Different Types Of Arthritis In The Hands – Hands are one of the first and most common areas affected by rheumatism. Here’s what to look out for and what to do about it.
Your hand is one of the most complex structures in the human body. It is designed for powerful gripping, lifting heavy objects, and manipulating small objects (such as passing a fine thread through the eye of a small needle). Each hand, consisting of the wrist, palm, and fingers, has 27 small joints, an equal number of bones, and numerous muscles, tendons, and ligaments. All of these complications make the hand a prime target for rheumatoid arthritis (RA).
Different Types Of Arthritis In The Hands
Rheumatoid arthritis is a chronic inflammatory disease in which your immune system mistakenly attacks the membrane lining around your joints. While RA can affect joints and organs throughout the body, it often affects the smaller joints first, especially the joints of the hands and wrists, as well as the joints of the feet.
Carpal Tunnel Syndrome Vs. Arthritis: What’s The Difference?
Research shows that an estimated 90 percent of people with rheumatoid arthritis experience pain, stiffness, or swelling in their hand joints, often leading to problems with daily activities.
Many joints are covered with a covering called synovium, which lubricates the joint so that it moves more easily. If you have rheumatoid arthritis, the synovium becomes inflamed, thickens, and produces excess synovial fluid. This is known as synovitis. This excess fluid — along with inflammatory chemicals released by the immune system — causes swelling, damage to the cartilage, and softening of the bone in the joint. According to the American Association for Surgery of the Hand, the swollen tissue can stretch the surrounding ligaments, leading to deformity and instability. Inflammation can also weaken and damage tendons. Ligaments are connective tissues that connect two bones. Tendons are ligaments that connect muscles to bones.
When RA affects the hand, it is most common in the wrists and knuckles, especially the MCP (metacarpophalangeal) joint, or the joint of the big toe where the fingers and thumb meet, and the PIP (proximal interphalangeal) joint or the common middle. explains Jemima Albaida, MD, assistant professor of medicine in the division of rheumatology at Johns Hopkins Medicine in Baltimore.
The first knuckle on top of the finger closest to the nail — the DIP, or distal interphalangeal joint — is usually spared in RA. (It is more commonly involved in other forms of arthritis, such as osteoarthritis or psoriatic arthritis.) In the wrist, rheumatoid arthritis often affects the joint between the two bones of the forearm, the radius and ulna.
Va Disability Ratings For Arthritis Conditions
RA tends to involve the small joints of the hands and feet in the early stages of the disease, adds Dr. Albaida, who also serves as director of the musculoskeletal ultrasound and injection clinic at Johns Hopkins.
In fact, a study in the Journal of Rehabilitation Medicine that included 200 rheumatoid arthritis patients found that 94 percent had at least one hand or wrist symptom and 67 percent had at least one associated condition, mostly from the early stages.
When your hands are affected by rheumatoid arthritis, you may experience swelling around the affected joint, leading to pain or tenderness. The joint may feel warm. The swelling is symmetrical, meaning it occurs in the same joints on both the right and left hand.
Lindsey S. Lally, MD, a rheumatologist at the Hospital for Special Surgery in New York City, says stiffness with immobility is also characteristic of rheumatoid arthritis in the hands. Symptoms such as stiffness and pain are usually worse in the morning and can last for at least 30 minutes or more.
Psoriatic Arthritis Is An Inflammatory Joint Condition Associated With Psoriasis
Together, these hand symptoms can interfere with your performance and ability to perform daily tasks and activities.
“This can manifest as difficulty using the fingers, decreased manual dexterity, inability to bend or straighten the affected joint, and decreased strength,” says Dr. Albaida. “Sometimes rheumatoid arthritis can cause the ligaments and tendons in the hand to loosen, leading to permanent deformities in the hand,” adds Dr. Lally. There is some evidence that hand deformity usually occurs within the first year of rheumatoid arthritis if left untreated.
The carpal tunnel is a narrow passage surrounded by ligaments and bones. It is located at the base of your hand and contains tendons and the median nerve that runs from your forearm to your palm. Any pressure on this important nerve in your wrist can cause tingling, numbness, or weakness in your hand and arm.
