A normal joint consists of two smooth, cartilage-covered bone surfaces that fit each other closely and move smoothly against each other.

Types of arthritis

Arthritis means “inflammed joint”.

In arthritis, smooth cartilage surfaces of joint become irregular and essentially “wear out.” Arthritis can affect any joint in the body, including the hands and fingers. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infection, gout, and psoriasis.

Rheumatoid arthritis of the hand

Rheumatoid arthritis affects the synovial tissues that line and lubricate the joints. The body produces antibodies (Rheumatoid autoantibodies) that attack these synovial tissues. These joint linings (synovium) becomes inflamed and swollen and erodes the cartilage and bone. The swollen tissue may also stretch the surrounding ligaments, which hold the bones together, resulting in joint deformity and joint instability. The tendon can get the inflammation too resulting in stretching out of and ruptures of the tendons.

This is a systemic condition affecting the whole body. Thus, multiple joints can be affected, usually on both sides of the body. Rheumatoid arthritis of the hand is most common in the wrist and the finger knuckles and proximal interphalangeal (PIP) joints (second joint from the tip of finger).

Signs and symptoms

  • Stiffness, swelling, and pain; sausage-shaped (fusiform) swelling of the finger
  • Rheumatoid nodules – a soft lump over the back of the hand that moves with the tendons that straighten the fingers
  • a shift in the position of the fingers as they drift away from the direction of the thumb (ulnar drift)
  • swelling and inflammation of the tendons that bend the fingers, resulting in triggering of the finger and sometimes causing numbness and tingling in the fingers (carpal tunnel syndrome)
  • rupture of tendons
  • unstable joints in the wrist, fingers, and thumb
  • deformity of the fingers

Diagnosis:

  • The clinical appearance of the hands and fingers
  • X-rays with certain characteristics of rheumatoid arthritis, such as narrowing of the joint space, swelling and diminished bone density near the joints, and erosions of the bone.
  • Blood or other lab tests to confirm the diagnosis (ESR, CRP, Rheumatoid factor and anti CCP test)

Treatment

Treatment is designed to relieve pain and restore function.

Most patients require non-operative treatment. Anti-inflammatory medications,oral steroids, and/or cortisone injections may be used. Several disease-modifying treatments are now available,including anti-malarial drugs, methotrexate, cyclosporine,gold, and other new drugs (remicade, enbrel) that help suppress the body’s immune system to reduce the inflammation and pain. A rheumatologist will often prescribe and monitor these medications.

Hand therapist can help the patients with exercises, splints, modalities such as paraffin (warm wax) baths, and instruction on how to modify handling in ways that may help relieve pain and pressure. Adaptive devices may help cope with the activities of daily living.

Surgery for tendon inflammation may include removing nodules, removing the inflamed tissue around tendon and cutting away rough bone that may scrape the tendons, and reinforcing the tendons. If a tendon rupture has occurred, a hand surgeon may be able to repair it with a tendon transfer or graft.

Surgery to treat the arthritic, unstable or deformed joints includes:

  • Removal of inflamed joint linings to help reduce pain
  • Correction of joint deformity and rebalancing of the surrounding soft tissues
  • Joint excision, joint replacements or joint fusions for damaged joints

There is no cure for rheumatoid arthritis. However, surgical procedures can often help correct deformities, relieve pain, and improve function.