Which joints are not affected by rheumatoid arthritis?

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Last updated: October 4, 2026 • View editorial policy

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Distal Interphalangeal Joints Are NOT Typically Affected by Rheumatoid Arthritis

The distal interphalangeal (DIP) joints are characteristically excluded from rheumatoid arthritis involvement and are specifically excluded from the ACR/EULAR classification criteria for RA. 1

Joint Involvement Pattern in Rheumatoid Arthritis

Joints Typically Affected by RA:

  • Small joints: Metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints, wrists 1
  • Large joints: Shoulders, elbows, hips, knees, ankles 1
  • Other joints: Temporomandibular joints, acromioclavicular joints, sternoclavicular joints 1

Joints NOT Typically Affected by RA:

  • Distal interphalangeal (DIP) joints - These are specifically excluded from RA assessment in the 2010 ACR/EULAR classification criteria 1
  • First carpometacarpal joints 1
  • First metatarsophalangeal joints 1

Clinical Reasoning

The ACR/EULAR classification criteria explicitly state: "Distal interphalangeal joints, first carpometacarpal joints, and first metatarsophalangeal joints are excluded from assessment" when evaluating joint involvement in RA 1. This exclusion is based on the characteristic pattern of RA, which predominantly targets the MCP and PIP joints rather than the DIP joints.

Important Caveats:

While DIP involvement is extremely rare in RA (occurring in less than 0.2% of cases 2), it can occasionally occur. However, when DIP joints are involved, this should prompt consideration of alternative diagnoses:

  • Osteoarthritis - The most common cause of DIP joint involvement, characterized by Heberden's nodes 3
  • Psoriatic arthritis - Can specifically target DIP joints or affect just one ray 3
  • Erosive osteoarthritis - Targets mainly the interphalangeal joints with inflammatory features 3

Answering the Multiple Choice Question:

From the options provided:

  • a) Distal interphalangeal - NOT typically affected ✓
  • b) Hip - CAN be affected (listed as a large joint in RA) 1
  • c) Temporomandibular - CAN be affected (specifically mentioned as possible involvement) 1
  • d) Wrist - COMMONLY affected (one of the most frequently involved joints) 1

The correct answer is (a) Distal interphalangeal joints.

References

1
Guideline

my treatment approach to rheumatoid arthritis.

Mayo Clinic Proceedings, 2012

2
Research

A handful of inflammation.

EULAR rheumatology open, 2026

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