How does rheumatoid arthritis (RA) cause joint deformity?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Deformity of the joint may develop over time as articular and supporting structures are damaged by the inflammatory process. By the time deformity has developed, the diagnosis of RA is in little doubt; however, optimal management of RA requires that the inflammatory aspects of the arthritis be recognized before the development of deformity.

Loss of cartilage from proteolytic and mechanical degradation, combined with stretching and weakening of the periarticular ligaments and their attachments, allows forces acting across the joints to deform them. The small joints in the hands and feet are most commonly deformed in this manner; more than 10% of patients with RA develop deformity of the small joints of the hands within the first 2 years of the disease, and at least 33% develop such deformities over time. Joint instability is seen if disruption of supporting structures has occurred.

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