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Condition

Rheumatoid Arthritis of the Hand & Wrist

An autoimmune condition that inflames the lining of the joints and tendons. Good medical treatment can control it, and targeted hand surgery can protect function when problems develop.

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a disease in which the body's immune system mistakenly attacks the lining of the joints (the synovium) and the sheaths around the tendons. Unlike ordinary wear-and-tear arthritis, RA is driven by inflammation, not by mechanical overuse. Over time the inflamed tissue can thin out the cartilage, stretch the supporting ligaments, and wear through the tendons that move the fingers.

RA tends to involve the small joints of the hand and wrist on both sides of the body. The knuckles (MCP joints), middle finger joints (PIP joints), and wrist are most commonly affected. Modern medical treatment with a rheumatologist has changed this disease dramatically — many patients today never develop the severe deformities that were once typical.

Common symptoms

  • Pain, swelling, and tenderness in the small joints of the hands, often on both sides
  • Morning stiffness that lasts longer than an hour
  • Warmth or a spongy feeling over the knuckles or wrist
  • Weakness of grip and trouble making a tight fist
  • A sudden loss of the ability to straighten one or more fingers, which can mean a tendon has ruptured
  • Numbness and tingling in the thumb, index, and middle fingers from carpal tunnel syndrome, which is common in RA
  • Fatigue and a general feeling of being unwell, especially during a flare

Why does it happen?

RA is an autoimmune disease. The exact cause is unknown, but genetics, smoking, and certain infections all seem to play a role in triggering the immune system to turn against the body's own tissues. It is not caused by overuse, activity, or diet.

How it is diagnosed

Rheumatologists make the diagnosis of RA using a combination of history, physical exam, blood tests (rheumatoid factor, anti-CCP antibodies, ESR, and CRP), and sometimes imaging. Most patients with RA should be followed by a rheumatologist, who manages the medications that control the disease itself.

A hand surgeon is consulted when specific hand or wrist problems develop — a tendon rupture, a compressive neuropathy, a deformity that is limiting function, or a joint that is painful despite good medical treatment.

Treatment options

Medical treatment (rheumatology)

The foundation of treatment is medication prescribed by a rheumatologist. Modern disease-modifying drugs (DMARDs) and biologic agents can control the inflammation that drives the disease and protect joints and tendons from damage. Starting these early and staying on them consistently is the single most important thing a patient can do for their hands.

Hand therapy and bracing

  • Splinting. Custom resting splints can support inflamed joints during a flare and reduce pain.
  • Certified hand therapy. Therapists teach joint-protection techniques, adaptive strategies, and gentle exercises that keep the hand moving without making inflammation worse.
  • Steroid injections. A targeted injection into an inflamed joint or tendon sheath can quiet a local flare that is not responding to systemic treatment.

Surgical treatment

Hand surgery in RA is not a substitute for medical treatment. It is used to address specific mechanical problems that medication cannot fix.

  • Tenosynovectomy. Inflamed tendon lining on the back of the wrist can wear through the extensor tendons, causing fingers to suddenly lose the ability to straighten. Removing this inflamed tissue before rupture occurs is a preventive operation that preserves tendon function.
  • Extensor tendon repair or transfer. Once a tendon has ruptured, it usually cannot be repaired end-to-end and must be reconstructed using a nearby tendon as a donor. Addressing this early gives the best result.
  • Carpal tunnel release. Carpal tunnel syndrome is common in RA because of inflamed tissue inside the carpal tunnel. Release of the transverse carpal ligament relieves pressure on the median nerve.
  • MCP joint arthroplasty. When the knuckle joints become painful, unstable, or severely drifted toward the small finger side, the joints can be replaced with silicone implants. This improves pain, corrects deformity, and restores a more functional arc of motion.
  • Wrist surgery. A painful, worn-out RA wrist can be treated with a partial wrist fusion, a total wrist fusion, or in selected patients a total wrist replacement. The right choice depends on the pattern of joint damage and on what the patient needs the wrist to do.
  • Correction of finger deformities. Swan neck and boutonnière deformities, if they are causing functional problems, can be improved with soft-tissue rebalancing or small joint fusion.

What to expect at your visit

Dr. Barrera will review your history and your current rheumatology treatment, examine your hands and wrists, and look specifically for problems where surgery can help — tendon rupture, compressive neuropathy, joint instability, or deformity that is limiting function. X-rays or MRI may be ordered. If surgery is not indicated, he will say so; hand surgery in RA is carefully timed, and the goal is to do the right operation at the right moment, not to operate for the sake of operating.

Dr. Barrera's approach

RA hand care works best as a partnership. A rheumatologist manages the disease; a hand surgeon watches for the specific mechanical problems that medications cannot fix and intervenes early, before a tendon ruptures or a joint fails. Dr. Barrera has fellowship training in reconstructive hand surgery and works closely with rheumatology to coordinate the timing of hand operations with your overall medical plan.

When to call the office sooner

Call us right away if you suddenly cannot straighten one or more fingers, if you develop severe swelling, warmth, and pain in a single joint along with fever (which can mean an infected joint), or if you develop new numbness, weakness, or pain that wakes you at night.

Related

Carpal tunnel syndrome · Trigger finger · Wrist arthritis

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