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. 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 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.
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 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.”
“The foot deformities from RA (bunions, claw toes, and hammertoes),” adds Huffman, “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.
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 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 American Academy of Orthopedic Surgeons (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. How to Care 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 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, at the wrist.
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 range of motion exercises.
What helps: Medications that help ease inflammation, pain, and stiffness, including oral medications and cortisone injections, can help. You may want to check in with your rheumatologist to minimize duration of the flare, if possible. Assistive devices such as reachers, grabbers, and jar openers — special tools that make it easier to grip objects — can help lessen strain. Wrist braces and 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 Michelle J. Ormseth, MD, a rheumatologist at Vanderbilt University Medical Center in Nashville, Tennessee, “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; apply them for no more than 20 minutes at a time, Cleveland Clinic recommends. Finger splints can also relieve pain in your fingers.
The Takeaway
While the symptoms of rheumatoid arthritis vary from person to person, certain joints tend to be more involved than others: the fingers, wrists, knees, ankles, and feet.
To limit joint damage, it’s important to follow your RA treatment medication regimen and make healthy lifestyle choices, like exercising, not smoking, and eating an anti-inflammatory diet.
But when certain joints are in pain, supportive footwear, braces or splints, some adaptive devices, and hot and cold therapy can alleviate symptoms.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Samir Dalvi, MD, is a board-certified rheumatologist. He has over 14 years of experience in caring for patients with rheumatologic diseases, including osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, and gout.
Diana Rodriguez is a full-time freelance writer with experience writing health-related news and feature stories. She is skilled in taking confusing doctor-speak and complex medical topics and crafting language that's easy for readers to understand. She is a managing editor at the Mayo Clinic and has written extensively for HealthDay. She lives in Louisville, Kentucky and holds a bachelor's degree in journalism and French from Miami University.
