In the past, rheumatoid arthritis (RA) took no prisoners. Once the disease grabbed hold, bony deformities — some with such telltale names such as hitchhiker’s thumb, swan neck deformity or curly or clawed toe deformity — were almost inevitable. These deformities made writing, walking and often overall functioning difficult, if not impossible, for many people with RA. In fact, many people ended up in a wheelchair due in part to these distortions and the pain they caused.

But today, earlier diagnosis and aggressive treatment are making such abnormalities in the bones a thing of the past. It’s not that rheumatologists don’t see these bony deformities anymore or that people with RA no longer develop them, it’s that they have become the exception instead of the rule.

“Bony deformities still do occur, and [they] are what we seek to prevent or reduce the incidence of when we treat RA,” says Eric Matteson, MD, chair of the department of rheumatology at the Mayo Clinic in Rochester, Minn. “We see fewer of them, and we see less severe ones today because of earlier recognition of the disease and earlier and more effective interventions.”

The whole RA treatment paradigm has changed. “We used to start treatment with disease-modifying antirheumatic drugs when bony erosions occurred, not before,” he says. “That is a thing of the past.”

Now the goal is to prevent these deformities from occurring in the first place. “Bony deformities are, in large measure, avoidable, if not totally avoidable by hitting RA early and hard,” Dr. Matteson says.

What Are Bony Deformities?

The inflammation of RA causes a rapid-fire division and growth of cells (pannus). The pannus then causes the synovium that lines your joints to thicken and releases enzymes that may chew up bone and cartilage. This is the destructive process that causes the involved joint to lose its shape and alignment. These deformities lead loss of function and the need for joint replacement surgery.