Introduction
Rheumatoid arthritis often affects the hand, causing chronic inflammation that leads to pain, swelling, and stiffness. This autoimmune condition can result in hand deformities and a reduction in functionality. Although there’s no cure, treatments like medication, hand therapy, splinting, and surgery can help manage symptoms and improve hand function.
Anatomy
Each finger is composed of three bones known as phalanges, separated by two joints. The joints closest to the fingertips are the distal interphalangeal (DIP) joints, while the middle joints are the proximal interphalangeal (PIP) joints. The hand above the fingers includes five metacarpal bones, with metacarpophalangeal (MP) joints at the base of each finger and thumb. These MP joints enable flexible movement in multiple directions. Cartilage covers the bones in each joint, creating a smooth, cushioned surface for movement. A layer called the synovium surrounds the joint and produces synovial fluid to reduce friction. Ligaments and tendons add stability and power to hand movements, supported by this protective structure.
Causes
Rheumatoid arthritis in the hand is caused by inflammation of the synovium, leading to the breakdown of cartilage and bone. This condition can also stretch the tendons and ligaments, resulting in joint misalignment. The exact cause of rheumatoid arthritis remains unknown, though age, autoimmune responses, and general inflammation are contributing factors. Rheumatoid arthritis tends to affect both hands symmetrically, often impacting women over the age of 30.
Symptoms
The MP joints are typically the first to show symptoms in the hand. Pain, swelling, and stiffness are common, as well as difficulty with movement and an audible creaking sound due to cartilage damage. In severe cases, fingers may shift toward the little finger, creating an “ulnar drift,” or bend abnormally, leading to deformities like boutonniere or swan neck.
Diagnosis
A diagnosis of rheumatoid arthritis is based on a medical history review, physical examination, and laboratory tests. Blood tests and imaging, such as x-rays, provide further insights. Your doctor may also assess muscle strength, joint range, and stability through specific hand movements.
Treatment
Rheumatoid arthritis requires lifelong management, including medication to reduce pain and inflammation, splinting, hand therapy, and, when needed, surgical intervention. Medication options range from over-the-counter pain relievers to prescription medications and injections, often combined with splinting for added support. Hand therapy may include warm wax or water soaks to ease pain and restore movement, along with recommendations for adaptive tools to assist with daily activities.
Surgery
When conservative treatments do not relieve symptoms, surgical options are available. Surgical goals focus on long-term pain relief and restoring function. Reconstructive procedures may replace damaged joints with artificial ones or use joint fusion to alleviate pain. Additional options include removing inflamed synovium, repositioning displaced tendons, and repairing damaged tendons.
Recovery
Recovery varies, but most patients can resume their usual activities within three months post-surgery. Your doctor will provide guidance based on your specific condition and procedure.
Prevention
While rheumatoid arthritis cannot be prevented, adapting daily activities can reduce strain on affected joints and help manage symptoms. Hand and occupational therapists can offer techniques to protect the joints, suggest adaptive tools, and provide exercise programs to support joint health and functionality.