Dr. Albaida explains that because RA can cause swelling and inflammation in the wrist, it can compress the median nerve and lead to carpal tunnel syndrome.
Hand Osteoarthritis Is Worse When It Affects Your Fingers And Base Of Thumb
The medical term for trigger finger is tenosynovitis. It occurs when the protective sheath or covering around the tendon becomes irritated and inflamed (tenosynovitis). The more common name refers to what happens next: The inflammation disrupts the normal sliding movement of the tendon through the sheath, and the affected finger gets stuck in a bent position. According to the Mayo Clinic, your finger can bend or straighten with a jerk — like a trigger being pulled and released. In severe cases, your finger can get stuck in a bent position. Rheumatoid arthritis is a risk factor for trigger finger.
According to the American Association for Surgery of the Hand, this hand condition is a unique symptom of rheumatoid arthritis. It happens when the big knuckle bones become so swollen and damaged that your fingers begin to bend abnormally and move sideways away from the thumb and toward the ulna bone in the forearm (which is on the little finger side).
This happens when the middle joint of the finger bends back more than normal (or hyperextends) and the top joint bends or bends down, resulting in a gooseneck shape.
Sometimes called a buttonhole deformity, the joint of the middle finger curves inward (toward the palm) and the joint of the top finger curves outward (away from the palm).
Arthritis & Its Different Types
Some people with rheumatoid arthritis develop hard lumps under the skin called nodules, often around pressure points. In the hands, nodules can appear on the joints of the fingers and wrists.
Hand pain and stiffness are the hallmark symptoms of rheumatoid arthritis, but these symptoms can stem from many different conditions.
“Sometimes it can be very difficult to determine whether the current symptoms in the hand are caused by ongoing inflammation, injury, or another condition such as osteoarthritis or some other entity,” says Dr. Albaida.
This type of hand pain usually occurs with osteoarthritis (OA), a degenerative condition in which the cartilage that protects the joint ends wears away over time. Dr. Lally explains that OA joint symptoms are often exacerbated by repetitive or overuse and exertion, such as gardening or crafting.
Arthritis Of The Hand & Wrist
With rheumatoid arthritis, on the other hand, pain and stiffness usually develop with non-use and after periods of inactivity, such as when you wake up in the morning after a night of inactivity.
Another way to tell the two apart: swelling in the hand and wrist in osteoarthritis is hard and bony. Dr. Albayda says swampy and crushed in RA.
Psoriatic arthritis (PsA) is another form of inflammatory arthritis that can cause painful and swollen joints that feel warm to the touch. However, psoriatic arthritis is more likely to cause a sausage-like swelling in the fingers and toes (called dactylitis).
Also, pain and stiffness in the first knuckle is common in psoriatic arthritis and osteoarthritis, but is rare in RA, says Dr. Lally.
Types Of Arthritis
This rash gets its name because they spread across the cheeks and bridge of the nose, creating a shape that resembles a butterfly spreading its wings. It’s a sign of lupus, an autoimmune disease that shares many symptoms with RA, including pain, stiffness, and swelling in the fingers and wrists. Read more about the different symptoms of lupus here.
Rheumatoid arthritis can increase your risk of developing this condition, but many other factors can also come into play, including wrist anatomy, nerve-damaging conditions, and possibly repetitive hand movements. It’s tricky because you can have carpal tunnel syndrome related to RA or not related to RA at all.
These are soft, round, benign nodules that usually develop along the tendons or joints of the wrist or hand. If it presses on a nearby nerve, it can cause pain, numbness, or weakness.
Tendonitis (inflammation of the tendon) and tenosynovitis (inflammation of the protective layer of the tendon) can cause complaints in the wrists and fingers.
Treatments For Rheumatoid Arthritis In Hands
If you injure your hand in an accident or while playing or exercising, it can cause acute pain that can be long lasting and chronic.
There’s no test to diagnose RA — and in the early stages, signs and symptoms can resemble many other diseases.
But an early diagnosis of rheumatoid arthritis is important for the best outcome. “We are learning that we have to manage inflammation more aggressively than before because joint damage can occur sooner,” Dr. Albaida says. Therefore, there has been a change in treatment paradigms towards early capture of patients and establishing treatment control on target.
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