Hand and Finger Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a painful inflammatory disease that causes swelling, stiffness, joint destruction, and deformity. Thisautoimmune disease has an effect on the cells that coat and lubricate joints (synovial tissue).

Although osteoarthritis (the "wear and tear" arthritis") may affect one joint, such as hand arthritis or finger arthritis, rheumatoid arthritis usually happens symmetrically. For instance, RA may affect both wrists, both hands, both knees, and both ankles and feet.

A Visual Guide to Understanding Rheumatoid Arthritis (RA)

What are the symptoms of hand and finger RA?

The wrist joints and the finger joints closest to the hand are common targets of hand RA. With hand and finger RA, you may feel the following:

• Hand pain, finger pain, swelling, and stiffness
• Hand joints and finger joints that are warm and tender to the touch
• The same joints affected symmetrically (both wrists, fingers on both hands)
• Finger joints that "creak" when moved; this is called crepitus
• Deformities in finger joints
• Carpal tunnel symptoms such as numbness and tingling of the hands
• More inflammation, pain, and stiffness that affect other symmetrical joints such as both sides of the jaw, both sides of the neck, shoulders, elbows, hips, knees, ankles, and feet
• Flu-like feeling
• Fatigue that is not easily resolved
• Pain and stiffness that last for more than an hour upon arising

What causes hand and finger RA?

Scientists are unsure about the causes of hand and finger RA. They do know that RA affects about 1.3 million Americans and occurs in all racial and ethnic groups. About two to three times as many women suffer from rheumatoid arthritis as men. Some rheumatoid arthritis research points to the following factors as possibly influencing rheumatoid arthritis:

• Genetic factors.
• Environmental factors such as a viral or bacterial infection.
• Hormones. RA tends to improve with pregnancy, whilebreastfeeding and the postpartum period (the time after delivery) may aggravate rheumatoid symptoms.

What is a swan-neck deformity?

Rheumatoid arthritis is a common cause of a swan-neck deformity. It's estimated that about 50% of those with RA have this deformity.

With a swan-neck deformity, the base of the finger and the outermost joint bend, while the middle joint straightens. Over time, this imbalance of the finger joints can result in the crooked swan-neck position. (True swan-neck deformity does not occur in the thumb.)

A swan-neck deformity can make it almost impossible to bend the affected finger normally; it can make it difficult to button shirts, grip a glass, or pinch with the fingers.

By examining the hand and fingers, a rheumatologist can diagnose a swan-neck deformity and determine appropriate treatment, which may include:

• Finger splints or ring splints
• Surgery to realign the joints or fuse the joints for better function

What is a boutonniere deformity?

Boutonniere deformity, also called buttonhole deformity, can occur as a result of rheumatoid arthritis.

With a boutonniere deformity, the middle finger joint will bend toward the palm while the outer finger joint may bend opposite the palm. This deformity may be the result of chronic inflammation of the finger's middle joint.

Treatment for boutonniere deformity may include splinting to keep the middle joint extended. Surgery may be needed.

What's the treatment for hand and finger RA?

Treatment for rheumatoid arthritis is a multifaceted regimen that includes:

• Medications.
• Rest and exercise.
• Splints and special arthritis aids that help take pressure off painful joints.
• Self-managing stress.
• Dietary changes, such as eliminating foods that may trigger inflammation and including foods that may help decrease inflammation, such as omega-3 fatty acids found in cold-water fish,vitamin D, and flax oil.
• Regular medical checkups.
• Physical therapy
•  Surgery to help restore function.

Which medications are used to treat hand and finger RA?

Medications commonly prescribed for RA include:

Disease-modifying anti-rheumatic drugs (DMARDs). These drugs are used with NSAIDs and /or corticosteroids in low doses. DMARDs include:

• methotrexate (Rheumatrex, Folex)
• leflunomide (Arava)
• hydroxychloroquine (Plaquenil)
• sulfasalazine (Azulfidine)
• gold (Myochrisine injected into muscles; Auranofin -- given orally)
• minocycline (Minocin, Vectrin, Dynacin)
• azathioprine (Imuran)
• cyclosporine (Neoral, Sandimmune)

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may be over-the-counter or prescription strength.

Biologic response modifiers (also in the category of DMARDs); these are usually used with methotrexate. Biologic agents include:

• adalimumab (Humira)
• anakinra (Kineret)
• etanercept (Enbrel)
• infliximab (Remicade)
• abatacept (Orencia)
• rituximab (Rituxan)
• tocilizumab (Actemra)
• tofacitinib (Xeljanz)

What are some tips to relieve hand and finger joint pain?

Regular exercise is extremely important to increase flexibility in the hands and fingers. It's also important to rest the painful joints. Hand or finger splints may help ease pressure during painful flares. In addition, arthritis aids and devices can help make daily living skills easier so you can avoid pain and injury. Here are some easy tips:

• To exercise your hands and fingers, you can use a soft foam ball like a Nerf ball (not a hard tennis ball). This helps to increase dexterity and reduce stiffness.
• Activities such as knitting or playing the piano can keep your fingers nimble and reduce pain associated with finger arthritis or hand arthritis.
• To protect your hands from injury, use as many joints as possible to share the load in any activity you do. Avoid favoring a particular finger or position with the hands.
• Seek help from an occupational therapist with arthritis aids and devices. These are available at most medical supply stores, pharmacies, and on the Internet.
• Use hook and loop fasteners to replace buttons on clothing.
• Add accessories to doorknobs for easier turning.
• Use rotary lamp switches that require just a touch to the lamp base rather than twisting a small knob switch.
• Try a long-handled shoehorn to put on your shoes without bending over and stretching your hands.
• Use lightweight household utensils, pots, and pans.
• Use lightweight plastic cups and dishes instead of heavy china.
• Try foam padding around your pen or pencil; these are available at most office supply stores.

Moist heat and ice are both effective in easy RA pain and stiffness.

Try using warm, moist compresses on your arthritic fingers and hands for 15 minutes before you exercise. Moist heat dilates blood vessels and increases the flow of blood, oxygen, and nutrients to the painful site.  

You may use a moist heating pad, a warm, damp towel, or a hydrocollator pack. You can also place your hands in a moist heat bath or try a warm paraffin (wax) bath. It may help your stiffness to use the moist heat for a few minutes after exercising.

Some patients with RA prefer ice packs, which reduce swelling and pain by constricting blood vessels. You might try a bag of frozen vegetables or ice wrapped in a clean towel. Apply this to the painful joint for 10 to 15 minutes at a time.

Alternating moist heat applications with ice packs may bring optimal relief. The most important thing is to find the pain-relieving therapy that works best for you. Then, make it part of your daily ritual to use the moist heat and/or ice packs before and after exercise.

SOURCES:

National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Living with Arthritis." 

National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Rheumatoid Arthritis."

National Institutes of Health: "X-Plain Rheumatoid Arthritis."

Arthritis Foundation: "Rheumatoid Arthritis Resources."

Arthritis Today: "How is Rheumatoid Diagnosed?"

American College of Rheumatology: "Rheumatoid Arthritis."

McIlwain, H., Bruce, D. Pain Free Arthritis, Holt, 2003.

American Society for Surgery of the Hand: "Rheumatoid Arthritis of the Hand."

The Merck Manuals: "Deformities."

EMedicine: "Swan-Neck Deformity."

News release, FDA.

Reviewed by David Zelman, MD on February 28, 2012