| |
Rheumatoid
Disease and the Hand
What is
rheumatoid arthritis?
Rheumatoid arthritis is an illness that can
affect almost every organ in the body. It
often attacks the tissues, called synovium,
that line the joints and tendons. The tissue
becomes swollen and covers the joints,
destroying bone and cartilage. The exact
cause of rheumatoid arthritis is not known.
It affects about 1% of the population, women
more often than men.
What
are the signs and symptoms?
In the early stages of the disease, joint
problems are the most common symptoms. A
general sense of being tired, or just not
feeling quite right, often happens before
the slow start of joint pain and swelling.
Morning stiffness is a frequent complaint.
As the disease continues, symptoms may
include swelling of different joints in the
hands, wrists, elbows, shoulders, hips,
knees, and feet. The swelling usually takes
place in the same joint on both sides of the
body, known as symmetrical swelling.
Rheumatoid arthritis may result in pain and
deformity. Occasionally, the disease affects
other organs of the body, such as the heart,
eyes, and lungs.
How
does it affect the hand?
Generally, the first and most common
complaint is swelling of the hand at the
knuckles, that gives the fingers a spindle
shape. This swelling often happens in the
wrist and the large knuckles in the middle
of the hand. The swollen tissue may destroy
the ligaments that hold the joints together,
and damage cartilage and bone. This can
result in certain deformities. The wrist may
turn toward the thumb side of the hand,
causing “ulnar drift” of the fingers (see
Figure 1). The swollen tissue may also
produce damage, causing the tendons to
rupture. When the tendon ruptures, you may
not be able to bend or straighten your
finger. Other problems that may happen are
swelling that causes pressure on the nerves
(carpal tunnel syndrome), or lumps
(rheumatoid nodules) found over various
joints of the hand and elbow.
How is
it treated?
Rheumatoid arthritis is usually treated with
medication. Surgery may help when medicine
does not control the disease. A wide variety
of non-steroidal, anti-inflammatory,
cortisone-like prescriptions are usually
used. Education for learning to live with
the limitations caused by this disease, such
as aids for daily activities, splinting, and
information on how to avoid damaging the
swollen joints, can be provided by a hand
therapist. Contact your local Arthritis
Foundation for resources and more
information about rheumatoid arthritis.
Surgery may
only be considered when medical treatment
does not work. The goals of surgery are to:
1) reduce pain, 2) improve function, and 3)
improve appearance. Surgical treatment may
include removing the swollen tissue from the
joints or around the tendons, which may
reduce pain and prevent more tendon damage.
If the tendon has already been damaged,
surgery may be done to repair the damage.
Rheumatoid nodules may be surgically removed
to improve appearance and comfort. In some
cases, large knuckles of the hand may be
treated by arthroplasty, a procedure where
artificial knuckles (made of silicone rubber
or other material) are inserted. This may
improve the use of the hand and lessen pain.
Surgical procedures performed on the
rheumatoid hand and wrist are often complex
and may require therapy.
Figure 1
Typical appearance of the hand in rheumatoid
arthritis. (Ulnar drift, swelling and
dislocations, little finger deformity.)
Copyrighted ©
2001 American Society for Surgery of the
Hand
|
|
