Rheumatoid Arthritis In The Hands

One Of The Most Painful And Debilitating Areas To Suffer RA, Successful Management Is Critical....

In This Article –

  • Causes of Rheumatoid Arthritis In The Hands
  • Hand Joints Affected
  • 11 Symptoms To Look Out For
  • Diagnosis
  • Types Of Deformity Caused By Rheumatoid Arthritis
  • 15 Potential Treatments For RA In Your Hands
  • 17 Coping Strategies If You Suffer With RA In Your Hands 

It is everyone’s nightmare if they knew the reality – waking up with burning fingers in pain, stiff to move and often twisted.

A life with rheumatoid arthritis that has affected your hands is enough to make all of us cringe. How you manage to cope and still live the life you want, is something we all should admire.

The hands are quite possibly the most delicate and most important parts of the human body. With more than 24 joints and infinite ligaments and tendons, they are one of our most important assets. Unfortunately, rheumatoid arthritis doesn’t care.

Once your bodies immune system turns against you it has no prejudice and can soon take away many of the activities that defined you as a person.

Here we focus on what can be done to help claw back every ounce possible of your old life.

Causes

As with all areas that rheumatoid arthritis attacks, doctors are unsure of why such a disease starts in the first place. Most speculation revolves around the idea that some people are more genetically disposed to getting it and that it only takes a triggering event such as an infection or fever, to set it off.

Hormones can also play a key role – this is partly why it is much more prevalent in women than in men. Curiously, it has also been known to change during pregnancy – the increased hormone levels causing great improvement in symptoms during pregnancy only to return in intensity after the birth.

After Rheumatoid Arthritis has begun, the hands are one of the most common areas to be affected. This is partly because of the sheer quantity of ‘synovial joints’ present.

A synovial joint is just a normal joint surrounded by a thin pliable membrane called synovium. This produces a clear fluid that lubricates the joint to facilitate movement known as synovial fluid.

When you suffer with Rheumatoid Arthritis in the hands, your own body sends white blood cells (your own protection against foreign invaders) to attack the synovium in your hand joints.

The synovial tissue reacts by producing extra layers of tissue at a rapid pace to try and protect itself (known as a ‘pannus’). The pannus itself then lodges between the joints in your fingers and hands, ultimately damaging the cartilage and affecting your bone.

The process of doing this ultimately creates additional fluid that further exacerbates the issue of swelling in your hands.

Lack of support…

This is also not helped by the fact that your hands have less supportive muscles than other joints such as your shoulder and so are more isolated. Your body has little method of using other muscles to support the joint and lessen the impact of the erosion.

Rheumatoid Arthritis is particularly painful in your hands because of the extremely large number of nerve endings present in your fingers and wrists.

Why Are Hand joints Affected?

Rheumatoid arthritis normally appears in several joints on both hands at the same time. Every joint is susceptible – from the knuckles (where the fingers meet the hand) to the final joint between the middle finger bone and the finger tip. This particular joint, technically known as the ‘Distal Interphalangeal Joint’ (or DIP for short) is the least likely to get rheumatoid arthritis until after symptoms have presented themselves on other finger/ hand joints.

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Spotting the Early Symptoms of Rheumatoid Arthritis Is Essential In Treating It Well.The List Below Are The Main Symptoms That Specifically Affect Your Hands. Be Sure To Check Our 23 Early Symptoms For Rheumatoid Arthritis For A Full List Of Early RA Symptoms as it is Likely They May Present Elsewhere First.

10 Early Symptoms of Rheumatoid Arthritis In The Hands

Rheumatoid Arthritis symptoms vary from person to person – both the type of symptoms and the length of time it will take to fully present. In some people, the symptoms of RA could become severe in just a matter of days, whereas for other people they may last weeks before the same level of hindrance is achieved.

Amongst the most likely symptoms to have to suffer with if you get rheumatoid arthritis in the hands are –

1.Finger Pain, with Swelling and Stiffness. Pain is usually a throbbing/ aching feeling. Swelling may make fingers closer resemble sausages!                                                                            

2.Creaking Joints. A creak/ cracking sound when moving your fingers

3.Carpel Tunnel Symptoms. These include numbness and tingling as well as swelling in the carpel tunnel (a passage between ligaments within your wrist passing the major ‘median’ nerve). As the passage narrows due to the inflammation, it squeezes the median nerve causing the tingling and numbness.

