Rheumatoid arthritis (RA) causes joint inflammation and deformity that make it difficult to perform daily activities. Diagnosis is made when X-rays show cartilage destruction and blood tests indicate the presence of an antibody called "rheumatoid factor."
Rheumatoid arthritis varies in its severity, may affect one or many joints, affects mostly women and although it can manifest in children as young as 2 years of age--the disease much more commonly found in people over 40.
Characteristics of Arthritic Hand
The joints are lined with tissue called "synovium" that produces "synovial fluid." This fluid lubricates the joints. During RA the synovium becomes inflamed, the tissue increases in size and bulges out from under the skin. As a result, the patient may experience pain, stiffness, muscle weakness, atrophy, loss of joint mobility or deformity, according to the Mayo Clinic.
Periods of flare-up may subside without causing deformity. Patients are treated with medication, and therapeutic interventions aim to prevent deformity. Therapy may include: Wearing splints to protect joints, learning energy conservation and joint protection techniques, gentle stretching exercises during remission and use of adaptive equipment such as build-up handles.
Hand Joint Deformities
As patients avoid movement to prevent pain, their hands become weaker and they lose mobility. One common deformity called "Boutonniere" is characterized by inability to bend the knuckles and excessive bending of the finger's middle joint (proximal interphalangeal joint or PIP). This deformity makes it difficult to open the hand, according to the website Hand University.
Another common deformity called "Swan neck" results when the PIP joint is unable to bend and the joint near the fingertip (distal interphalangeal joint or DIP) is excessively bent causing the fingers to look like a swan's neck. Frequently the wrist becomes deviated to the side so that it cannot be straightened.
Other Joints Affected by Rheumatoid Arthritis
RA can affect the hips, knees, feet and ankles so that inflammation and pain make it difficult to walk. The arch of the foot may flatten and hip and knees may develop flexion (bent) contractures that make it difficult to use stairs, sit comfortably or be able to reach their feet to put on shoes. RA affecting the elbow and shoulder joint may also impact abilities to perform self-care tasks such as dressing and bathing.
Systemic Symptoms
Rheumatoid arthritis is a systemic disease, which means that it affects not only joints but the entire body. Common symptoms are fatigue, stiffness, fever and depression
An occupational therapist can help patients learn techniques to compensate for weakness, fatigue and loss of movement. Examples of this would be to use a cart when bringing heavy dishes from the kitchen to the dining room or pushing to squeeze water out of a towel rather than using the wringing movement that are harmful to joints. As patients learn to be as independent as possible, depression may be alleviated.
References
- "Rheumatic Disease: Occupational Therapy and Rehabilitation", Jeanne L. Melvin, 1989.
- "Handbook of Severe Disability, Walter C. Stolov & Michael R. Clowers, 1981.
- The Mayo Clinic
