Ask a Doctor: Rheumatoid Arthritis

Hand surgeon Mark Joseph Yuhas, MD answers your questions about rheumatoid arthritis.

What is arthritis? Can it affect the hand and wrist just the same as other joints such as the hip and knee?

Arthritis is a term that is used to describe pain and stiffness in a joint. A joint is a location in the body where two bones articulate, or move. Typically these joints have cartilage, a type of material in the body that is smooth and helps the joint to move without pain or restriction.

Arthritis involves a process where the cartilage is no longer smooth and begins to “break down”.  This can result in pain, swelling, and loss of motion in many joints in the body including the fingers, hand, and wrist.

Are there different types of arthritis?

Yes, there are multiple forms of arthritis that can affect the joints. Generally, we describe arthritis as degenerative (also known as osteoarthritis) or inflammatory. There are other forms or causes of arthritis, such as gout, infection, or post-traumatic.

Rheumatoid arthritis is a type of inflammatory arthritis. Other types of inflammatory arthritis include psoriatic arthritis, lupus, and ankylosing spondylitis.

How is rheumatoid arthritis different than other types of arthritis such as osteoarthritis?  Do they have similarities?

Rheumatoid arthritis is a type of autoimmune arthritis. It causes protective mechanisms in our body to instead attack certain structures, including the joints.

This can result in swelling of the lining of the joint (synovium and capsule), affecting not only the cartilage, but also the associated ligaments and tendons that all help to make a joint function properly.

Both rheumatoid arthritis (RA) and osteoarthritis commonly affect the hand and fingers. They both can cause swelling, pain and joint stiffness.

However, RA will often affect multiple joints at the same time. Also, the pattern of joints involved and resulting appearance of the hand and fingers can often be unique to rheumatoid arthritis.  

What is the cause of rheumatoid arthritis?

The exact cause of rheumatoid arthritis and other autoimmune diseases can be hard to determine. There is certainly a genetic component that plays a role in this disease, so it is often helpful to have knowledge of family history of joint diseases. Other factors such as smoking, hormonal changes, and stress may also have an influence.

How do I know if I have rheumatoid arthritis? What type of testing or workup can I expect?

There are various tools that are used to determine the type of arthritis and cause of joint pain. Frequently, hand surgeons are one of the first physicians to evaluate someone with potential rheumatoid arthritis because of hand and joint pain.

The diagnosis is often made with an accurate medical and family history from the patient, followed by a thorough exam focusing on the joints, specifically the hand and wrist.

X-rays are often helpful to evaluate the joints of the hand and wrist. These images can show certain patterns that give clues to the type of arthritis.

Certain blood tests and lab tests may also be requested if there is suspicion of rheumatoid arthritis.

What are some of the treatment options for rheumatoid arthritis?

When a diagnosis of rheumatoid arthritis is established, many times a team approach to treatment is used. This importantly involves the patient’s primary care physician as well as a rheumatologist. Hand surgeons, other orthopaedic surgeons, and therapists may also play a role in the ultimate treatment strategy for each patient.

Medications for RA are usually managed by a rheumatologist and can include disease-modifying antirheumatic drugs (DMARDs) as well as non-steroidal anti-inflammatory medications (NSAIDS) and steroids. They can be very important for controlling symptoms and preventing advancement of the disease.

Other treatment for symptoms may include a cortisone shot into the joint, which can improve pain. Splinting and activity modification strategies with the help of a hand therapist can often be very useful as well.

Finally, various forms of surgical treatment may be helpful depending on the location and severity of the disease. Talking with your hand surgeon and treatment team will help the patient make the best decision to control their symptoms and improve their function.

Dr. Mark Yuhas is an Orthopaedic Surgeon who specializes in Hand, Wrist, and Elbow care. He practices with Wellington Orthopaedic and Sports Medicine/ Mercy Orthopaedics and Sports Medicine in Cincinnati, OH. His current interests include trauma of the hand, wrist, and elbow; sports injuries of the upper extremity; and arthritis throughout the hand and wrist.