibodies, and current inflammation measured with erythrocyte sedimentation rate (ESR) and C-reactive protein (PCR) values.
  • Instrumental tests: X-rays (hands and feet), joint ultrasound, MRI, BMD

When the disease has an extra-articular involvement, a spirometry, chest CT, and echocardiogram may also be necessary.


Early diagnosis is essential to prevent irreversible joint damage. Given the complexity of this disease, several specialists are involved in its treatment, first and foremost the rheumatologist.

Today, drugs used to treat rheumatoid arthritis have improved prognosis, reducing inflammation and pain.  However, these are not always enough.  If the disease is at an advanced stage, it may be necessary to intervene surgically to regain functional skills.

UPMC Institute for Health Chianciano Terme has a team of highly specialized orthopedic surgeons for diagnosis and treatment of the most common diseases of the hand and wrist.

For further information: +39 0578 61198