Rheumatoid Arthritis

DESCRIPTION

Rheumatoid arthritis is just one type of arthritis out of many. Essentially, arthritis means an inflamed joint. A joint normally consists of two cartilage-covered bone surfaces that glide smoothly against one another. When joints become inflamed, the joint swells and does not move smoothly. Over time, the gliding surface wears out.

Wear and tear arthritis (osteoarthritis), gouty arthritis, and psoriatic arthritis are three other common types of arthritis. This condition can affect many parts of the body. Patients with rheumatoid arthritis often wake up with stiff and swollen joints. Early on, many patients feel tired. Two thirds of patients with rheumatoid arthritis have wrist and hand problems.

CAUSES

Rheumatoid arthritis affects the cells that lubricate and line joints. These tissues become swollen and end up stretching supporting structures of the joints such as ligaments and tendons. As the support structures stretch out, the joints become deformed and unstable. The joint cartilage and bone wear away. Often the joints feel hot and look red. Rheumatoid arthritis is most common in the wrist and knuckles (Figure 1). It typically happens in both hands.

SIGNS AND SYMPTOMS

While stiffness, swelling and pain are common symptoms for all types of arthritis, there are some symptoms that are unique to rheumatoid arthritis. They are:

  • Firm bumps along fingers or the elbow
  • Soft lump on the back of the hand that moves as the fingers straighten
  • Abnormal bend or collapse of fingers (Figure 2)
  • Sudden inability to straighten or bend a finger
  • A bent middle finger joint (Boutonniere deformity - figure 3)
  • A bent end of the finger and over-extended middle joint (Swan-neck deformity - figure 3)
  • Bones in the wrist that stick out

In addition, patients with rheumatoid arthritis often have problems with numbness and tingling in their hand (carpal tunnel syndrome). This is because the swelling of the tendons causes pressure on the nearby nerve.

How Rheumatoid Arthritis is Diagnosed

The diagnosis of rheumatoid arthritis is made based on an examination, x-rays and lab tests.  Your doctor will ask questions about your symptoms and how the disease has affected your activities. Your physician will also ask whether other family members have had rheumatoid arthritis or symptoms similar to yours. There are several blood tests that are often ordered to confirm the diagnosis. MRI - a special imaging study - has also been used to help confirm the diagnosis.

TREATMENT

Treatment for rheumatoid arthritis aims to decrease swelling, relieve pain and maintain function. While there is no cure for this condition, medications are available that slow the progression of the disease. Treatment typically involves a team approach among the patient, physicians and therapists. A rheumatologist is often the physician that monitors and determines the best type of medicine for the patient.

Your hand therapist will provide instruction on how to use your hands in ways that help relieve pain and protect joints. Therapists also can provide exercises and splints to help you live a normal life.  

Rheumatoid arthritis can be a progressive disease. In certain cases, preventive surgery may be recommended. Preventative surgery may include removing lumps, removing inflamed tissue, or removing bone spurs that may rub on tendons or ligaments.

There are several types of procedures to treat joints affected by rheumatoid arthritis, including removal of inflamed joint lining, joint replacements and joint fusions. The specific procedure(s) chosen depends on many factors. These factors include the particular joints involved, the degree of damage present, and the condition of surrounding joints.  

One of the most important factors in deciding the most appropriate surgical procedure is the needs of the patient. There are often many ways to treat hand deformities from arthritis. Your hand surgeon can help you decide on the most appropriate treatment for you.

© 2008 American Society for Surgery of the Hand
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Copyright 2015 by American Society for Surgery of the Hand