Rheumatoid arthritis (RA) is an autoimmune disorder that causes inflammation and swelling in the joints. These symptoms can result in swelling to develop in the hands, feet, and other parts of the body.
Both at-home and medical treatments are available to help reduce swelling associated with RA.
This article takes a look at how RA can lead to swelling, the areas it affects, and how best to treat this symptom.
RA causes the body’s immune system to attack the synovium, which lines the joints. The synovium produces a fluid that helps the joints move more smoothly.
When the immune system attacks the synovium, it often results in inflammation and swelling. Sometimes inflammation of the synovium membrane leads to swelling and tissue thickening. Other times, too much synovial fluid in the joints causes the problem.
Sometimes, swelling can be severe. Excessive swelling can make it more difficult for a person to move the joint.
Over time, the continued swelling and inflammation can also weaken ligaments in the joints. This weakening can lead to atypical characteristics of the feet and hands, such as claw toe or hammer toe. However, these are late symptoms of RA.
Swelling caused by RA
- hands
- wrists
- feet
- knees
- ankles
- hips
- elbows
- shoulders
The swelling in RA
In 20% of cases, foot and ankle symptoms are the first to appear.
If the swelling is severe, a doctor may recommend removing excess fluid from the affected joint. This procedure is known as joint aspiration.
A doctor may also inject a substance called hydrocortisone into the joint. This is an anti-inflammatory medication that can reduce some of the symptoms that lead to swelling. Before this procedure, a doctor may apply topical anesthetic spray or lidocaine to the skin above the aspiration site.
In addition to these more immediate fixes, a doctor will prescribe medications to help a person manage their RA. A ‘treat to target’ approach aims to reach and maintain a stage of symptom remission.
Some people will take a combination of medications designed to prevent RA flare-ups and slow the disease’s progression. The body can repair RA damage if inflammation is inhibited over time.
Examples of these medications include:
Disease-modifying antirheumatic drugs
Disease-modifying antirheumatic drugs (DMARDs) help reduce how often symptoms occur as well as slow the disease’s progression.
Medications may include:
- methotrexate (Rheumatrex)
- hydroxychloroquine (Plaquenil)
- sulfasalazine (Azulfidine)
- tofacitinib (Xeljanz)
- leflunomide
- Janus kinase inhibitors
Many people will take DMARDs in combination with corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs), which help to reduce inflammation.
Biologic agents
RA symptoms that do not respond to DMARDs may benefit from biologic response modifiers. These medications block immune system signals that can cause inflammation and swelling.
Examples of these medications include:
- sarilumab (Kevzara)
- tocilizumab (Actemra)
- rituximab (Rituxan)
- anakinra (Kineret)
- abatacept (Orencia)
- etanercept (Enbrel)
- infliximab (Remicade)
Combinations
It is important to note that medications can have side effects that cause complications on their own. For example, DMARDs and biologics are immunosuppressants that
Arthritic damage to the joints is irreversible. As a result, management of the disease is essential to a person’s quality of life and for keeping their joints mobile.
Learn the differences between DMARDs and biologics for RA here.
A person can use several home remedies to help reduce RA-related swelling. Examples of these include:
- Resting affected joints: Anyone experiencing pain with a particular exercise should avoid doing that exercise until a flare-up improves.
- Icing affected areas: Applying a cloth-covered ice pack to an affected area may help minimize swelling. Apply the ice pack for no longer than 20 minutes and repeat between three and four times throughout the day.
- Putting the feet or hands in a cool bath: Placing hands or feet in a tub or pan of cool water can help ease muscle tension and improve movement.
- Taking NSAIDs: These drugs include naproxen and ibuprofen. Anyone who is currently taking other RA medications should check with their doctor to make sure NSAIDs will not interact with them. Topical NSAIDs are also available over the counter.
Giving the body time to heal and recover after a flare-up is essential for dealing with the swelling and discomfort that can accompany RA.
While some RA flare-ups that cause swelling are unpredictable, others may follow a pattern. Some known triggers of RA include:
- illness
- overexertion
- inadequate sleep habits
- stress
- smoking
Some people may find it helpful to keep a journal of the foods they eat and the activities they do on a daily basis. Anyone who experiences a flare-up can check their journal to look for patterns. They should also inform their primary care doctor of these flares. A doctor will be able to advise on potential treatment alterations.
Identifying these patterns may help a person avoid further episodes of RA swelling.
In addition to tracking flares, people with RA should also follow any treatment plans that their doctor recommends. Doing so can help a person manage their RA on a daily basis.
Ideally, a person and their doctor will find the right combination of medications and lifestyle changes that can help reduce swelling flare-ups caused by RA.
If a person has three or more swelling flare-ups in a month, they should see a doctor. They may need to try another type of medication or look at further treatment options.