RA and Joint Deformity
Rheumatoid arthritis not only causes pain on a daily basis to the patient, but unfortunately has the potential to cause deformities. Before more aggressive treatments were available, almost everyone with RA was confined to living with some degree of misshapen joints, but that is no longer the case.
Today, stronger medications make these deformities rarer, though that doesn’t mean they are eradicated completely. There are some warning signs that you may develop complications with your joints, such as a very high rheumatoid factor (RF) or a high C-reactive protein (CRP), both of which can be found during normal blood tests.
Deformities in RA patients’ joints differ from osteoarthritis patients’ deformities in a few ways. For example, with osteoarthritis, which typically occurs when a patient is older, the damage is more attributed to general “wear and tear” of the joint. RA damage occurs because of the inflammation of the joints.
When the synovial membrane is swollen due to RA activity (the membrane around the joint), it leaves the joint vulnerable to all sorts of damage. The tendons may become damaged due to the swelling and the patient may experience cartilage loss. Additionally, the loss of bone mass and erosion may occur, leading to further damage.
Hands and Fingers
The biggest and most debilitating joint abnormalities are those of the hands, such as fingers. Those experiencing joint issues may have boutonniere finger (when the first joint of the finger extends backward unnaturally while the middle joint is turned inward) or finger swan neck (when the first joint of the finger extends forward unnaturally).
Patients may also experience dislocation of one or more fingers, all of their fingers drifting toward one direction (or in some cases, in all different directions) or partial dislocation of joints or the wrist. For some, their thumbs may take on the appearance of a Z, in what is known as Z-thumb.
All of these can be extremely painful and can render the joints unusable, resulting in further disability. However, doctors often work with patients once they have begun to develop these deformities in the hands particularly, as it is widely recognized that having issues with the hands more often affect daily life in a negative way.
Treatment for hand deformities includes medication, ice and rest in the event of pain. Other treatment includes occupational therapy for keeping fingers limber, wrist splints, and silver rings, which may keep the joint stable and prevent it from continuing to grow in such a way that it is later rendered unusable.
In some cases, a joint replacement is recommended. This is not typically done on the middle or index fingers, as they are not as necessary for gripping objects (though it can be done on them as well). In most cases, the joint is fitted with a prosthesis made of either plastic, metal or silicone. The prosthesis can be cemented onto the bone, or it can be placed a bit further out so that the bone will grow onto the prosthesis and place it there permanently.
Next page: more on hands and fingers, plus feet and toes and rheumatoid nodules.