The Effects Of Rheumatoid Arthritis On The Hands

Rheumatoid Arthritis is a chronic disease of joints, which commonly affects the hand, and progresses gradually, but can lead to major deformities. It also affects skin in addition to joints, and can also affect other joints. It is a disease that is difficult to cure, and most often needs to be managed with medication and other supportive therapies.
The Effects of Rheumatoid Arthritis on the Hands
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Rheumatoid Arthritis is slowly progressing disease that cripples by affecting multiple joints, the most visible impact often being on the joints of the hands. The disease, which has autoimmune origins and hence is usually difficult to cure, requires long term management with patience and perseverance. Awareness about the disease can often by crucial in dealing with it....

RHEUMATOID ARTHRITIS is an auto immune disease wherein the immune system of the body attacks one's own joints, leading to their injury, swelling, pain and deformities. It involves multiple joints, the most common of which are joints of hands, feet and neck, but

it can also involve other joints. The maximum impact of this disease is usually on hands, where it involves the joints as well as the skin.

Impact on Joints of the Hand

Rheumatoid arthritis is a slowly progressing disease. One very characteristic feature of this disease is the symmetrical nature of arthritis - most symptoms appear on both hands simultaneously. In the early phase of the disease, there is only pain and stiffness of joints which is maximum in the morning and somewhat improves as the day progresses. This is a major characteristic that differentiates Rheumatoid arthritis from osteoarthritis.

As the disease progresses, the joints of the fingers swell up and pain aggravates. Typically the joints are tender to touch, movement leads to pain and on touching they give a typical 'doughy' feeling, which is due to the inflammation of the synovial membrane, which covers the joints.

As the disease progresses further, the joints become too stiff and movement becomes totally restricted. Gradually the joints become deformed. The deformities in Rheumatoid arthritis are of three typical types. In some patients, there is straightening (hyper-extension) of proximal inter phalangeal joints along with clenching (flexion) of distal joints, giving the fingers a shape similar to that of neck of swan, termed 'SWAN NECK DEFORMITY'. In other patients the deformity consists of clenching (flexion) of fingers near the palm and straightening (hyper-extension) of the rest of the fingers - a condition termed 'BOUTONNIERE DEFORMITY'. The deformities can develop in many other ways, though in almost all of them, there is a deviation of fingers towards the little finger.

With subsequent progression of disease, effective use of hands for day to day activities gets more and more impaired, and in an advanced stage, it may become virtually impossible to do even daily routine jobs with the deformed hands. The deformed hands

are clearly visible and characteristically apparent.

Impact on Skin of Hands

In addition to the joints, Rheumatoid arthritis also impacts the skin of the hand, mainly in the form of Rheumatoid nodule, nail infarcts and necrosis.

RHEUMATOID NODULE is a very characteristic feature of Rheumatoid arthritis typically seen over the bony joints of the fingers. They are small nodules usually a few millimeters to a centimeter in size, and hard but not bony in feel. They are a very common feature of this condition.

Purplish discoloration of the skin near the nail-fold occurs due to swelling of very small blood vessels in the skin, as part of the same auto-immune process that causes this condition. This coloration is because of blood clotting and dead skin.

Other major impacts on skin include discoloration and dryness of skin of the fingers and a reddishness or 'erythema' of the skin of the palm. Both of them are due to the injury to blood vessels. Sometimes, the skin may become very thin, termed as 'RICE PAPER SKIN'. In some others skin may become very fragile and is easily injured.

Progression of Rheumatoid Arthritis

Rheumatoid arthritis progresses slowly but the course of disease is usually downhill. After about five years, most patients are unable to carry on with their occupation. In about ten years, it becomes difficult to do any effective work with the hands.

Treatment of Rheumatoid Arthritis

For pain and swelling, NSAIDs like ASPIRIN, IBUPROFEN, NAPROXEN and DICLOFENAC are the most commonly used medicines, though ACETAMINOPHEN (TYLENOL) is also a useful option for those who can not tolerate NSAIDs. Corticosteroids may be used for providing functional relief of joints.

A major treatment of Rheumatoid arthritis consists of DISEASE MODIFYING MEDICINES. These include AZATHIOPRINE, CICLOSPORIN, D-PENICILLAMINE, HYDROXYCHLOROQUINE, SULFASALAZINE and METHOTREXATE. These medicines reduce the immune system mediated injury and halt the progression but they also come with side effects and sometimes may have to be changed because of them.

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