Rheumatoid arthritis is an inflammatory process that affects the synovium, or lining, of both joints and tendons.  The effects of rheumatoid arthritis can be mild, and several new medications can keep joint destruction to a minimum and allow patients to continue a normal and relatively unaffected lifestyle.  Unfortunately, in some circumstances the effects can be severe.
As the synovium becomes inflamed within the joints, there is destruction of the joint surface, leading to disruption not only of the joint surface but of the ligaments, resulting in dislocation of the joints and abnormal positioning of the wrist, fingers, and thumb.  Related effects on the flexor tendons can also produce functional problems and can result in rupture of the tendons and an inability to flex or extend the fingers or wrist.

Symptoms
The initial clinical presentation is that of swelling, either of the wrist, hand, or fingers, or of swelling in the region of the carpal tunnel at the wrist, which can produce carpal tunnel syndrome.
Initially, rheumatoid arthritis affects the metacarpophalangeal joints, which become inflamed, and the proximal phalanx dislocates towards the palm.  The fingers usually angulate toward the small-finger side of the hand, and there is inability to straighten the fingers out.  This problem is followed by arthritic changes at the proximal interphalangeal joint in the fingers.  With an imbalance of the tendon function, finger deformities result.

Treatment
It is essential for patients with rheumatoid arthritis to receive vigorous medical care.  Splinting of the fingers, the appropriate oral medications to prevent or reduce inflammation, and appropriate therapy to maintain range of motion and function are all essential parts of this management.
If ongoing deterioration and loss of function are evident, then surgical intervention may be necessary.  It is important not to wait until the deformities are too severe before obtaining appropriate surgical treatment.  If each problem is dealt with as it arises, hand function can be maintained in the long run.
Replacement of the metacarpophalangeal joints with silastic implants and realignment of the tendons and soft tissues around the joints are also very effective in treating the problem and preventing further deformity.
There may also be a need to realign tendons within the fingers and sometimes to fuse joints, especially the distal interphalangeal joint (the joint at the end of the finger).  Similar treatment may be required for thumb deformities.
Such treatment should also be coordinated with treatment of wrist problems, as the wrist may be deviated to one side or the other, and moving tendons from one side of the wrist to the other can improve finger function.  Sometimes fusion of the wrist or a wrist prosthesis may be needed as well, to maintain good function and appearance of the hand and wrist.

Information about the related carpal tunnel syndrome can be found at our and pages.