Rheumatoid Arthritis (RA) of the Hand

An autoimmune disease, rheumatoid arthritis is a chronic, inflammatory condition that results in inflammation, pain, and swelling of the lubricating, soft-tissue membranes that surround the joints, known as the synovial membranes. The inflamed synovial membranes cause the joints to become swollen and painful, eventually resulting in damage to the cartilage, bone erosion and deformity. RA can significantly impact a person’s quality of life. The causes of RA are not yet fully understood; although, it is believed to largely be a result of genetic factors. Women between the ages of 40-60 are more frequently affected; however, this disease can appear at any age.  

Symptoms of rheumatoid arthritis may include tender, swollen and warm joints, stiffness in the morning that may last for hours, decreased motion, fatigue, fever and weight loss. Although this disease can affect any joint, it is commonly found in the small joints of the hands and feet. In the hand, the joints may become unstable and deformed, and the knuckles may become inflamed, resulting in the fingers losing their normal alignment. It can also cause the tendons of the wrist to be inflamed and rupture. RA can lead to other hand problems, including carpal tunnel syndrome, trigger finger, and/or boutonniere or swan-neck deformities of the fingers.

Diagnosis of RA begins with a physical exam. Patients presenting with warm, swollen, and painful joints will most likely be administered a blood tests. One course of lab work will focus on the immunological response by checking for elevated antibodies and proteins. Another lab test will look at the inflammatory markers, which will assist with establishing the degree of inflammation. X-rays may be used to for analyzing bone deformities or determining progression of the disease, while MRIs and ultrasound will help determine the severity of the disease.

Treatment for rheumatoid arthritis is designed to stop inflammation, relieve symptoms, prevent joint and organ damage (due to swelling of the veins), and improve physical function and overall well-being. Typical healing regimens include anti-inflammatory medications, corticosteroid medications, disease-modifying antirheumatic drugs, and biological response modifiers. A physician may also recommend the use of splints or braces, low-impact exercise, and modification of daily activities. Surgery may be necessary to correct deformities of the fingers that occur as a result of the disease. Surgery may also be required if joint synovitis is unable to be controlled with medications, or if the tendons of the hand and wrist become inflamed or weakened.