Rheumatoid arthritis is a system-wide disease that’s triggered by faulty reactions from the immune system. But how does immune dysfunction lead to joint pain?

See What Is Rheumatoid Arthritis (RA)?

Using illustrations from our Rheumatoid Arthritis Video, this blog post explains the progression of RA in the joints of the hand.

Watch: Rheumatoid Arthritis Overview Video

Rheumatoid arthritis is a type of arthritis that causes inflammation throughout the body’s joints. It causes pain, stiffness, swelling, and deformity in the joints.

Symptoms often appear first in the joints of the hands and feet. Specifically, the joints at the base of the fingers and the base of the toes.

See Hand Rheumatoid Arthritis (RA) Signs and Symptoms and Foot and Ankle Rheumatoid Arthritis (RA) Symptoms

Joint problems first develop as membranes that line and lubricate the space between joints, called synovium, become inflamed as they are mistakenly attacked by white blood cells.

See How Do Synovial Joints Work?

From here, the disease progresses in 4 phases.

In phase 1, the synovium responds to the attack of the white blood cells, or leukocytes, by quickly growing layers of new cells. This can cause the surface of the synovium to become rough and grooved.

It also causes the fluid in the synovium to increase, causing joint swelling. This immune response can trigger warmth and redness in the joint.


Phase 2 involves the synovium continuing to thicken, which causes the formation of tissue known as pannus over the ends of the bones.

See What Is Pannus?

In phase 3, the pannus begins to release enzymes known as lysosomes that break down the cartilage in the joint and surrounding tissue. This can alter the joints’ alignment, causing deformity.

See a list of possible hand deformities that RA can cause.

Phase 4 of rheumatoid arthritis involves the joint inflammation spreading to the nearby tendons and joint capsule that surrounds the joint. This can severely limit joint movement.

Another possible symptom of the condition is rheumatoid nodules, which are hard lumps under the skin that usually appear on or near the hands and elbows.

If RA is affecting your hands or feet, there are ways to treat the symptoms specifically in those areas, such as occupational therapy, splinting, orthotics, injections, or even surgery.

See Treatments for Rheumatoid Arthritis (RA) in Hands and Treating Rheumatoid Arthritis (RA) of the Foot and Ankle

Learn more:

Rheumatoid Arthritis (RA) Treatment

How Rheumatoid Arthritis (RA) Causes Fatigue