Pictures of Rheumatoid Arthritis in Knees, Hands, and More

How RA Affects Each Area of the Body

Rheumatoid arthritis (RA), an autoimmune disease, causes distinct joint damage that can be seen on X-rays. Its symmetrical pattern—meaning it occurs on both sides of the body—helps identify osteoarthritis (OA) from rheumatoid arthritis in knees. Pictures of RA show damage in both knees, where OA typically affects only one.

Imaging studies in RA also show joint space narrowing, bone erosion, and joint deformity. This damage occurs from inflammation in the synovial lining (membrane lining the joints). The inflamed synovium releases enzymes that digest bone and cartilage.

This article discusses what RA looks like in different joints. It explains common symptoms and shares pictures of rheumatoid arthritis in knees, hands, feet, shoulders, hips, spine, and other joints. 

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An Overview of Rheumatoid Arthritis

Rheumatoid Arthritis in Knees

The knee joint is the largest and strongest one in the body. It's formed by the femur (thighbone), tibia (shinbone), and patella (kneecap) coming together. In a healthy knee, these are cushioned by wedge-shaped pieces of cartilage (called the menisci).

Rheumatoid Arthritis in the Knee

When this area is damaged by RA, the pain, swelling, and stiffness may be severe, especially after you've been inactive for several hours. Other symptoms may include:

  • Difficulty bending and/or straightening the knee
  • The knee "locking" while you walk
  • A grinding, snapping, or creaking noise when you walk
  • Weakness or buckling

Joint damage and deformity can be repaired by knee replacement surgery, which can also reduce pain and restore function. An estimated 790,000 total knee replacements are performed in the U.S. each year.

Rheumatoid Arthritis in Hands and Wrists

Advanced Rheumatoid Arthritis

Rheumatoid arthritis most commonly begins in the small joints of the fingers, hands, and wrists. It can damage joints and cause several kinds of hand deformity, such as:

  • Rheumatoid nodules: Firm lumps under the skin near joints
  • Joint effusion: Abnormal accumulation of fluid inside the joint
  • Joint stiffness: Difficulty moving or impaired range of motion
  • Ulnar drift/ulnar deviation: A characteristic deformity in which the fingers appear to lean toward the little finger
  • Contractures: Shortening or hardening of muscles and connective tissues, leading to deformity and rigid joints
  • Wrist subluxation: Partial dislocation (see below)

Rheumatoid Arthritis in Ankles and Feet

X-ray image of feet with bunions

 andervelden / Getty Images

An estimated 90% of people with RA will have symptoms in their feet and ankles at some point, and these are among the smaller joints that may be impacted early in the disease progression.

The specific problems attributed to foot and ankle RA depend on the joints involved:

  • Ankle: An early symptom of ankle involvement is pain while walking up or down slopes or stairs.
  • Hindfoot (heel area): The first symptom of RA in the hindfoot is difficulty walking on irregular surfaces, such as rough terrain or gravel. Pain is most common on the outside of the foot. Later on, bone movement can lead to a deformity called flatfoot that includes pain in the arch, inside of the ankle, or outside of the ankle.
  • Midfoot (top of foot): Ligaments that support your arch can be weakened by RA, which can lead the arch to collapse. This often causes the toes to point outward and may also lead to a large bump in the arch.
  • Forefoot (ball of foot, toes): Complications of RA in the toes and ball of your foot include bunions (painful swelling at the base of the big toe) and permanently curved toes, which are called hammertoes or claw toes.

Deformities can make it difficult not only to walk but to wear shoes.

Rheumatoid Arthritis in Shoulders

X-ray of patient with shoulder pain

 Anthony Bradshaw / Getty Images

The ball-and-socket joint of the shoulder may be an early joint for RA to hit. Research suggests that shoulder impairment may be significant in the first 18 months of disease activity.

Symptoms specific to RA in the shoulder include:

  • Lowered shoulder muscle strength
  • Impaired shoulder and arm movement
  • Shoulder pain

These symptoms can have a big impact on your activity level and ability to perform daily activities.

Rheumatoid Arthritis in Elbows

X-ray of elbow affected by rheumatoid arthritis

 choja / Getty Images

Studies say the elbows are involved in between 20% and 65% of rheumatoid arthritis cases. Elbow symptoms you may experience include:

  • Pain
  • Swelling
  • Joint instability

If drug treatments and other approaches are unsuccessful at managing elbow symptoms, surgical procedures may be considered.

