RHEUMATOID ARTHRITIS IN THE HAND
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is classified as 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. Rheumatoid arthritis usually affects both hands with a predilection for the wrist, knuckle (metacarpophalangeal joints) and the first joint of the finger (proximal interphalangeal joint). It may also affect the shoulder joint, neck vertebrae, hips, knees and feet joints.
What are the related symptoms of rheumatoid arthritis?
Rheumatoid arthritis commonly presents with morning stiffness, swollen and painful joints and hand lumps. With time, deformities may develop secondary to the 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. Other symptoms of rheumatoid arthritis include weight loss, slight fever, fatigue and numbness and tingling.
Dr van der Spuy will make a diagnosis 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 rheumatoid arthritis is anti-CCP and is believed to be more sensitive and specific for making the diagnosis.
What does treatment for rheumatoid arthritis include?
Rheumatoid arthritis may be managed medically (with medication) by a Rheumatologist. The goal of rheumatoid arthritis treatment is 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 by performing hand surgery.