Rheumatoid Arthritis

What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA), an inflammatory disease of joints, is progressive and disabling. It can affect the appearance and the function of the hands and other parts of the body. It often deforms finger joints and forces the fingers into distorted positions that hamper movement.

How does it affect the hand?

RA causes swelling and deformity of the wrist and fingers. The swollen tissue may destroy the ligaments that hold the joints together, and damage cartilage and bone. These deformities can interfere with hand function. The swollen tissue can damage tendons, causing them to rupture. If a tendon ruptures, you may not be able to bend or straighten your finger. Rheumatoid arthritis can also cause pressure on the nerves or large nodules protruding from joints.

When to seek treatment?

Treatment of RA requires medications prescribed by a rheumatologist [link here to our rheumatology department]. Managing the disease may also require assistive devices for daily activities, splinting, and treatment by a hand therapist.

A rheumatologist may refer to a hand surgeon when pain or functional difficulties reach beyond medical management. Goals of surgery are to reduce pain, improve function or repair damage caused by the disease. Surgical procedures often require postoperative therapy, and the recovery period varies, depending on the procedure. To reduce the risk of complications, it is essential to continue maximum medical management before and after surgery.

What is Rheumatoid Arthritis?

Rheumatoid arthritis, an inflammation of the joints, is a disabling disease that can affect the appearance and the function of the hands and other parts of the body. It often deforms finger joints and forces the fingers into a bent position that hampers movement. The exact cause of rheumatoid arthritis is not known. It affects about 1% of the population, women more often than men.

What are the signs and symptoms?

In the early stages of the disease, joint problems are the most common symptoms. A general sense of being tired, or just not feeling quite right, often happens before the slow start of joint pain and swelling. Morning stiffness is a frequent complaint. As the disease continues, symptoms may include swelling of different joints in the hands, wrists, elbows, shoulders, hips, knees, and feet. The swelling usually takes place in the same joint on both sides of the body, known as symmetrical swelling. Rheumatoid arthritis may result in pain and deformity. Occasionally, the disease affects other organs of the body, such as the heart, eyes, and lungs.

How does it affect the hand?

Generally, the first and most common complaint is swelling of the hand at the knuckles, that gives the fingers a spindle shape. This swelling often happens in the wrist and the large knuckles in the middle of the hand. The swollen tissue may destroy the ligaments that hold the joints together, and damage cartilage and bone. This can result in certain deformities. The wrist may turn toward the thumb side of the hand, causing "ulnar drift" of the fingers. The swollen tissue may also produce damage, causing the tendons to rupture. When the tendon ruptures, you may not be able to bend or straighten your finger. Other problems that may happen are swelling that causes pressure on the nerves (carpal tunnel syndrome), or lumps (rheumatoid nodules) found over various joints of the hand and elbow.

How is it treated?

Rheumatoid arthritis is usually treated with medication. Surgery may help when medicine does not control the disease. A wide variety of non-steroidal, anti-inflammatory, cortisone-like prescriptions are usually used. Education for learning to live with the limitations caused by this disease, such as aids for daily activities, splinting, and information on how to avoid damaging the swollen joints, can be provided by a hand therapist.

Surgery may be considered when medical treatment does not work. The goals of surgery are to: 1) reduce pain, 2) improve function, and 3) improve appearance. Surgical treatment may include removing the swollen tissue from the joints or around the tendons, which may reduce pain and prevent more tendon damage. If the tendon has already been damaged, surgery may be done to repair the damage. Rheumatoid nodules may be surgically removed to improve appearance and comfort. In some cases, large knuckles of the hand may be treated by arthroplasty, a procedure where artificial knuckles (made of silicone rubber or other material) are inserted. This may improve the use of the hand and lessen pain. Surgical procedures performed on the rheumatoid hand and wrist are often complex and may require therapy.

List of Physicians Who Treat Rheumatoid Arthritis

It is important to find a physician who has specialized training in caring for all conditions of the hand, wrist and forearm, ranging from acute, limb-threatening injuries to chronic, degenerative diseases. At the University of Michigan Hand Center, all of our physicians are board certified surgeons with specialization in plastic surgery and additional fellowship training in hand surgery.

For details about education, experience, and specialty in this clinical area, please visit these physician profile pages:

Scheduling an Initial Consultation

If you are considering treatment, the first step is to schedule an initial consultation with a plastic surgeon. To schedule an appointment at the University of Michigan Hand Clinic, please call (734) 998-6022.

What to Expect During the Initial Consultation

Depending on the complexity of your condition, you may visit with more than one physician, surgeon, therapist, or physician extender. You should plan on your consultation lasting between 1-2 hours. During this important visit, you should expect:

To provide a complete medical history, including information about previous surgical procedures; past and present medical conditions; and any medications or herbal supplements you are taking.
To undergo a physical examination.
To discuss possible options for treatment of your condition, including whether surgery is recommended.
To discuss in detail the surgical procedure recommended; the recovery and rehabilitation period, and the probable outcome in terms of function and appearance.
To discuss possible risks and complications of the procedure.
To ask your surgeon if there is anything about the procedure you don't understand.

Hand Therapy and Rehabilitation

Whether as a non-surgical option or to enhance your recovery from hand surgery, the plastic surgeon may recommend a course of rehabilitation (physical and occupational therapy) under the direction of a trained hand therapist. Hand therapy is provided on site at the University of Michigan's Hand Center by our team of Occupational and Physical Therapists. Referrals can be arranged closer to your home when that is more convenient.

Preparing for Your Surgery

If your plastic surgeon recommends surgery to treat the condition, you'll work with the Hand Center scheduling nurse to set a date for the operation. You will be given a pre-operative information packet that explains everything you should do and know before your surgery date. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. You should arrange for someone to drive you home after your surgery, and to help you out at home for a day or two.

Where Your Surgery Will Be Performed

The majority of these procedures are completed on an out-patient basis. Your procedure will take place at the University of Michigan Hospitals which provides state-of-the-art surgical suites and recovery areas.

Types of Anesthesia

In some cases, general anesthetic is not necessary. Your surgeon will discuss the best anesthetic options to make you feel comfortable and relaxed during the procedure, including local anesthesia in your hand and/or an anesthetic block near the shoulder.

After Your Surgery

Click here for information about how to care for yourself after the surgery and what to expect during your recovery. It is very important that you follow your surgeon's instructions. Your post-operative rehabilitation may include hand exercises, heat and massage therapy, electrical nerve stimulation, splinting, traction, and special wrappings to control swelling. Keep in mind that surgery is just the foundation for recovery. It's crucial that you follow the therapist's instructions and complete the entire course of therapy if you want to regain the maximum use of your hand. Also, remember that you may be one handed for up to six to eight weeks after your procedure. This can affect your ability to dress yourself, cook, clean, bathe or drive. Consider having someone with you during your recovery period.