4.Trigger Finger. Your tendons become inflamed and lock your finger in a partly closed position. Also known as ‘Tenosynovitis’ this is seen as a very strong indicator of rheumatoid arthritis of the hands.

5.Fatigue. A real aching feeling after doing a finger or hand-intensive activity.

6.Misshapen Finger Joints or Fingers. Please see photo below or read the ‘deformities’ section for a description of the more extreme cases.  

7.Restricted use of hands. You may not be able to fully bend fingers or form a fist

8.A Soft Lump On The Back Of Your Hands. This is likely to move when you flex or stretch your fingers.

9.Presence Of Rheumatoid Nodules. These are hard lumps of inflammatory tissue that develop under the skin near to the finger/ knuckle joints. Typically, they are not painful and can be shrunk with the appropriate medication.

10.Flushing Of The Skin. Skin over the wrists and knuckles can become inflamed and hot.

Diagnosis

Your Doctor is the only person who can fairly diagnose rheumatoid arthritis. If they suspect RA, then it is likely they will give you an X-Ray to test for the likely signs such as errosions of the bone and narrowing joint space. Other blood tests can then be performed to make sure the diagnosis is correct.

Types of Finger Deformity Caused By Rheumatoid Arthritis

Swan-Neck In essence the base joint of your finger closest to your hand and the end joint closest to the end of your finger both bend, while the middle joint stops bending and straightens. In combination this forces you hand to form a sort of ‘swan-neck’ shape (hence the name).

Boutonniere – In this case, your middle joint suffers really severe inflammation and bend towards the palm of your hand. The end joint may also bend the other way (opposite the palm). This is often one of the cases that requires surgery to correct.

Trigger Finger The tendons in your hand become inflamed (also known as tenosynovitis), resulting in your finger getting stuck in a bent position, similar to that taken as if you were planning to fire a gun. Sometimes the finger will ‘click’ or pull out of the position only to lock back in again almost immediately.

Ulnar Drift This is where fingers point away from the thumb. In short, the knuckles become so damaged that your fingers start to dislocate and ‘drift’ sideways.

Hitchhikers thumb Your thumb forms a basic Z shape, due to hyperextension of your knuckles.

Mallet Finger The joint nearest the tip of your finger is bent towards the palm.

Treatments For Rheumatoid Arthritis In The Hands

1.Self-Care. Stay fit and keep in good mental health, prevent accidents and care more effectively for other minor ailments

2.Take Your Medication. Read the leaflet and take it accurately. Some drugs will be designed to control your pain, while others will be trying to slow or stop the progression of the disease.

3.Regular Reviews. Keep in contact with healthcare team to make sure condition is under control.

4.Occupational Therapy. An occupational therapist is very good at helping to provide an overview of your treatment options. They will talk to you about disease self-management, assisting devices and exercises that may help but wont cause you more pain. They are also likely to recommend using heat/cold compresses as part of your management and will discuss with you how to modify certain activities to reduce your pain levels. Basically, they will go over a lot of the information we put down here.

5.Rest and Relaxation.

6.Use Hot/ Cold Therapies. Use warmth for 15 minutes before exercising to increase the flexibility in your hands, then soak them in ice filled water afterwards to reduce swelling/ encourage strength. This cold method can also be used when you suffer a sudden flare up.

7.Use a DAS (disease Activity score) to measure regularly and decide on best treatment

8.Reduce Your medication as soon as possible.

9.Keep Well. Get a flu jab and also pneumococcal vaccination

10.Physical Therapy. Will improve flexibility and range of motion, providing you follow a special programme that doesn’t overwork your hands/ fingers.

11.Change Your Diet. Avoid foods that might trigger inflammation and eat more foods rich in amino acids that could curb inflammation such as fish like Mackerel or Salmon that are high in omega 3 fatty acids.

12.Keep A Positive Mindset. Positivity has a magical effect on human bodies. Positive thinking not only helps you to cope with the pain, but you are more likely to come up with innovative solutions for reducing the strain on your hands. This will all help achieve an active, pain-reduced life.

