Hand Therapies for Rheumatoid Arthritis
Learn about treatment options when RA affects your fingers, hands and wrists.
With its 29 joints and an intricate network of muscles, ligaments and tendons to support them, the human hand is capable of exacting tasks such as performing surgery or fingering a violin. But when arthritis enters the picture, even the simplest of tasks – signing your name, turning pages or typing – can be difficult or painful.
“For rheumatoid arthritis of hands, the main treatment is good medical management,” says Dori Neill Cage, MD, an orthopaedic hand surgeon in San Diego. Additionally, she says, occupational therapy interventions such as splinting and adaptive aids may be prescribed to reduce deforming stresses on the joints of the hands and maintain mobility. Finally, if joint damage has occurred, surgery may be an option.
Medications and Injections
The medications you take to relieve pain and control arthritis throughout your body are crucial to controlling inflammation and preventing damage to the joints of your hands. Depending on the severity of your arthritis and other factors, these may include disease-modifying antirheumatic drugs (DMARDs), biologic therapies, as well as nonsteroidal anti-inflammatory drugs (NSAIDs).
If these treatments don’t completely control inflammation or inflammation is confined to just one or a few joints, corticosteroid injections may be another option. These medications that are similar to a hormone your body makes naturally and may be injected directly into affected joints to relieve inflammation.
In a 2015 study of 85 people with early RA published in Annals of the Rheumatic Diseases, researchers examined a treat-to-target strategy with methotrexate and intra-articular corticosteroids. They found the protocol effectively decreased inflammation of the joints and tendons, reduced osteitis (inflammation of areas surrounding the bone) and reduced structural damage as judged by hand MRIs. The addition of a biologic drug was associated with further reductions in osteitis and tendon inflammation.
Corticosteroids are often injected along with a long-lasting anesthetic to provide pain relief. Injections may be repeated if needed; however, doctors typically limit them to three or four per joint per year to reduce the risk of side effects.
Splinting and Devices
Injections are often combined with splinting to support and ease stress on the affected joint and help prevent deformity. Some splints are designed so that you can use your hands while wearing them. However, you should only wear a splint as directed by your occupational therapist, because immobilizing joints too long can lead to wasting of the muscles that support them.
Whether readymade or specially fitted, splints are only one form of therapy provided by occupational therapists. Others include education about ways to perform tasks that put less stress on the affected joints and tools and devices that spare the joints, says Carole Dodge, an occupational therapy supervisor with the University of Michigan Health System.
“Even with cutting food there are adaptive knives,” says Dodge. “There are a lot different jar openers and kitchen tools, as well as key holders that make it easier to turn a key and other devices that help you do tasks with less force needed.”
In many cases, strengthening and stretching exercises, as prescribed by an occupational or physical therapist, can also help relieve symptoms and improve function.
In a 2016 study published in Arthritis Care & Research, 242 people with hand RA were randomly assigned to continue their regular treatment, while 246 were assigned to a program of exercises designed to improve a variety of hand and wrist movements. When researchers measured movement variables at 4 and 12 months, they found that improvements in grip strength at 4 months predicted improved hand function at 12 months. The role of joint mobility exercises in improving function was less clear.
If conservative treatments fail to relieve symptoms or persistent inflammation leads to tendon ruptures or joint deformity that hinders function, surgical treatment is indicated, says Dr. Cage. Surgical treatments for common problems of the hand include
- Silicone Metacarpophalangeal Joint Arthroplasty (SMPA) – replacement of damaged joints at the bases of the fingers with prostheses made of silicone to correct deformities, pain and lost function.
- Arthroscopic Wrist Synovectomy – removal of the membrane lining the wrist joint to ease pain and stiffness of the wrist caused by persistent inflammation.
- Tendon Transfers – replacing tendons damaged by inflammation with healthy tendons to restore hand function.
- Wrist Arthrodesis – immobilizing the wrist – often using plates, rods or pins – to stabilize it and relieve pain. Commonly referred to as joint fusion, arthrodesis may also be used to stabilize the thumb if tendon that enables you to flex your thumb ruptures.