RHEUMATOID ARTHRITIS IN THE HAND


Rheumatoid arthritis (RA) is classified as an inflammatory arthritis. This, per definition, implies that there is an inflammatory process that drives the disease. In RA, the inflammatory process is caused by an autoimmune process (the body produces antibodies against itself) that stirs an inflammatory process in the joints and tendon synovial sheaths. The inflammatory process produces enzymes that destroy cartilage, ligaments and even bone.

It affects approximately 1% of the population and twice as many women as men. It usually affects females in their middle age, although the elderly and children can be affected. RA usually affects both hands with a predilection for the wrist, knuckle (metacarpo-phalangeal joints) and first joint of the finger (proximal interphalangeal joint). It may also affect the shoulder joint, neck vertebrae, hips, knees and feet joints.

Rheumatoid arthritis commonly presents with morning stiffness, swollen and painful joints and lumps. With time, deformities may develop secondary to ligament and joint destruction. The wrist may deviate to the thumb side with the ulna becoming more prominent. The fingers may drift towards the little finger. The fingers can develop boutonniere or swan neck deformities.

The diagnosis is usually made with clinical suspicion, confirmed by blood markers. The most important marker in the blood is the Rheumatoid factor. It is positive in 80% of patients with the disease. Additional to this, some general inflammatory markers (ESR and CRP) are raised. A new marker for RA is anti-CCP and is believed to be more sensitive and specific for making the diagnosis.

The disease is managed medically (with medication) by a Rheumatologist. The goals of treatment are to suppress inflammation and to relieve pain. The hand surgeon occasionally makes a diagnosis by means of a tissue biopsy in suspected cases.

The hand surgeon usually plays a part in the management of advanced disease to correct deformities, decompress pinched nerves, repair ruptured tendons and replace joints.

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