Hand Pain, Swelling, and Inflammation

We depend on our hands for daily activities, ranging from typing on a computer keyboard and opening a door to threading a sewing needle and opening a can of soup. When rheumatoid arthritis (RA) affects the joints of the hand, these common activities may become difficult or impossible.

For many people with RA, the joints of the hands are the first joints to be affected by the disease. These joints may feel tender when your hand is squeezed or when you move them. It is also common for RA to weaken your hand’s grip. Some people with RA experience redness and swelling on their entire hand. If left untreated, RA can cause your hands to become bent or twisted.^1,2

How does RA affect the hand?

Each hand is made up of 29 joints along with a network of muscles, ligaments, and tendons that support the joints. These joints are covered with a layer of cartilage and lined with a thin membrane called the synovium. The synovium cushions the joints and releases a fluid that makes it easier for your joints to move. This is called synovial fluid.³

In people with RA, the body’s immune system attacks the healthy tissues inside the joints. This causes an inflammatory response that results in swelling, stiffness, and pain, especially when the joint is used. Other common symptoms of RA in the hands and fingers include:³

• Joints that are warm and tender to the touch
• Tenderness
• Redness on the palms
• Limited range of motion
• Numbness and tingling in the hands, also known as carpal tunnel syndrome

There are periods of time when RA symptoms become worse, known as flare-ups or flares. These flares are then followed by periods when symptoms decrease. As RA progresses, ligaments, joints, and cartilage become more damaged. This leads to increased pain and inflammation, and, in some cases, deformities like:⁴

• Swan-neck deformity – The base of the finger and the outermost joint bend but the middle joint straightens
• Boutonniere (buttonhole) deformity – The middle finger joint bends toward the palm while the outer finger joint bends the opposite way
• Ulnar drift – The fingers lean away from the thumb and toward the pinky finger
• Hitchhiker’s thumb – The thumb flexes at the joint where it meets the palm, then bends backward at the joint below the thumbnail

The exact cause of RA is not known. Researchers believe that some people have genes that make them more likely to develop RA. However, this does not mean that people with these genes automatically develop RA. There is usually something that triggers the condition, like an infection. This causes the immune system to start attacking the joints.^1,5

How is RA hand pain treated?

There is no cure for RA, so treatment focuses on managing the inflammation, pain, and stiffness that affect your hands. Treatment depends on your symptoms and how severe they are. It may include nonsurgical and surgical options. The goals of RA treatments include:^2,6

• Stop or reduce inflammation
• Relieve symptoms
• Prevent joint and organ damage
• Improve function and well-being
• Reduce long-term complications

Nonsurgical treatments for RA hand pain

In most cases, treatment for RA symptoms in the hands begins with nonsurgical options. They can help reduce your symptoms and keep them from getting worse. The options may include:^3,5

• Limiting or stopping activities that make your hand pain worse
• Wearing a splint to help support your joints and ease the stress placed on them
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to help reduce pain and inflammation. Topical NSAIDs (medicine applied directly to the skin) can also be applied in the areas of the joints.
• Doing exercises that help improve the range of motion and function in your hands and fingers. Your doctor may have you work with a physical therapist to find exercises that work best for you.
• Getting steroid injections into your hand joints can help reduce inflammation
• Using assistive devices to reduce stress on the joints, like electric can openers and key holders

If the above steps do not improve your RA symptoms, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs). These are drugs that are designed to stop the immune system from attacking the joints. This slows or prevents joint deformity. There are both benefits and risks of DMARDs, so talk to your doctor about whether these drugs are right for you.⁸

Surgical treatments for RA hand pain

If your symptoms do not respond to medicine or lifestyle changes, your doctor might recommend surgery. The most common surgical options include:^3,9

• Fusion (arthrodesis) – During this procedure, the surgeon removes damaged cartilage and then uses pins, plates, or screws to hold joints in the finger together to create a stronger, more stable knuckle. This is more commonly used in the joints near the ends of the fingers. However, this limits flexibility and movement.
• Total joint replacement (arthroplasty) – During this procedure, a surgeon removes your arthritic cartilage and part of the bone from the affected joints in your hand and replaces it with an implant, usually made from silicone rubber

Learn more about hand surgery