Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that causes inflammation of the joints. The inflammation can become so severe that the function and appearance of the hands are affected. Rheumatoid arthritis may cause deformities in the joints of the fingers, making movement difficult, and lumps, known as rheumatoid nodules, may form over small joints in the hands and wrist.

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 6 weeks. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow juvenile rheumatoid arthritis. The disease can, however, affect bone development in a growing child.

Causes

The exact cause of rheumatoid arthritis is not known, however it is an 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 may then lead to a destruction of the skeletal system. Rheumatoid arthritis may also have devastating effects on other organs, such as the heart and lungs. Researchers believe certain factors, including heredity, may contribute to the onset of the disease, which most often occurs between the ages of 20 and 45. Rheumatoid arthritis affects more women than men, with 75% of persons with rheumatoid arthritis being female.

Symptoms

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

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

Symptoms of rheumatoid arthritis may resemble other medical conditions or problems. If you experience 4 or more of the following symptoms, you may be diagnosed with rheumatoid arthritis:

• Morning stiffness that lasts longer than one hour for at least 6 weeks
• Three or more joints that are inflamed for at least 6 weeks
• Presence of arthritis in the hand, wrist or finger joints for at least 6 weeks
• Blood tests that reveal rheumatoid factor
• X-rays that show characteristic changes in the joints

Diagnosis

Diagnosing rheumatoid arthritis in its early stages can be difficult, because symptoms may be very subtle and go undetected in x-rays or blood tests. In addition to a complete medical history and physical examination, we use the following procedures to diagnose rheumatoid arthritis:

• X-ray – Invisible electromagnetic energy beams are used to produce images of internal tissues, bones and organs onto film
• Joint Aspiration – Fluid is removed from the swollen bursa to exclude infection or gout as possible causes
• Biopsy (of nodules tissue) – Using a needle or during surgery, tissue samples are removed from the body and examined under a microscope to determine if cancer or other abnormal cells are present
• Blood Tests – Blood samples are used to detect certain antibodies, called rheumatoid factor, and other indicators for rheumatoid arthritis

Treatments

We will work with you to determine a specific treatment plan that’s right for you based on the following factors:

• Your age, overall health and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures or therapies
• Expectations for the course of the disease

Your treatment may include:

• 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 - If splinting and physical therapy do not work to treat your rheumatoid arthritis, we may do surgery to repair or reconstruct your hand or wrist in a variety of ways, including:
  
  
  • Surgical cleaning - Performed on patients with rheumatoid arthritis, or other types of hand arthritis, this surgery involves removing inflamed and diseased tissues within the hands to help increase their function.
    
    
    
  • Joint replacement - Also called arthroplasty, this surgery may be used to treat patients with severe arthritis of the hand or older patients, with a lower activity level. Joint replacement involves replacing a joint that has been destroyed by the disease process with an artificial joint. Typically made out of metal, plastic, silicone rubber or a patient’s own body tissue (such as a tendon), artificial joint replacements may provide a decrease in pain and an increase in function of the hands and fingers.
    
    
    
  • Joint fusion - This option usually involves removing the joint and fusing together two ends of bones, and is usually used on patients with advanced arthritis. Joint fusion makes one large bone, without a joint. After the fusion, there is no movement in the fused joint.
  
  It is important to remember that surgery for rheumatoid arthritis 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 physician is required for optimal control of this disease.