Rheumatoid arthritis

Rheumatoid arthritis is a chronic autoimmune disorder, which means the body's immune system attacks its own healthy cells and tissues. The response of the body causes inflammation in and around the joints, which then may lead to a destruction of the skeletal system. Rheumatoid arthritis also may have devastating effects to other organs, such as the heart and lungs. Joint inflammation can become so severe that the function and appearance of the hands, as well as other parts of the body, can become affected. In the hand, rheumatoid arthritis may cause deformities in the joints of the fingers, making it difficult to move the fingers. Lumps, known as rheumatoid nodules, may form over small joints in the hands and the wrist.

The joints most commonly affected by rheumatoid arthritis are in the hands, wrists, feet, ankles, knees, shoulders and elbows. The disease typically causes inflammation symmetrically in the body, meaning the same joints are affected on both sides of the body. Symptoms of rheumatoid arthritis may begin suddenly or gradually. The following are the most common symptoms of rheumatoid arthritis in the hands. However, each individual may experience symptoms differently. Symptoms may include:

• Pain
• Stiffness
• Swelling over the joints
• Decreased movement
• Pain that is worse with movement of the joints
• Bumps may be noted over the small joints
• Difficulty performing activities of daily living, such as tying shoes, opening jars or buttoning shirts
• Decreased ability to grasp or pinch

Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger that causes inflammation and stiffness of joints for more than six weeks. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow juvenile rheumatoid arthritis. However, the disease can affect bone development in the growing child.

The exact cause of rheumatoid arthritis is not known. Researchers believe certain factors, including heredity, may contribute to the onset of the disease. Rheumatoid arthritis affects more women than men (70 percent of individuals with rheumatoid arthritis are women). The disease most often occurs between the ages of 30 and 50.

Diagnosis of rheumatoid arthritis may be difficult in the early stages because symptoms may be very subtle and go undetected on X-rays or blood tests. In addition to a complete medical history and physical examination, diagnostic procedures for rheumatoid arthritis may include the following:

• X-ray: A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Joint aspiration: This involves a removal of fluid from the swollen bursa to exclude infection or gout as possible causes.
• Biopsy (of nodules tissue): A procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope to determine if cancer or other abnormal cells are present.
• Blood tests: These tests are done to detect certain antibodies, called rheumatoid factor, and other indicators for rheumatoid arthritis.

If a person has four or more of the following symptoms, they may be diagnosed with rheumatoid arthritis:

• Morning stiffness that lasts longer than one hour for at least six weeks
• Three or more joints that are inflamed for at least six weeks
• Presence of arthritis in the hand, wrist, or finger joints for at least six weeks
• Blood tests that reveal rheumatoid factor
• X-rays that show characteristic changes in the joints

Treatment may include:

• Medications may be used for pain relief, to treat inflammation and to slow the disease from progressing
• Splints to help protect the joints and strengthen the weak joints
• Physical therapy to help increase the strength and movement of the affected areas

Surgery may be performed if the above treatment options fail. The decision for surgery should be made in consultation with your doctor. Repair or reconstruction of the hand and wrist can be performed in a variety of ways, including the following:

• Surgical cleaning: Inflamed and diseased tissues within the hands can be removed to help increase function.
• Joint replacement: This type of surgery, also called arthroplasty, may be used in cases of severe arthritis of the hand. This option may be performed on older patients with a lower activity level. Joint replacement may provide a decrease in pain and an increase in function of the hands and fingers. This involves replacing a joint that has been destroyed by the disease process with an artificial joint. This artificial joint may be made out of metal, plastic, silicone rubber, or the patient's own body tissue (such as the tendon).
• Joint fusion: This option usually involves removing the joint and fusing together two ends of bones. This makes one large bone without a joint. This option is usually used on patients with advanced arthritis. After the fusion of the bone, there is an elimination of movement in the fused joint.

It is important to remember that surgery does not correct the underlying disease. It only helps correct the deformities caused by the disease. Rheumatoid arthritis can continue to cause problems in the hand, and may even require additional surgery. Close follow-up with your doctor is required for optimal control of this disease.