13.Use Splints And Special Arthritis Aids.

14.Manage Your Stress Levels. Increased stress will leave you feeling low and your bodies’ ability to withstand the effects of the rheumatoid arthritis even further reduced.

15.Hand Surgery. If all else fails, corrective surgery can straighten bent and locked joints/ tendons.Principally rheumatoid arthritis is treated with a combination of home ‘avoidance’ strategies (making sure you avoid making the symptoms worse), home soothing strategies (to control the pain) and medication. 

The Rheumatoid Folly Of ‘No Pain, No Gain’

There are many thing you can do to help with Rheumatoid arthritis in the hands – but it is worth emphasizing that the old adage of ‘pushing through the pain’ does not work here.

Footballers may try to ‘run off’ an injury and many of us may subscribe to the theory ‘no pain, no gain’ – but when it comes to RA, you are very likely to only make things worse and actually speed up the progress of the disease by not approaching activities differently.

This does not mean suspend your life altogether – just take simple steps to make certain activities less straining on your hands.

18 Tips for Coping with Rheumatoid Arthritis in the Hands.

Thanks for this section in particular go to some of our members who have kindly helped to contribute to the following list, because as well as those specific treatments detailed above, there are a number of day to day changes you can make to help ease the pain….

Coping Tip 1. Use lightweight kitchen utensils, cups, dishes and other household items where possible to reduce strain on your fingers.

Coping Tip 2. Put foam padding around tools that you use (and don’t have to wash) such as pens and pencils.

Coping Tip 3. Use gloves when opening jars etc to give yourself a much better grip without having to tighten your hands.

Coping Tip 4. Use loop and hook fasteners on the end of zips on clothing to replace buttons for easier grip.

Coping Tip 5. Avoid carrying bags in your hand – either get bags with shoulder straps (if you’re shoulders are ok) or use a basket with wheels

Coping Tip 6. Get a small trolley/ basket on wheels for carrying items around the house.

Coping Tip 7. Use electrical appliances whenever they are available

Coping Tip 8. Grip items with the palm of your hands where possible

Coping Tip 9. Make sure if you use a shoehorn it’s a long-handled one so you don’t have to stretch your hands when bending over to put your shoes on.

Coping Tip 10. Change shoes with laces to velcro ones or slip-ons for much easier fastening.

Coping Tip 11.Use both hands whenever you are thinking of lifting anything – no matter how small, it all helps

Coping Tip 12. Get pans with a handle on both sides and slide them on to work surfaces rather than lift them. You can always purchase a protective cover for your worktop, you cant purchase new hands!

Coping Tip 13. Add accessories to door knobs to make them larger and easier for turning

Coping Tip 14. Change light switches to touch-responsive ones where you had twisting switches, so they require much less gripping.

Coping Tip 15. Use a soft sponge ball for exercising so you can squeeze it easily during exercise sessions.

Coping Tip 16. Fit larger handles on cupboards/ draws etc or use something to bulk the handles out (masking tape over foam perhaps)

Coping Tip 17. Buy smaller quantities of everything (milk, bottles of drink etc) or pour them into smaller bottles when you get home, so you’re not always having to lift out huge containers

Coping Tip 18. Open doors with your whole body rather than your hand. In other words push it open with a combination of your foot and shoulder/ arm. Spreading the force, minimises the impact on your body.

The Final Word –

Rheumatoid arthritis is a particularly cruel disease to get, having no cure and causing considerable disruption to your life. When it comes to rheumatoid arthritis in the hands, this really is a battle at the cliff edge of your quality of life.

A quick diagnosis is essential, but then so is taking full responsibility for your treatment. Self-management is the key as there is only so much that drugs and even surgery can offer. However, with a focus on minimising the use of your hands and fingers in particular, you can still keep as normal a life as possible in the circumstances.

Reducing the strain on your hands by making simple adjustments to your surroundings and the way you carry out day-to-day tasks can make all the difference. Rheumatoid arthritis may one of the most painful forms of arthritis, but it doesn’t mean you don’t have options to make the best of it.

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