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Rheumatoid Arthritis (RA) of the Hand

Rheumatoid arthritis, a condition that can attack joints throughout the body, commonly affects the joints and surrounding tendons of the wrist and fingers. It can cause the joints to become swollen, painful and possibly deformed. This can interfere with normal hand function. It can significantly impact a person's quality of life.

The causes of RA are not fully understood. It is most likely caused by inherited genetic factors. Environmental factors may also play a role in triggering the condition. The disorder causes the immune system to attack the joints. This results in inflammation and swelling of the synovial membranes that surround the joints. This inflamed synovium leads to cartilage damage and bone loss around the joint.

Symptoms of rheumatoid arthritis in the hand can include stiffness. This stiffness is often worst in the morning. Rheumatoid arthritis can cause pain and swelling in the joints, especially the joints at the base and middle of the fingers, the hand, and the wrist. The joints may become unstable and deformed. The knuckles may become inflamed, and the fingers may gradually lose their normal alignment. Often, the fingers angle away from the thumb. Rheumatoid arthritis can cause the tendons of the wrist to become inflamed. In severe cases, these tendons may rupture. Early tendon inflammation may cause a soft lump to form on the back of the hand or wrist. A person who has rheumatoid arthritis may develop other hand problems. These may include trigger finger, carpal tunnel syndrome, and boutenniere or swan-neck deformities of the fingers.

Treatment options include anti-inflammatory medications, disease-modifying antirheumatic drugs, and a class of drugs called biological response modifiers (commonly called biologics). A physician may recommend splints or braces, exercise, and modification of daily activities. If joint synovitis cannot be controlled with medications, or if the tendons of the hand and wrist become inflamed or weakened by the disease, surgery may be needed. Surgery may also be needed to correct deformities of the fingers that often result from the disease.

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