There are a number of key signs and symptoms practitioners look for when diagnosing rheumatoid arthritis in the hand and wrist, including but not limited to:
Hand joint swelling
RA triggers an inflammatory response that results in a buildup of synovial fluid as well as a thickening of joint tissue in fingers and wrists. The swollen joints may feel tender to the touch.
In contrast to osteoarthritis and many other forms of arthritis, rheumatoid arthritis usually affects both sides of the body equally. For example, inflammation may occur in both the right and left wrists at the same time. Symmetrical inflammation can make mild hand swelling difficult to notice, because there is no “normal” hand with which to make a comparison.
Pain and stiffness
People with rheumatoid arthritis often complain of localized pain in the wrists and knuckles (MCP/PIP). Stiffness is often worst in the morning or after periods of inactivity. Simple tasks, such as getting dressed, using a smartphone, or preparing food may become difficult.
Flushing of the skin
The skin over the wrist(s) and knuckle(s) may become red and warm to the touch.
Carpal tunnel syndrome
People with rheumatoid arthritis may experience tingling and numbness in their hands and fingers. These symptoms are the result of swelling and inflammation in the carpal tunnel, a narrow channel between bones and ligaments within the wrist through which a major nerve passes. Called the median nerve, this nerve and its branches provide feeling to the thumb, index finger, long finger, and half of the ring finger. When the space in the carpal tunnel decreases, the median nerve becomes squeezed, and a person may feel numbness and/or tingling in the thumb and associated fingers.
Fatigue and flu-like symptoms
Rheumatoid arthritis is a systemic inflammatory disease that may cause body-wide symptoms, including fatigue, nausea, and fever.
Presence of rheumatoid nodules
Hard, rounded bumps made of inflammatory tissue may develop underneath the skin near the affected hand joints. These nodules are not usually painful and may shrink with the use of RA medications. Nodules can develop on fingers and wrists, and frequently develop on forearms and elbows.2
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Malalignment of one of more finger joints
Over time, the destruction of bone and joint tissue may cause fingers and thumbs to become permanently deformed. However, hand deformities are not inevitable. (See Hand Deformities, below).
When inflammation and related symptoms become acute, it is referred to as a rheumatoid arthritis flare.
Hand Deformities from Rheumatoid Arthritis
The advent of medications to treat rheumatoid arthritis has reduced the likelihood that rheumatoid arthritis will cause permanent deformities to the hand, wrist and fingers. However, deformities are possible when hand joints have degraded and bones no longer align normally.
The most common finger and wrist deformities are described below.
- Trigger finger is caused by tenosynovitis of fingers’ flexor tendon, which allows fingers to bend. The middle knuckle is stuck in a bent position, making the finger look as if it is pulling the trigger of a gun.
- Boutonniere deformity, or buttonhole deformity, occurs when the middle knuckle joint (PIP joint) becomes stuck in a bent position while the large knuckle (MCP joint) and outermost knuckle (DIP joint) hyperextend.
- Swan's neck deformity occurs when the large knuckle (MCP joint) and the outermost knuckle (DIP) abnormally flex, while the middle knuckle (PIP joint) hyperextends. This results in the finger resembling a swan's neck.
- Hitchhiker's thumb, sometimes called duckbill or Z-thumb, occurs when the thumb’s large knuckle (MCP joint) abnormally flexes while the top knuckle (IP joint) hyperextends. Some people think this abnormal bending resembles a Z-shape.
- Ulnar deviation, also called ulnar drift, refers to when the fingers angle away from the thumb. This deformity occurs when the large knuckles (MCP joints) are so damaged that the fingers begin to dislocate and drift sideways, toward the forearm’s ulna bone.
Hand deformities can usually be prevented or delayed with treatment.
- Weisbart, E. Ziegler, OW. Rheumatoid arthritis. Rochester, NY: University of Rochester Medical Center Health Encyclopedia. http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P01133. Accessed November 13, 2014.