We depend on our hands with their many small joints, bones, tendons, ligaments, and muscles 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 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. Over time, RA affects joints in a typical symmetrical pattern, with pain, swelling, and inflammation.1,2
How will RA affect my hand?
In RA, joints in the hand will be tender when squeezed or during movement and a decrease in grip strength will be evident. In some patients, there may be a visible swelling and redness affecting the entire hand.2
Early in the course of RA, swelling with build-up of synovial fluid typically occurs in the joints between the intermediate and proximal phalanges. Swelling that affects the distal phalanges typically does not occur until later in the disease process. Affected joints will be tender to the touch and swelling will result in a restriction of range of motion. A reddening of the palms may also be evident.2
In some cases, swelling may affect the entire hand, resulting in what is called a “boxing glove” appearance. Swelling may be so severe that the patient loses the ability to touch finger tips to the palm.2
The tendons (fibrous cords that attach muscle to bone) of the hand may become affected by inflammation of the joint. Additionally, formation of an RA nodule at the wrist may impede tendon function, resulting in an inability to extend one or more fingers. Eventually the nodule may cause the tendon to rupture, resulting in loss of function of fingers.2
Without the proper management, RA may result in deformity of the hands, with tendons on the back of the hand becoming tight and fingers developing exaggerated profiles.1
Management of symptoms affecting the hands
Treatment of RA symptoms affecting the hands depends on the severity of symptoms and the extent of damage, including the stage of disease, the number of joints affected, the nature of disability, and the patient’s goals and needs. Options include drug treatment, splinting, injections, and surgery.3
Drug treatments. The initial approach to treatment should involve medications to control inflammation and pain (including analgesics [NSAIDs], disease-modifying anti-rheumatic drugs [DMARDs], and glucocorticoid injection).3
Non-drug management approaches. Rest and/or restricted activity and application of heat or cold may also be used to provide relief of acute pain. Splinting is commonly used to immobilize and support affected joints in the hand. However, use of splinting for too long a period of time may result in atrophy of the muscles that stabilize injured joints.3
Physical therapy and other forms of rehabilitation may be useful in maintaining and improving range of motion and strength.
Surgery. If joint symptoms do not respond to medication or other management approaches, surgical interventions may be used. Choice of surgical options depends on the nature of damage to joints and other structures and may include joint reconstruction, replacement, or fusion.3
Surgery is used to address a range of deformities and problems affecting the hands that are characteristic of RA. These include:
- Ulnar deviation of digits
- Boutonniere (buttonhole) deformity
- Swan-neck deformity
- Mallet finger
- Tendon rupture