The first surgery is typically arthroscopic synovectomy, in which much of the synovium is removed. If that's unsuccessful, elbow-replacement surgery may be considered.

Rheumatoid Arthritis in Hips

Hip joint pain
MedicalRF.com / Getty Images

RA can impact any joint and the more aggressive it is, the more joints it affects. When it strikes your weight-bearing joints—the hips, knees, and ankles—it can have a huge impact on your mobility.

Symptoms specific to RA in the hips include:

  • Aching pain in the groin, buttocks, outer thigh, or knee
  • Pain in the hip joint that's severe enough to make walking difficult
  • Pain that's worse after sitting or sleeping but improves with activity

Hip replacement surgery can reduce pain, restore function, and correct joint damage and deformity in people with RA.

Joint replacements exist for other joints too, such as the shoulder, wrist, and ankle, but the most common ones are for hips and knees. About 450,000 Americans have a hip replaced each year.

Rheumatoid Arthritis and Joint Dislocation

X-ray of dislocated shoulder

  Science Photo Library / Getty Images

Joint erosions, which are visible on X-ray, are associated with limited joint mobility and function. As the joint becomes eroded and cartilage is damaged, bone-on-bone contact can be the painful end result.

Severe damage to cartilage, tendons, ligaments, and bone can cause joints to become unstable. Joint instability can lead to subluxation (partial dislocation) or, less often, dislocation.

While many joints can become deformed or subluxed due to RA, toes are among the more common ones. The associated pain, damage, and functional limitations often lead to a loss of mobility.

People who've had RA for more than a decade are at risk of developing a condition called cervical myelopathy, in which joints of the spine can dislocate and put pressure on the brain stem, spinal cord, and spinal nerve roots.

This is an uncommon but serious problem that needs to be corrected with surgery to avoid permanent damage.

Rheumatoid Arthritis Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Rheumatoid Arthritis and Systemic Disease

Rheumatoid arthritis doesn't only affect the joints. It's a disease of systemic inflammation that may also affect other parts of your body, including:

  • Eyes: Inflammation from RA is associated with cataracts, dry eye syndrome, glaucoma, and scleritis (inflammation of the white part of the eye).
  • Heart: People with RA have higher rates of cardiovascular diseases, including heart attack, stroke, heart failure (HF), ischemic disease, pericarditis, myocarditis, and cardiomyopathy.
  • Jaw: RA can affect the temporomandibular joint (TMJ) that moves your jaw. TMJ can make it harder to open and close your mouth, cause pain when chewing, and headaches. 
  • Kidneys: RA is associated with higher rates of chronic kidney disease, but research shows RA medications that target inflammation may preserve kidney health.
  • Lungs: Rheumatoid lung disease is most common in men who are positive for rheumatoid factor, have subcutaneous nodules, and have a long disease course.
  • Nerves: Nerve compression or entrapment can be caused by joint damage and inflammation. Carpel tunnel syndrome and peripheral neuropathy are the most common nerve conditions in RA.
  • Skin: RA can cause nodules (lumps of tissue under the skin). Inflammation of blood vessels (vasculitis) in the skin can appear as tiny red dots that can progress to skin ulcers. RA medications can also make you more sensitive to sun exposure. 
  • Teeth: Gum disease and tooth loss are also more prevalent in RA, especially in those who also have Sjögren’s syndrome. Medications used to treat RA can also contribute to an increased risk of oral bacterial infections and fungal infections, like oral thrush. 

Summary

Rheumatoid arthritis causes a distinct pattern of joint damage that can be seen in X-rays. This is typically symmetrical, with the same joints affected on both sides of the body. 

RA commonly affects the hands, wrists, elbows, shoulders, knees, hips, ankles, and feet. Imaging studies often show joint erosion and dislocations that cause symptoms of pain, inflammation, and a decreased range of motion.  

Other parts of the body can be affected by RA, including the eyes, heart, lungs, skin, and teeth. If you've been diagnosed with RA, tell your healthcare provider about any new symptoms that arise, whether they relate to your joints or not.

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By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.