Dr Pr. D’Agostino, MD, PhD

Hand Clinic Brussels - Lasne

LOUISE +32 2 534 29 99 LASNE +32 2 653 11 11

Rheumatoid arthritis

QT Pathologies (EN)

Rheumatoid arthritis is the most common inflammatory arthritis in adults.

The word arthritis literally means "inflamed joint."

It is a chronic inflammatory degenerative disease characterized by arthritis often bilateral and symmetrical, which progresses in spurts into the deformation and destruction of joints.

Normally, the joint is made up of two smooth, cartilage-covered bone surfaces that fit together as a matched set and that move smoothly against one other. In rheumatoid arthritis, these become irregular and soft surfaces do not fit together properly.

The hands and wrists, rheumatoid arthritis can be very painful and debilitating.

Other causes of arthritis of the hand are infection, gout and psoriasis.

  • Rheumatoide arthritis with deviation "en coup de vent cubital" of the fingers Rheumatoide arthritis with deviation "en coup de vent cubital" of the fingers

Rheumatoid arthritis is an autoimmune disease of unknown origin.

Rheumatoid arthritis affects the cells that line and normally lubricate the joints (synovial tissue). This is a systemic condition (can affect the whole body), which means that it may affect multiple joints, usually on both sides of the body.

The joint lining (synovium) becomes inflamed, swollen (hypertrophic) and erodes the cartilage and bone. This synovial hypertrophy, due to its increasing volume, will also take up more space than available in the joint. This will generate a power up of ligaments and joint capsule surrounding (structures that hold bones together) and will stretch them, which will result in deformation and instability of joints.

The same phenomenon can be observed in the synovium of tendons (string-like structures connecting muscles to bones). The inflammation gradually eroding the tendons and can engender their breakup.

This failure can also occur by a process of friction of the tendons on the bony structures deformed (attrition phenomenon).

Rheumatoid arthritis of the hand is most common in the wrist and the finger joints (the MP and PIP joints).

Stiffness, swelling, and pain are symptoms common to all forms of arthritis in the hand. In rheumatoid arthritis, some joints may be more swollen than others. There is often a sausage-shaped (fusiform) swelling of the finger. Other symptoms of rheumatoid arthritis of the hand include:

  • a soft lump over the back of the hand that moves with the tendons that straighten the fingers
  • a creaking sound (crepitus) during movement
  • a shift in the position of the fingers as they drift away from the direction of the thumb
  • swelling and inflammation of the tendons that bend the fingers, resulting in clicking or triggering of the finger as it bends, and sometimes causing numbness and tingling in the fingers (carpal tunnel syndrome)
  • rupture of tendons with loss of ability to straighten or bend certain fingers or the thumb
  • unstable joints in the wrist, fingers, and thumb
  • deformity in which the middle joint of the finger becomes bent and the end joint hyperextended (Boutonnière deformity)
  • hyperextension (sway-back) at the middle joint of the finger associated with a bent fingertip (Swan neck deformity)
  • Extensor hood rupture, capsular distension and rupture of the collateral radial ligament of the 5th finger metacarpophanlangeal (MCP) joint. Complete inability to straighten the finger and bring it in contact with the other fingers Extensor hood rupture, capsular distension and rupture of the collateral radial ligament of the 5th finger metacarpophanlangeal (MCP) joint. Complete inability to straighten the finger and bring it in contact with the other fingers

The clinical appearance of the hands and fingers helps to diagnose the type of arthritis.

Clinical examination will determine whether you have similar symptoms in other joints and assess the impact of the arthritis on your life and activities. X-rays will also show certain characteristics of rheumatoid arthritis, such as narrowing of the joint space, swelling and diminished bone density near the joints, and erosions of the bone. If your doctor suspects rheumatoid arthritis, he or she may request blood or other lab tests to confirm the diagnosis.

  • Radiographic features of rheumatoid arthritis (front) Radiographic features of rheumatoid arthritis (front)
  • Radiographic features of rheumatoid arthritis (profile ¾) Radiographic features of rheumatoid arthritis (profile ¾)
  • Affection of the wrists : bilateral carpitis Affection of the wrists : bilateral carpitis
  • Radiographic features of a Psoriatic arthritis Radiographic features of a Psoriatic arthritis
  • Radiographic features of a Psoriatic arthritis Radiographic features of a Psoriatic arthritis
  • Radiographic features of a Micro-crystalline arthritis, gout-type here Radiographic features of a Micro-crystalline arthritis, gout-type here

Treatment is designed to relieve pain and restore function. If you have rheumatoid arthritis in your hands, medications can help decrease inflammation, relieve pain and slow the progression of the disease. Anti-inflammatory medications, oral steroids, and/or cortisone injections may be used. Several disease modifying treatments are now available, including anti-malarial drugs, methotrexate, cyclosporine, gold, and other new drugs (remicade, enbrel) that help suppress the body's immune system to reduce the inflammation and pain.

A rheumatologist will often prescribe and monitor these types of medications. Your physician may also refer you to a hand therapist for exercises, splints, modalities such as paraffin (warm wax) baths, and instruction on how to use your hands in ways that may help relieve pain and pressure and also protect your joints.

Adaptive devices may help you cope with the activities of daily living. Rheumatoid arthritis often affects the tendons as well as the joints. The tendons that become inflamed may trigger (click) or rupture. If this happens, you may be unable to bend or straighten your fingers or to grip properly.

In certain cases, specific preventive surgery may be recommended. Preventive surgery may include removing nodules, releasing pressure on tendons by removing the inflamed tissue and degenerated, rough bone that may scrape the tendons, and reinforcing the tendons. If a tendon rupture has occurred, a hand surgeon may be able to repair it with a tendon transfer or graft, in addition to performing these other procedures. Surgery to treat the arthritic joints includes removal of inflamed joint linings, joint replacements, joint fusions, and in some cases, removal of damaged bone. The specific procedure(s) depends on a variety of factors, including the particular joint(s) involved, the degree of damage present, the condition of adjacent joints, and your own needs.

Unfortunately, there is no cure for rheumatoid arthritis. However, surgical procedures can often help correct deformities, relieve pain, and improve function.

Optimal care entails a team approach between the rheumatologist, hand surgeon, hand therapist, and patient. It is particularly important that surgical intervention be appropriately timed to rebalance the hand and preserve the joints for as long as possible, before the development of more severe deformities has occurred.

During your consultation, Dr. D'Agostino will discuss the current treatment options and can help you choose the best treatment based on your particular case.

  • Recovery of the extension and adduction of the fifth finger function after surgical repair of the extensor hood and capsular ligament complex Recovery of the extension and adduction of the fifth finger function after surgical repair of the extensor hood and capsular ligament complex