Rheumatoid arthritis is a chronic, systemic autoimmune disease that becomes serious, if left untreated. Its cause is unknown. It classically affects the lining of the joints and tendons. This may result in swelling with eventual joint destruction and wearing away of the tendons. The amount of progression and severity of the condition varies among patients. Although the musculoskeletal system is affected first, rheumatoid arthritis can also affect many other body systems.
WHAT ARE THE SYMPTOMS OF RHEUMATOID ARTHRITIS?
In the early stage of rheumatoid arthritis, your joints may become warm, swollen and painful, but your knuckles may only appear slightly red unless the swelling in the tissue is very serious. If your tendons are involved, swelling may be greater at your wrist. This swelling may cause median nerve compression. Symptoms such as pain on movement and triggering or locking of the fingers indicate tendon involvement, which may lead to the tendons breaking. In the final stage of rheumatoid arthritis, scar tissue replaces the chronic swelling. The hand, if left uncorrected, adopts a painless fixed position and has very little motion and function.
HOW IS IT DIAGNOSED?
Diagnosis is based on a list of inclusive criteria first developed by the American Rheumatism Association. These criteria were developed because no laboratory tests or observations are conclusive. Once the diagnoses is confirmed, your physician will assess the current condition of your joints and tendons and the severity of the disease.
WHAT IS THE TREATMENT FOR RHEUMATOID ARTHRITIS?
Your treatment will be based on your current condition and disease stage. In the initial or proliferative stage, the changes that have occurred are still reversible and management is supportive: pain control; therapy to protect joints/tendons while maintaining range and power; and orthotics or bracing for joint protection. If swelling persists, the swollen synovial tissue may be removed from the joints or tendons. This procedure may be combined with other procedures, such as carpal tunnel or trigger finger release. In the second or destructive stage, pain and swelling control continues; therapy and orthotics maximize function while minimizing deformity; and a home evaluation may be necessary to assess the need for lifestyle modification or assistive devices. Surgery may include tendon reconstruction and joint realignment or reconstruction. In the final or reparative stage, the hand may have a very limited ability to move. Various surgical procedures can be used to improve the quality of function and appearance of the hand and wrist.