Reviewed by: HU Medical Review Board | Last reviewed: October 2020 | Last updated: December 2020
The wrist is a complex joint that allows us to accomplish many of the hand and finger movements we rely on for a range of daily tasks, from unscrewing the lid on a jar to brushing our hair. Normally, we take the use of our wrists for granted. However, when rheumatoid arthritis (RA) affects the wrist, it can make many common tasks and movements difficult or impossible, leading to pain, discomfort, and even significant disability.
The wrist is often one of the first and most commonly affected joints in people with RA. Some of the first symptoms are pain and swelling in the area, as well as stiffness that can impact range of motion. Early and aggressive treatment to control inflammation and slow or prevent joint damage is important. Chronic inflammation of the wrist can lead to deformities and loss of function.1,2
How does RA affect the wrist?
The wrist is a complex joint that is actually made up of many smaller joints. It includes two large bones and eight smaller ones. When healthy, the bones easily glide over each other during movement. They are protected by smooth cartilage that covers the joint surfaces.
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 and pain, especially when the joint is used. In the early stages of RA, joint tenderness and mild stiffness are common. As the disease progresses, symptoms include:2,3
- Redness or warmth in or around the wrist
- Wrist pain, stiffness, and swelling that last for long periods of time
- Severe joint stiffness in the morning that usually lasts for at least 30 minutes
Over time, the inflamed tissues inside the joints begin to thicken. Eventually, this process also makes the joints less stable and decreases range of motion.2,3
In some cases, RA is symmetrical, which means it usually affects the same joints on both sides of the body. As the condition gets worse, ligaments, joints, and cartilage become more damaged, leading to deformities.2,3
RA symptoms often experience periods when their symptoms become worse, known as flare-ups or flares. These flares are then followed by periods when symptoms decrease.
The exact cause of RA is not known. Researchers believe that some people have genes that can make them more likely to have RA. However, people with these genes do not automatically develop RA. There is usually something that triggers the condition, like an infection. This causes the immune system to start attacking the joints.2,3
How is RA wrist pain treated?
While there is no cure for RA, there are different ways you can manage the inflammation, pain, and stiffness that affect your wrists. Treatment depends on your symptoms and how severe they are. The goals of RA treatments include:1,4
- Stop or reduce inflammation
- Relieve symptoms
- Prevent joint and organ damage
- Improve function and well-being
- Reduce long-term complications
Treatment includes nonsurgical and surgical options.
Nonsurgical treatments for RA wrist pain
In most cases, the first treatment approach includes nonsurgical options. They can help reduce your symptoms and help them from getting worse. The options may include:5
- Limiting or stopping activities that make your wrist pain worse
- Wearing a wrist 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 wrist. Your doctor may have you work with a physical therapist to find exercises that work best for you.
- Getting steroid injections into your wrist joints can help reduce inflammation
- Alternately soaking your wrists in warm and cold water to help reduce swelling
If the above options do not control 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.6
Surgical treatments for RA wrist pain
If your RA symptoms do not respond to nonsurgical options or medicines and your quality of life has been impacted by your arthritis, your doctor might recommend surgery. The goal of wrist surgery is to improve or restore your wrist and hand function, and provide pain relief.5
The type of wrist surgery used depends on how severely your joints are damaged. Surgeries include:5
- Synovectomy – During this procedure, the surgeon removes the synovium, the thin membrane that lines the joints.
- Proximal row carpectomy – During this procedure, the surgeon removes the 3 wrist bones that are closest to your forearm. This surgery is designed to reduce pain while maintaining some wrist motion.
- Fusion (arthrodesis) – This procedure is often used if motion is causing your pain. During this procedure, the surgeon removes damaged cartilage and then uses pins, plates, or screws to hold the wrist joint in a permanent position. Eventually, the wrist bones fuse (grow) together.
- Total wrist replacement (arthroplasty) – During this procedure, the surgeon removes the damaged cartilage and bones in your wrist. They will then place new metal or plastic joint surfaces to restore your joint function. This procedure allows more wrist movement than fusion.
In some cases, surgeons perform partial fusion, where only a few of the wrist bones are fused together. This preserves some wrist motion. However, if you have extensive arthritis, a complete fusion may be necessary. In this case, all of the wrist bones, as well as 1 of the bones in the forearm, are fused together. This eliminates wrist motion, but arm rotation and finger/thumb motion are usually preserved.