DESCRIPTION

Arthritis is an inflammatory condition affecting the joints—areas where two cartilage-covered bone surfaces meet to glide smoothly. When inflammation occurs, joints swell and lose their smooth movement, which over time can lead to cartilage wear. Although many types of arthritis exist, rheumatoid arthritis is a systemic disease that often presents with morning stiffness, swelling, and fatigue. Notably, around two-thirds of patients experience problems in their wrists and hands.

CAUSES

In rheumatoid arthritis, the synovium—the tissue lining and lubricating the joints—becomes inflamed and swollen. This inflammation stretches supporting structures such as ligaments and tendons, eventually leading to joint instability and deformity. As the disease progresses, the continued inflammation erodes the cartilage and bone, causing joints to feel hot and appear red. The condition typically affects the wrists and knuckles in a symmetric pattern, meaning both hands are usually involved.

SIGNS AND SYMPTOMS

While general arthritis symptoms include stiffness, swelling, and pain, rheumatoid arthritis has some distinct features:

• Nodules and Lumps: Firm nodules may develop along the fingers or elbows, and soft lumps can form on the back of the hand.
• Deformities: Patients may experience finger angulation, Boutonniere deformity (bent middle joint), and Swan-neck deformity (overextended middle joint with a bent fingertip).
• Other Issues: Swollen tendons may lead to numbness or tingling (carpal tunnel syndrome), crepitus (a squeaky joint sound), or even joint locking.

DIAGNOSIS

Diagnosing rheumatoid arthritis involves a comprehensive approach:

• Clinical Examination: Your doctor will ask about your symptoms, family history, and the impact on daily activities, and will perform a detailed hand examination.
• Imaging: X-rays and sometimes MRI scans are used to identify signs such as joint space narrowing, decreased bone density, and erosions near the joints.
• Lab Tests: Blood tests such as the rheumatoid factor, sedimentation rate, and anti-CCP (cyclic citrullinated peptide) help confirm the diagnosis.

TREATMENT

The treatment of rheumatoid arthritis aims to reduce inflammation, relieve pain, and maintain joint function:

• Medications: While there is no cure, medications can slow the disease progression.
• Team Approach: Optimal care involves collaboration among rheumatologists, hand surgeons, hand therapists, and primary care physicians.
• Therapy: Hand therapists provide exercises, splints, and adaptive devices to protect joints during daily activities.
• Surgery: In advanced cases or to prevent further damage, surgical interventions may be recommended. Options include removing inflamed tissue, tendon repairs (via transfers or grafts), synovectomy (removing the joint lining), joint replacement, or joint fusion. The choice of procedure depends on the joints involved, the extent of damage, and the patient’s specific needs.