Rheumatoid arthritis of the hand is an autoimmune condition that causes joint inflammation and pain.
Rheumatoid arthritis is a chronic inflammatory condition that frequently affects the small joints of the hands, often among the first and most noticeably affected areas. Unlike osteoarthritis, which results from mechanical wear, rheumatoid arthritis is driven by inflammation of the joint lining, which can progressively damage cartilage, bone and the surrounding tendons if not well controlled.
The condition typically affects joints symmetrically, meaning both hands are usually involved in a similar pattern, which is a distinguishing feature from other forms of hand arthritis.
Rheumatoid arthritis is an autoimmune condition, meaning the body's immune system mistakenly attacks the lining of the joints, called the synovium. The exact trigger is not fully understood, though genetic predisposition and environmental factors, including smoking, are recognised contributors. It is more common in women and typically develops in mid-adulthood, though it can occur at any age.
Common features of rheumatoid arthritis in the hand include:
The symmetrical pattern and prolonged morning stiffness help distinguish rheumatoid arthritis from other causes of hand joint pain.
Rheumatoid arthritis is primarily managed by a rheumatologist, with medication aimed at controlling the underlying immune-driven inflammation and limiting joint damage. Orthopaedic assessment complements this medical management, focusing on joint protection, splinting, and hand therapy to support function.
Where joint damage or tendon problems develop despite good medical control of the underlying disease, surgical options include synovectomy, removing inflamed joint lining, tendon repair or reconstruction for tendons weakened or ruptured by the disease, and joint fusion or replacement for joints with significant structural damage.
Modern disease-modifying treatment has substantially improved outcomes for rheumatoid arthritis, and many people achieve good control of the disease with well-managed medication, limiting the joint damage that was more commonly seen in the past. Where structural damage or tendon problems do develop despite good medical control, orthopaedic surgery can meaningfully improve hand function and comfort.
Rheumatoid arthritis of the hand is a chronic autoimmune condition managed primarily with disease-modifying medication under a rheumatologist, with orthopaedic surgery reserved for structural joint damage or tendon problems that develop despite good medical control. With modern treatment, many people maintain good hand function for many years. Persistent, symmetrical joint swelling and stiffness, particularly lasting over an hour each morning, is worth having properly assessed.
