Rheumatoid Arthritis (RA) of the Hand (Arthritis Foundation Approved)

Overview
Rheumatoid arthritis, a condition that can attack joints throughout the body, commonly affects the joints and surrounding tendons of the wrist and fingers. It can cause the joints to become swollen, painful and possibly deformed, interfering with normal hand function and significantly impacting a person’s quality of life.

Causes
The causes of RA are not fully understood. It is most likely caused by inherited genetic factors, but environmental factors may also play a role in triggering the condition. The disorder causes the immune system to attack the joints, causing the synovial membranes that surround the joints to become inflamed and swollen. This inflamed synovium leads to cartilage damage and bone loss around the joint.

Symptoms
Symptoms of rheumatoid arthritis in the hand can include stiffness (often worst in the morning), and pain and swelling in the joints, especially the joints at the base and middle of the fingers, the hand, and the wrist. The joints may become unstable and deformed. The knuckles may become inflamed, and the fingers may gradually lose their normal alignment. Often, the fingers angle away from the thumb. Additionally, the tendons of the wrist can become inflamed, and in severe cases may even rupture. Early tendon inflammation may result in a soft lump on the back of the hand or wrist. A person who has rheumatoid arthritis may develop other hand problems such as trigger finger, carpal tunnel syndrome, and boutenniere or swan-neck deformities of the fingers.

Treatment
Treatment options include anti-inflammatory medications, disease-modifying antirheumatic drugs, and a class of drugs called biological response modifiers (biologics for short). Splints or braces, exercise, and modification of daily activities may also be prescribed. Surgery may be needed when joint synovitis is not controlled by medications or the tendons of the hand and wrist become inflamed or weakened by the disease. Deformity of the fingers may also be treated with surgery to improve hand appearance and restore function.