Rheumatoid Arthritis is a chronic (ongoing) inflammatory disease. It develops when your body's immune system starts to attack your joints and the tissues around them. The hand, more than any other part of the body, tends to be affected by rheumatoid arthritis.
If the disease is not properly treated, the hand and finger joints can become deformed over time. However, with early recognition of the disease, modern treatments can lead to fewer deformities and a much better outlook.
What causes rheumatoid arthritis of the hand?
Unlike osteoarthritis, which results from wear and tear on the joints, rheumatoid arthritis is an inflammatory condition initiated by the body's own immune system.
Like most autoimmune conditions the exact causes not known. There seems to be a heredity factor, and various triggers have been suggested (for example smoking, eating a lot of red meat or drinking a lot of coffee) but an exact link has not been demonstrated. Some doctors believe it may be triggered by stress, infection, virus or hormone changes, but as yet there isn't any evidence to prove this.
What we do know is that rheumatoid arthritis affects between 1 and 3 people in every 100, and affects 2 to 3 times more women than men. It can develop at any age, although it is most likely to develop between the age of 30 and 50.
How does rheumatoid arthritis affect the hand?
The symptoms of rheumatoid arthritis result from the body's immune system treating the joint tissues as if they were foreign bodies. It normally affects both hands, usually the same joints on each side.
The main parts of the joint that are affected are
- The synovium, or synovial membrane - these are the tissues that line and lubricate the joints
- The bursae - these are small sacs of fluid that help your muscles and tendons move easily over each other
- The tendon sheaths - the tubes in which your tendons move.
Rheumatoid arthritis usually appears gradually and the main symptom is pain and tenderness in the wrist, knuckles, thumb and finger joints. The symptoms may come and go at first - it's normal to have "flare-ups" followed by periods without symptoms. If left undiagnosed and untreated, the damage caused by rheumatoid arthritis tends to progress in three stages:
Early stage of rheumatoid arthritis
Patients experience joint pain and swelling as white blood cells move into the lining of the joint. This inflammation causes proteins to be released. Over the long term, these proteins make the joint linings grow thicker, and also damage cartilage, bone, tendons and ligaments.
Middle stages of rheumatoid arthritis
In time, and especially without treatment, rheumatoid arthritis can cause the joints to erode and lose their shape and the bones to no longer line up correctly. Fingers may start to appear crooked and the hand may begin to deviate outward from the wrist. At this point the difficulty of treating the symptoms without surgery increases. The joint and tendon damage done during this stage can lead to complications and eventual loss of function.
Late stages of rheumatoid arthritis
Untreated deformities of the finger and hand may lead to joint instability and even cause the tendons in the hand to rupture, meaning you will lose the ability to do many things with your hand.
Treatments for rheumatoid arthritis
To begin with, if your symptoms have only recently developed, treatment focuses on two fronts:
- Controlling the systemic disease with drug therapy, which targets the molecular mechanisms that cause joint inflammation. A determination of the risk for disease progression is important for your rheumatologist to make because this assessment will guide therapeutic decisions
- Alleviating local synovitis (swelling of the joint linings) with physical therapy and lifestyle changes. Assistive devices to relieve stress on your joints and splints to help rest the joints may both be useful. Some patients may also benefit from local injections of cortisone to reduce inflammation in the joints.
The main aim of this multidisciplinary approach in the early stages is to prevent any hand deformities from developing. If they do develop, surgical treatment may be required.
Surgical treatments for rheumatoid hand
If medical approaches do not control the symptoms, surgery may be needed. The kinds of surgical procedures that may be suitable include the following:
- Arthrodesis, which means fusing the joints together so that the damaged parts are not moving against each other. This can reduce joint pain and improve the stability and function of the hand.
- Arthroplasty, which means replacing parts of the joint with artificial parts, including silicone spacers between bone surfaces. This may improve the movement of the affected joint.
- Arthroscopic synovectomy: this is a type of keyhole surgery in which inflammatory parts of the wrist joint linings can be removed in a minimally invasive way, improving function and reducing pain.
- Soft tissue reconstruction and tendon transfers may occasionally be required for advanced cases where the tendons have been damaged.
Contact us and make an appointment
To discuss hand symptoms, you suspect might be those of rheumatoid arthritis, please get in touch to make an appointment at one of our regular clinics.