What happens in rheumatoid arthritis and what are symptoms?

What are the symptoms of rheumatoid arthritis? Symptoms include pain, swollen, reddened, sore and inflamed joints, being fatigued (even exhausted) and just feeling sick.   RA often involves bilateral joints.  (I mean the knuckles of both hands, not just one hand).  Joints frequently involved include jaw, neck, shoulders, hips, knees, ankles and feet. 

What happens during rheumatoid arthritis?  The body’s defense system (immune system) goes awry and attacks itself.  Normally our immune system recognizes infection or foreign substances (non-self substances) and sends out antibodies (special proteins) and white blood cells which attack and destroy the infectious agent (germ, virus, etc) or foreign substances. 

In rheumatoid arthritis, this normal process becomes extreme and exaggerated. “The protective immune cells move from the blood stream into the joint.  Once inside the joint the immune cells begin producing enzymes, antibodies and cytokines.  These chemicals (enzymes, antibodies and cytokines) damage the joint, causing joint stiffness and pain.  The synovial lining of joints overdevelops, invades the deeper bone and destroys the cartilage.  Doctors call this synovial overgrowth ‘pannus.’  Articular cartilage on the ends of bones, is eaten away by destructive enzymes and the exposed raw bones rub together, causing pain.  The damage becomes visible on x-rays as the joint space becomes narrow and hollow spaces in the bones, called erosions, occur.”  (SEHohler, Arthritis:  A Patient’s Guide, (Jefferson, NC:  McFarland & Co., Inc, 2008, 18.)