When people hear the general term arthritis, they typically think of an older person with joint pain. This concept misses the mark when describing rheumatoid arthritis (RA). When people think about RA, they might picture someone with grossly disfigured hands or feet. One of the symptoms of RA that doctors often examine is bone erosion – typically in the fingers.
But as an autoimmune disease, RA can impact much more than the bones. It can damage a variety of soft tissues including the eyes (iritis), lungs (fibrosis), heart, blood vessels (vasculitis), nerves (carpel tunnel), and skin (nodules, ulcers), and connective tissue (cartilage, tendons, ligaments).[i] Often-times, the soft tissue damage occurs long before bone erosion is visible or even before an official RA diagnosis comes.
Two symptoms which I personally experienced before an official diagnosis of RA were iritis – inflammation in the eyes, and torn Achilles tendons (an ongoing problem with me). Chronic tenosynovitis (inflammation of the sheath of a tendon), such as that found in rheumatoid arthritis, can result in the permanent damage and tearing of the involved tendon. Such tendon problems caused by RA are well known by the scientific community and are linked to joint deformities.[ii] Tendon problems have even been posited as being one of the most powerful predictors of early RA.[iii] Sophisticated imaging techniques developed in the last few decades, such as MRIs and ultrasound, can reveal connective tissue damage in joints caused from RA including tenosynovitis and bursitis.[iv] Bursitis, inflammation of the fluid-filled sacs that protect joints[v], often accompanies tenosynovitis. RA is also implicated as a cause of soft tissue damage in shoulders[vi] and cartilage damage in knees.[vii]
It is interesting to note that the diagnostic criteria[viii] used to diagnose RA, while including general joint synovitis as indicated by pain, swelling, and tenderness, don’t include other soft tissue problems. These criteria are in place in spite of the fact that some of the soft-tissue problems occur long before the presence so-called hallmark symptoms like bone erosion. It could be that such a wide variety of symptoms across patients occur and the criteria are based on those symptoms that tend to be universal. However, a quick read of patient blogs (see my list) reveals that many RA patients suffer profusely from soft tissue damage. From a patient perspective, it would be beneficial if soft-tissue damage from RA would be given increased attention in the general literature (it’s difficult to find information) and in diagnostic criteria.