Rheumatoid Arthritis of
the Hand

Rheumatoid arthritis is a long-term inflammatory condition, causing severe swelling, pain, and stiffness in the joints.

Rheumatoid arthritis develops as a person’s immune system begins to attack the joints and the tissues surrounding them.

The condition is usually found to affect a person’s hands, wrists, and feet, with the hand being where we see the highest number of cases reported.

We’d advise anyone who believes they are potentially showing signs or suffering symptoms of rheumatoid arthritis to visit their GP immediately.

Early diagnosis matched with modern-day treatments can help reduce the speed at which rheumatoid arthritis takes hold, leading to fewer deformities, and a reduced risk of joint damage.

Rheumatoid Arthritis in Hands causes and treatment

Causes of rheumatoid arthritis of the hand

Rheumatoid arthritis, unlike osteoarthritis (wear and tear on the joints), is an autoimmune disease. 

It causes painful inflammation of the joints, which is caused by your body’s immune system.  Where the immune system would typically fight infection; instead, it attacks healthy cells surrounding your joints by mistake; hence joints become painful, stiff, and swollen.

Unfortunately, the exact cause of rheumatoid arthritis, like most autoimmune conditions, is unknown; however, research has shown there to be some triggers that may not show a direct link but do have some bearing. These triggers include:

  • Hereditary factors
  • If you are a woman
  • If you smoke
  • If you eat a substantial amount of red meat
  • If you drink a lot of coffee

Some reports have also stated that rheumatoid arthritis may also be triggered by:

  • Stress
  • Infection
  •  Viruses
  • Hormone changes

However, it’s important to note; there is little evidence to prove this to be 100% accurate.

What we do know is that this condition affects between 1 and 3 people in every 100, and it affects two to three times more women than men.

It can also develop at any age; however, with many of our patients, we find it most common in those aged between 30 – 50.

How does it affect the hand?

The hand, wrist, and fingers are all made up of different and multiple joints. As such, because rheumatoid arthritis means your immune system is now working against you and attacking healthy cells and tissues that protect your joints, your fingers, wrist, and hand can be affected very quickly.

We also find that it will typically affect both hands and the same joints on each side.

The main parts of the joints affected are:

  • The bursae – the small sacs of fluid that allow your muscles and tendons to move around each other with ease
  • The synovial membrane (or synovium) – the tissues that line and lubricate the joints
  • The tendon sheaths – the smaller tubes in which your tendons move.

Rheumatoid arthritis doesn’t appear dramatically overnight. It is a progressive condition that, unfortunately, worsens as it progresses.

At The Manchester Hand Surgeon

some of the main symptoms and initial symptoms our patient’s report is pain and tenderness in the thumb, wrist, finger joints, and knuckles.

At first, these symptoms can come and go, often depending on what activities you are carrying out or the temperature which your body is exposed to.

When the symptoms do arise, they are what we call “flare-ups” or “flares,” where you may experience symptoms for a certain period followed by no symptoms for a time after.

A flare-up can be difficult to predict, however with the correct treatment, we can help to limit and reduce the number of flare-ups our patient’s experience, as well as minimise, and in some cases, even prevent the long-term damage rheumatoid arthritis can do to your hands.

Speak to the hand experts.

Talk to the people that care. If you suspect you have rheumtoid arthritis of the hand, please call us to make an appointment at one of our specialist hand clinics today.

Stages of Rheumatoid Arthritis

We work and support patients at various stages of the disease. Providing suitable treatment and preventative measures for all.

For us, the damage that rheumatoid arthritis can cause can be categorised into three stages:

The Early Stage

At this stage, most patients will notice some joint pain and a little swelling around the wrist joints, finger or thumb joints, or even their knuckles. This is caused due to white blood cells moving into the lining of the joint. This swelling and inflammation cause proteins to be released, and it is the released proteins in this capacity that begin to cause problems. Problems such as making joint linings grow thicker over the long term, as well as damage to cartilage, tendons, bone, and ligaments.

The Middle Stage

Over time, and if treatment is delayed, rheumatoid arthritis can slowly begin to cause the joints to erode. Losing their shape to such a degree, that the bones themselves no longer line up correctly. Because of this, fingers can start to bend and appear crooked, and a patient’s hand may begin to deviate outward from the wrist.

At this stage, it is increasingly difficult to treat the symptoms and relieve the pain without surgery. This stage also sees considerable damage to joints and tendons, leading to further complications resulting in the eventual loss of movement and joint function.

The Late Stage

It is at this stage where The Manchester Hand Surgeon sees most of our patient referrals. At this stage, patients will often come to us with untreated deformities of the fingers and hand. This often leads to joint instability, which can cause tendons to rupture.

What does this mean for you?

Unfortunately, you will lose the ability to carry out everyday routine activities using your hands. Where even the simplest of tasks will not only become difficult, they will become extremely painful.

Treatment

Early diagnosis matched with the most appropriate treatment suitable to you, we can help support our patients with the condition without the use of surgery.

For us, in the early stages, treatment focuses on two important areas: 

  1. Drug therapy. There is a range of drug therapy treatments available that help to target the molecular mechanisms that cause joint inflammation. We can also offer local cortisone injections to some patients, where appropriate, with such medication helping to reduce inflammation in the joints considerably, providing relief for weeks, and in some cases months. We work with each patient to diagnose the extent of the condition, as well as help, determine the risk for disease progression. This helps us to provide a range of options and suitable treatments for all of our patients.
  2. Physical therapy, including lifestyle changes. The second area we focus particular attention on is using physical therapy as well as suggesting some subtle lifestyle changes to help reduce swelling of the joint lining (alleviating local synovitis). We can provide assistive devices and splints to help relieve the stress on your joints, providing your bones and joints with much-needed rest.

We use this multidisciplinary approach in the early stages to help prevent further damage and deformities developing in hand and fingers. Our team are hand experts, and we love what we do.  That’s why we’re with you throughout every stage of your treatment.

If your condition has become worse, or deformities have developed, and the arthritis is beyond the early stages, surgery may be the most suitable option for you.

 

Surgical Treatment

Surgical treatments for rheumatoid arthritis carried out by the team at The Manchester Hand Surgeon, include:

Arthrodesis

This procedure involves fusing the joints so that the damaged parts no longer move against each other. This procedure helps to reduce joint pain as well as improve overall stability and hand function.

Arthroplasty

Also known as joint replacement, arthroplasty is a procedure that involves replacing part or all of a joint with artificial parts. These artificial parts can include placing silicone spacers between the bone’s surfaces.

Joint replacement surgery is a much bigger surgical procedure than arthrodesis; however, our team will be with you at every step, providing reassurance and full information at each stage.

This surgical treatment may improve the movement of the affected joint.

Arthroscopic Synovectomy

This is a type of keyhole surgery to remove inflamed joint tissue. This surgery is minimally invasive and can help by extracting parts of the wrist joint lining that is most affected by the disease.

After the procedure, your wrist and hand may feel tender and swollen, and this is completely normal. After full rest, this treatment will improve the function of your hand and reduce the level of pain you experience.

Soft Tissue Reconstruction and Tendon Transfers

Tissue reconstruction and tendon transfers may be required on occasion for advanced cases of rheumatoid arthritis and where tendons, in particular, have been severely affected and damaged.

Aftercare

With all surgery, our team will provide a full aftercare treatment plan for you. Providing you with recommended stretches, exercises, rest periods, pain killers, and more.

Depending on the treatment you receive, recovery can take between 6-14 weeks, for the hand to return to full strength. For the hand to regain full movement and range, recovery can be up to 6 months.

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