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Rheumatoid Arthritis of the Hand

Introduction
Rheumatoid arthritis commonly affects the hand.  Rheumatoid arthritis is a long-term chronic inflammatory disease.  It causes the joints in the hand to become painful, swollen, and stiff.  Rheumatoid arthritis can lead to hand deformity and loss of function.  Symptoms are treated with medications, hand therapy, splinting, and surgery.

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Anatomy
Your fingers are made up of three bones called phalanges.  Two joints separate the phalanges.  The distal interphalangeal (DIP) joints are located near your fingertips.  The proximal interphalangeal (PIP) joints are located in the middle of your fingers.  The hand above your fingers is made up of five metacarpal bones.  Your metacarpophalangeal (MP) joints are located at the base of your fingers and thumb.  The MP joints allow your fingers and thumbs to move up and down and from side to side.
 
The bones in your finger joints are covered with cartilage.  Cartilage is a very tough shock absorbing material.  The cartilage forms a smooth surface and allows the bones in your joints to glide easily during motion.  A membrane called a synovium covers the joint.  The synovium secretes a fluid called synovial fluid.  The synovial fluid acts as a cushion and lubricant between the joints.  It reduces friction between the bones and helps prevent “wear and tear.”
 
Ligaments are strong tissues that connect your hand bones together and provide stability.  Your ligaments are also lined with synovium.  The synovial fluid allows the ligaments to glide by the joints easily during movement.  Tendons are strong fibers that attach your muscles to your bones.  The tendons and muscles power your hand joints and enable them to move.

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Causes
Rheumatoid arthritis is a common form of arthritis that frequently affects the hand.  Rheumatoid arthritis causes the synovium to become inflamed and swollen.  It causes the cartilage and bones to deteriorate.  Tissues surrounding the joint may also be affected.  As swelling occurs, the tendons and ligaments stretch.  This can lead to joint malalignment and deformity.  Rheumatoid arthritis is one of the most serious and disabling types of arthritis.
 
The primary cause of rheumatoid arthritis is unknown.  Arthritis can occur for many reasons, including aging, “wear and tear,” autoimmune disease, and inflammatory disease.  Rheumatoid arthritis can occur in the small and large joints of the body.  Many joints may be involved at the same time.  Rheumatoid arthritis tends to occur symmetrically, meaning that if one hand develops it, the other hand does too.  Rheumatoid arthritis can affect people of all ages, but it most frequently occurs in women and those over the age of 30.

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Symptoms
Rheumatoid arthritis most frequently affects the MP joints in the hand.  Your joints may feel stiff, swollen, and painful.  You may have difficulty moving your fingers.  You may hear creaking noises when you move your joints.  This is a sign that the cartilage is affected.  It may be difficult to use your hands for your regular activities.  Your symptoms may increase after you have used your hands.
 
Your joints may be unstable and unable to achieve their normal positions and motions.  Your fingers may move from their normal positions and lean towards your little finger.  This is called an ulnar drift.  Your DIP and PIP joints may bend in the opposite way they are supposed to creating a crooked finger.  This can result in a boutonniere deformity or a swan neck deformity.

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Diagnosis
Your doctor can diagnose rheumatoid involvement of the hand by reviewing your medical history and examining your hand.  You will be asked about your symptoms and level of pain.  You may be asked to perform simple movements to help your doctor assess your muscle strength, joint motion, and joint stability.  Blood tests and other laboratory tests can help identify rheumatoid arthritis.  Your doctor will order x-rays and perhaps other imaging tests to provide more information about your joints.

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Treatment
There is no cure for rheumatoid arthritis.  It is a life long condition.  You may experience times when symptoms flare up and times when symptoms are not so bad.  Treatments for rheumatoid arthritis of the hand are aimed at reducing pain, improving mobility, increasing function, and preventing further injury.  Treatment options include medications, splinting, hand therapy, and surgery.  The type of treatment that you receive depends on the severity and extent of the arthritis in your hands.  Your activity level and desired outcomes are considered as well.
 
Over-the-counter or prescription medications may be used to reduce swelling and pain.  In some cases, injected medications may be used.  Injections are usually combined with joint splinting.  Splints are worn during activities to provide support to the joints.
 
Hand therapy can help reduce pain, swelling, and restore movement.  A hand therapist may use modalities, such as warm wax soaks (paraffin bath) or warm water soaks to help ease your pain and improve joint flexibility.  Your hand therapist can recommend products you can use at home to make some tasks easier.  A hand therapist can also recommend ways to adapt your hand movements during ordinary tasks to protect your joints.

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Surgery
If non-surgical treatments fail, there are many surgical options for rheumatoid arthritis of the hand.  The goals of surgical treatments are long-term pain relief and improved functioning.  Reconstructive surgery can restore damaged joints.  A joint can be removed and replaced with an artificial joint.  An artificial joint can restore pain-free motion. 
 
Joint fusion is another surgical option.  Joint fusion surgery secures the bones in a joint together.  Joint fusion can relieve pain, but it does not restore movement because the joint cannot move.  All joint surgeries are usually followed by hand therapy.
 
There are many other surgical procedures for rheumatoid arthritis of the wrist and hand.  Depending on your particular problems, other procedures include removing inflamed synovium from a joint (synovectomy), rebalancing tendons that have moved out of place, removing bone spurs that rub on tendons, and repairing ruptured tendons.

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Recovery
Recovery times vary from individual to individual.  Generally, most people can return to their regular activities at about three months following their surgery.  Your doctor will let you know what to expect.

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Prevention
There is no known way to prevent or cure rheumatoid arthritis of the hand.  Symptoms tend to appear gradually over time.  You may be able to relieve your symptoms and prevent deformities by adapting the way that you use your hand for activities.  A hand therapist or an occupational therapist can advise you on joint protection methods.  The therapists can recommend adaptive equipment, such as grooming tools or kitchen utensils with built up handles, to relieve stress on your joints.  It is important to wear your splints as directed and participate in your home exercise programs.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.