Rheumatoid Arthritis:
Types, Treatments, & Joint Replacement Options

What is autoimmune dysfunction and rheumatoid arthritis (RA)?

Rheumatoid arthritis (RA) is an autoimmune disorder in which the body’s immune system mistakenly attacks its own joints. Instead of defending against harmful invaders, the immune system triggers inflammation in the synovial tissue that lines joints. Over time, this chronic inflammation can erode cartilage and bone, causing pain, stiffness, swelling, and decreased mobility.

Unlike normal wear-and-tear arthritis, RA often affects joints symmetrically, meaning both wrists, knees, or hands are involved, and can also impact other organs, such as the heart, lungs, and eyes. Early recognition and treatment of autoimmune dysfunction are crucial to slowing joint damage and maintaining mobility.

What are the different types of RA?

Rheumatoid arthritis presents in several forms, which can influence treatment decisions.

Seropositive RA: Patients test positive for specific antibodies, such as rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP). This form is often associated with more aggressive joint damage, faster disease progression, and a higher risk of systemic complications compared with seronegative RA. Doctors may monitor seropositive patients more closely and start treatment earlier to protect joint function.
Seronegative RA: Patients lack these antibodies but still experience joint inflammation, stiffness, and damage. While seronegative RA may progress more slowly and sometimes appear milder, it can still significantly impact quality of life. Its unpredictable nature requires careful monitoring, as joint destruction can occur even without detectable antibodies.
Juvenile RA: This type develops in children under age 16 and can affect not only joints but also growth and overall development. Juvenile RA may present differently from adult RA, sometimes involving fewer joints or causing intermittent flares.
Palindromic RA: Characterized by sudden, temporary flares of pain and swelling that fully resolve between episodes. Unlike other forms of RA, palindromic RA may not immediately cause permanent joint damage. However, repeated flares can progress to classic RA in some patients.

Blood test results can vary, and no single test can definitively confirm or rule out RA. Diagnosis typically relies on a combination of factors, including multiple blood tests, imaging studies (such as X-rays or ultrasounds), a physical examination, and a review of clinical history.

When does RA Require Treatment?

Early diagnosis and treatment are important to slow disease progression and preserve joint function. Interventions are tailored to the severity of symptoms and may include medications, lifestyle adjustments, minimally invasive procedures, and surgery.

Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, target the underlying autoimmune process to slow or prevent joint damage. Biologic agents target specific components of the immune system, such as blocking certain inflammatory proteins, to reduce ongoing inflammation and prevent further joint deterioration. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can help manage pain and swelling, often providing relief while DMARDs or biologics take effect.

Physical therapy and occupational therapy strengthen muscles, improve joint mobility, and teach strategies to protect joints during daily activities. Low-impact exercise, such as swimming or cycling, promotes flexibility without overloading the joints. Weight management reduces stress on affected joints, and ergonomic adaptations at home or work can help maintain independence and comfort.

Injections directly into affected joints, such as corticosteroids or hyaluronic acid, can temporarily relieve inflammation and pain, improve mobility, and serve as a bridge while other treatments take effect.

Surgery for RA may be recommended when joint damage becomes severe, causing pain, limited mobility, or significant loss of function. Procedures range from joint debridement to partial or total joint replacement, depending on the location and extent of damage.

Is Physical Therapy for RA Effective?

Physical therapy is generally recommended for most RA patients, but the intensity and type of exercises depend on disease severity and joint involvement.

Targeted exercises can help maintain joint mobility, strengthen supporting muscles, and reduce pain, while stretching and low-impact activities improve flexibility and function. Therapists also teach patients strategies to protect their joints during daily tasks and suggest adaptive tools or ergonomic adjustments, helping them stay active and slow the progression of their disease.

What does RA Joint Replacement involve?

Joint replacement, or arthroplasty, is typically considered when RA has caused severe joint damage that limits mobility or causes significant, chronic pain.

In advanced RA, joints can develop significant deformities, including characteristic finger joint nodules, wrist deviation, knee misalignments, and ankle joint destruction. The elbow joints can become unstable and severe hip arthritis can cause difficulty walking, and even dislocation. The feet may also be affected, with conditions such as bunions or overlapping toes.

Total joint replacement is considered the most effective surgical option for restoring function and alleviating pain in severely damaged joints, with hips, knees, and shoulders most commonly replaced due to their critical role in mobility. Smaller joints – such as those in the fingers – may also benefit from arthroplasty when pain or deformity interferes with daily activities.

During the procedure, the orthopedic surgeon removes the damaged joint surfaces and replaces them with durable artificial implants. Recovery typically involves physical therapy, gradual return to weight-bearing activities, and ongoing monitoring to prevent complications or implant issues. Most patients can resume many daily activities within a few weeks, though full recovery and optimal function may take several months.

At Premier Orthopaedic & Trauma Specialists, our team provides physical therapy and surgical care designed to protect your joints, relieve pain, and help you maintain mobility for years to come. Contact us today to schedule a consultation and explore your treatment options.

From complex trauma care and physical therapy to total joint replacement and hyaluronic injections, we do it all. Our team covers every area of orthopaedics – shoulders to fingers and hips to toes. It’s rare to find this level of specialized care and expertise under one roof.