When Rheumatoid Arthritis Affects Your Hands and Fingers


When Rheumatoid Arthritis Affects Your Hands and Fingers

Rheumatoid Arthritis Hands: What Causes Pain in Your Hands With RA?

Inflammation, swelling, and stiffness in the wrists, hands and fingers are often of the first signs of rheumatoid arthritis (RA). And these symptoms can make it hard to do the simplest tasks, such as turning a doorknob or opening a bottle or jar.

Hand and Finger Joints Affected By RA

Your metacarpophalangeal joints, or the joints that connect your fingers to your hands, are the one that RA will likely be affected. You may also experience pain and inflammation in your middle knuckles, called the proximal interphalangeal joints.

It is also possible to experience pain in the joints of the wrist that connect to the forearm.

The distal interphalangeal joints, or the outermost joints of your thumbs and fingers, are least affected, but if you experience pain in these joints, it is because you have symptoms in the metacarpophalangeal and/or proximal interphalangeal joints.

How RA Affects Your Hands and Fingers

Most of the joints in your body are synovial joints. This means they are flexible and encircled with a thin lining called synovium. Synovium produces a clear, sticky fluid that lubricates joints, making it easier for them to move.

RA inflames the hand’s synovium, affecting the joints and tendons. All that inflammation eventually results in deformity of joints and breaking of tendons.

Symptoms of Rheumatoid Arthritis in the Hands

The most common symptoms of RA in the hands and fingers are pain, swelling, and stiffness. Other symptoms you may experience are:

  • Warmth and tenderness in hands and fingers
  • Pain and stiffness of the hands and fingers for more than an hour upon awakening
  • Misshapen fingers
  • Numbness and tingling, and other carpal tunnel symptoms
  • Fatigue

People who have hand involvement with RA will experience symptoms in both hands.

Tendon Involvement

When RA affects the tendons, it results in a condition called tenosynovitis.   Some people who have tendon damage never experience pain associated with inflammation of the tendons.

When tenosynovitis affects the flexor tendons, it causes a condition called trigger finger. Your flexor tendons help you to bend your fingers, and a trigger finger will cause the proximal interphalangeal joint to get stuck in a bent position.

Severe and consistent inflammation of joints, tendons, and ligaments (ligaments connect bones) will cause hand and finger deformities over time.

Treatments

Treating RA in your hands and fingers depends on the extent of symptoms, stage of your disease (mild vs. severe), how many joints are affected, if you have limitations, and what your goals and needs are.

The most common treatment options are medications, non-drug approaches, and surgery.

  • Medicine. Your doctor will prescribe treatments to bring down inflammation and control pain. Analgesics (acetaminophen, nonsteroidal anti-inflammatory drugs, and opioid drugs such as morphine and oxycodone), disease-modifying anti-rheumatic drugs (DMARDs), and corticosteroids are the most common medications for controlling RA inflammation and pain.
  • Non-drug approaches. Resting and restricting your activity levels can help you to manage pain and applying heat and cold can provide pain relief.  Splinting can mobilize, and support affected joints in your hands, but splinting is not a long-term option, because it can lead to muscle atrophy (weakness). Physical therapy can help you to improve hand strength and range of motion. And occupational therapy can teach you how to protect your hands and fingers from joint damage with the use of assistive devices and practical strategies.
  • Surgery. When joint symptoms don’t respond to treatment, and there are joint damage and deformity, surgical interventions might be considered. The type of surgery will be determined based on the deformity and which joints are affected and may include reconstruction, replacement or fusion surgeries.

Joint Deformities

Hand and finger deformities in RA are an indication of a severe disease, this according to researchers out of Lund University Hospital, Lund, Sweden.

The Swedish study also found that more than half of people affected by RA will develop deformities after ten years, and most deformities start to develop during the first year. And these deformities impact the quality of life and daily function.

Common hand and finger joint deformities associated with RA include:

  • Trigger finger.
  • Boutonniere deformity. This results in the middle finger bending towards the palm, while an outer finger may bend in the opposite direction.
  • Swan-neck deformity. The type of deformity causes the base of your finger and outermost joint to bend, and the middle finger to straighten.
  • Hitchhiker’s thumb. The thumb will flex at the metacarpophalangeal joint and hyperextend at the interphalangeal joint, resembling a Z-shape.
  • Ulnar deviation. This incurs when the fingers slant away from the thumb. The metacarpophalangeal joints are so damaged that the finger starts to become displaced and move towards the ulna bone (long bone of the forearm stretching from the elbow to the smallest finger).

The Bottom Line

Treatments can help to prevent or delay RA hand and finger deformities. Therefore, it is important to take all medications prescribed by your doctor and to follow your doctor’s advice for managing symptoms in your hands and fingers, and throughout your entire body.

Resources

Everyday Health (Managing Symptoms of Arthritis in Your Hands)

American Society for Surgery of the Hand (Rheumatoid Arthritis)

Oxford Academic (Hand deformities are important signs of disease severity in patients with early rheumatoid arthritis)

National Institutes of Health (Severe rheumatoid arthritis hand deformity)

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