Rheumatoid arthritis (RA) is a chronic autoimmune disorder that significantly affects the joints, particularly in the hands and wrists. One of the earliest indicators of RA is stiffness and swelling in the wrists and knuckles, which can eventually lead to joint damage and deformities. The hands, with more than 25 joints, are highly susceptible to RA’s damaging effects. Common hand deformities associated with RA include Boutonniere deformity, Swan neck deformity, and Hitchhiker’s thumb deformity.
Boutonniere deformity involves the flexing of the lower finger joint (PIP) towards the palm, while the top finger joint (distal interphalangeal or DIP) extends away from the palm. Swan neck deformity is characterized by the flexing of the MCP and DIP joints towards the palm and hyperextension of the PIP joint. Hitchhiker’s thumb deformity occurs when the lower thumb joint (MCP) flexes while the upper thumb joint hyperextends.
Occupational therapy is a key approach in managing RA hand deformities. It includes exercises and splinting, which can not only improve hand function but also slow the progression of deformities. For those with severe hand disease, occupational therapists can design specific exercise programs and splints to enhance function and potentially reduce the progression of deformity.
It’s noteworthy that hand deformities can occur early in the disease, often within the first year if RA goes untreated. Specific hand issues exacerbated by RA include carpal tunnel syndrome, where the carpal tunnel – a narrow passageway surrounded by ligament and bone – is affected.
The hand is a crucial element in the rehabilitation of RA patients, given the prevalence of deformities, which occur in approximately 90% of patients. These deformities are not only a functional issue but also pose psychological challenges, as they involve muscle strength reduction, limited range of motion, and the difficulty of accepting these changes.
For further information on managing RA hand deformities, visit Healthline, Verywell Health, NCBI Bookshelf, WebMD, CreakyJoints, and Physiopedia.
