Therapy for Rheumatoid Arthritis in the Hand

It is easy to take hand function for granted until rheumatoid arthritis causes pain and swelling in the fingers, thumbs, and wrists. Therapy can help decrease hand pain and improve hand function so that daily activities, such as getting dressed, using a laptop, and sleeping, are more comfortable. Therapy can also slow down or prevent joint damage and the development of hand deformities.

Therapy may be provided by a licensed occupational therapist or certified occupational therapy assistant. Physicians often prescribe occupational therapy to patients who have rheumatoid arthritis, but a prescription is not always needed. Rules vary from state to state.

Read more about Hand Pain and Rheumatoid Arthritis (RA)

What Occupational Therapists Do

The field of occupational therapy is rooted in helping people participate in any activities that are important to them, including work, hobbies, sports, and everyday tasks, such as driving and household chores.

A professional occupational therapist is trained to:

• Look at the interaction between a person’s body, environment, and required daily activities
• Work collaboratively with patients to improve their ability to perform specific tasks and accomplish goals
• Address both the physical and emotional effects of arthritis and other chronically painful conditions

Occupational therapists’ coursework and professional training place special emphasis on how to recognize and help people coping with emotional and mental health issues.^1-3 For example, an occupational therapist can suggest ways to decrease the stress and fatigue associated with autoimmune arthritis. Such guidance can boost an individual’s sense of well-being and improve their quality of life.

See Hand Rheumatoid Arthritis (RA) Signs and Symptoms

This article discusses 5 ways occupational therapy can help people who have rheumatoid arthritis symptoms in their hands. It also includes instructions for several hand exercises that may be done at home.

1. Protect the Hand from Pain and Deformities

Using specific strategies and techniques to protect the joints may decrease hand pain and prevent deformities from appearing years later.⁴ An occupational therapist is trained to teach joint-protection techniques.

Joint protection typically involves distributing weight across many joints, rather than putting stress on just one or two joints. For example, a therapist may demonstrate the best way to pick up an infant without hurting the wrists or how to hold a coffee mug without straining the thumb.

An occupational therapist may also recommend other joint-protection strategies and techniques, such as:

• Using warm and cold therapy. Applying a warm compress may ease joint stiffness, particularly in the morning. Applying a cold compress may help relieve discomfort in hot, tender, inflamed joints.

  See Applying Heat vs. Cold to an Arthritic Joint

• Preventing and adapting to deformities. Once a deformity has occurred it cannot be reversed. However, an OT can help a person recognize a developing deformity and suggest ways to possibly prevent it or slow down its progression, which may include splinting (see #4 below).
• Wearing compression gloves. An occupational therapist can suggest gloves that provide gentle compression, which may reduce swelling and pain in the hand joints.⁵

It is worth noting, not all research studies support the use of compression gloves, and not all therapists will recommend them.^6,7 Compression gloves are generally safe to use and a patient can try them and decide if they provide benefit.

2. Cope with the Psychosocial Effects of Pain

Living with hand pain and/or hand deformities can be a frustrating, isolating experience. In addition to suggesting ways to decrease and prevent hand pain, an occupational therapist may help address the mental and social effects of the pain.

Occupational therapists may:

• Use cognitive behavior therapy techniques to encourage helpful thought patterns and behavioral responses to hand pain.
• Address the way hand pain affects relationships. For example, hand pain may affect sexual intimacy or shared, cherished hobbies, such as gardening or dancing.

If appropriate, occupational therapists may also recommend that patients obtain additional guidance from mental health counselors.

3. Use Tips and Tricks to Accomplish Everyday Tasks

One of the advantages of working with an occupational therapist is that they can tailor recommendations for an individual’s habits and home and work environments. Customized recommendations can boost independence, productivity, and confidence.

An occupational therapist may also recommend personalized adaptive equipment, ranging from specially designed scissors to ergonomic computer keyboards. The therapist can help determine what equipment will work best for an individual and demonstrate how to use it.

4. Use Customized Hand Splints

An occupational therapist can perform an in-depth evaluation of the many muscles and structures in the hand and recommend custom or prefabricated orthotic devices, particularly hand splints. Splints can:

• Prevent or discourage certain movements that trigger pain
• Encourage and help maintain hand positions
• Improve the ability to do daily activities

For example, an occupational therapist may recommend a new parent wear a splint to stabilize the thumb and wrist, which can minimize hand pain while picking up and holding a baby.

5. Improve Hand Strength

An occupational therapist may suggest a customized home exercise program to improve hand strength. Research suggests that hand exercise programs:

• Improve hand function, such as grip strength.^8-10 Performing tasks using the hands may become easier and more comfortable.
• Increase people’s confidence in their ability to successfully accomplish tasks. Having a sense of control over symptoms has positive mental benefits.^11,12
• Will not increase stiffness and pain,^9,13 and may even reduce them.^10,14

It is important to get a personalized evaluation and treatment plan from a qualified health care practitioner, such as a licensed occupational therapist or a physical therapist who has special training in the hand. A personalized plan can help maximize benefits and minimize future joint damage.

See Treatments for Rheumatoid Arthritis (RA) in Hands

While a personalized hand exercise plan is recommended, a few general exercises are okay for most people with rheumatoid arthritis.