Hand Rheumatoid Arthritis

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Original Editor - Lucinda hampton Top Contributors - Lucinda hampton, Shaimaa Eldib, Anas Mohamed, Nupur Smit Shah, Sehriban Ozmen and Kim Jackson

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Introduction

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the hand joints and leading to impairment in hand functions.

• Most common clinical presentation of RA is polyarthritis of small joints of hands: proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints and wrist.
• The hand is one of the main elements of the rehabilitation of patients with rheumatoid arthritis (RA) due to deformities, which occur in approximately 90% of patients.
• It is a serious problem, both in the psychological and functional aspect, connected with muscle strength reduction, a limited range of motion and non-acceptance of the changes in the shape of the limb.
• Adults with RA should have access to specialist physiotherapy, with periodic review (NICE guideline)

Clinically Relevant Anatomy

The hand contains a complex range of structures which permit a wide variety of movements, many of which are essential for day-to-day tasks. For anatomy see Wrist and Hand  

1. Synovium - In patients with rheumatoid arthritis, the synovium is strongly thickened and inflamed. 
2. RA affects the joints of the hand and wrist including

• Wrist joint
• Metacarpal joints
• Metacarpophalangeal Joint (MCPJ) – condyloid joints comprised of the articulation between metacarpal and proximal phalanx in each of the 5 digits.

• Interphalangeal Joints – between the phalanges and there are two in each digit. The thumb is an exception, and has only oneinterphalangeal joint. The two joints are the:
  • Proximal Interphalangeal Joints (PIPJ) 
  • Distal Interphalangeal Joints (DIPJ)

Pathological Process

Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease.

• The immunological process within the connective tissue contributes to progressive disability.
• It starts in the synovial membrane and leads to a gradual deterioration of articular and periarticular structures and deformity development.
• Problems which are constantly experienced by RA patients include morning joint stiffness and reduced muscle strength.
• The first symptoms are symmetrical carpal and metacarpophalangeal arthritis manifested by pain, oedema, exudate and a limited range of motion.
• Progressive hand dysfunction contributes to various limitations in the personal, social and professional aspects of life.
• Pain is the dominant symptom reported by patients.
• Rheumatic pain is chronic and lasts from the onset of the disease until the end of a patient’s life
  

Clinical Presentation

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Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Resources

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