Many people feel occasional pain, stiffness or weakness in their hands, fingers and wrists. Often, it is nothing to worry about. But when the aching does not go away, or your knuckles look puffy and feel stiff every morning, it is worth a closer look. About 53.2 million U.S. adults have been diagnosed with some form of arthritis, and rheumatoid arthritis is one of the types most likely to show up first in the hands. If you have been living with hand pain and have not yet talked with a doctor, you may be wondering: What is rheumatoid arthritis? How do I know if I have it?
Rheumatoid arthritis (RA) is an autoimmune disease in which the immune system attacks the lining of the joints, most often starting in the small joints of the hands and feet on both sides of the body. Early signs include swollen, tender knuckles or wrists and morning stiffness that lasts longer than 30 minutes, and a doctor can confirm RA with a physical exam, blood tests and imaging.
Rheumatoid arthritis is the most common autoimmune type of arthritis. Unlike osteoarthritis, the “wear-and-tear” arthritis that develops over years of use, RA happens when the body’s immune system mistakenly attacks its own tissues. It is a chronic condition with no cure. The good news is that the outlook today is much brighter than it was a generation ago. With an early diagnosis and the right treatment plan, most people can manage RA and keep doing the activities they enjoy.
“About 75% of RA patients are women.”
— American College of Rheumatology
What Are the First Signs of Rheumatoid Arthritis?
In rheumatoid arthritis, the immune system targets the synovium, the thin lining that cushions and lubricates your joints. The lining becomes inflamed and swollen, which causes pain and stiffness and, over time, can damage cartilage and bone. In its early stages, RA often includes:
- Swelling, tenderness or warmth in the small joints first, especially the joints of the hands, wrists and feet
- Joint stiffness that is worse in the morning or after rest and lasts longer than 30 minutes
- Pain or aching in more than one joint
- The same joints affected on both sides of the body
- Fatigue, an occasional low-grade fever and loss of appetite
- Numbness or tingling (“pins and needles”) in the fingers, which can happen when swelling in the wrist presses on the median nerve and causes carpal tunnel syndrome
RA symptoms tend to come and go. Periods when the disease is more active, called flares, are often followed by stretches with little or no swelling and pain. And because RA usually affects joints symmetrically, if the knuckles on your right hand are swollen and stiff, there is a good chance your left hand feels the same way.
Left untreated, RA can do more than make your hands ache. Over time, inflamed joints can bend out of shape and shift out of place, making it harder to grip a coffee cup, button a shirt or turn a doorknob.
Rheumatoid arthritis can affect more than your joints
RA is a systemic condition, which means it can affect the whole body. In some people, it can also involve:
- Lungs—inflammation and scarring that can cause shortness of breath
- Heart and blood vessels—a higher risk of hardened and blocked arteries, along with inflamed blood vessels
- Eyes and mouth—dryness
- Skin—firm bumps called rheumatoid nodules, which usually form near pressure points such as the elbows
- Bones—thinning bones (osteoporosis) that break more easily
Rheumatoid Arthritis or Osteoarthritis? Both can cause painful, stiff hands, but they are very different diseases.
• Rheumatoid arthritis: An autoimmune disease that inflames the joint lining. It often starts in the small joints of the hands and feet, usually affects the same joints on both sides of the body, can bring fatigue and fever, and typically begins between ages 30 and 50.
• Osteoarthritis: Much more common than RA. It develops as cartilage wears away over years of use and generally affects older adults.
Because the two are treated differently, getting the right diagnosis matters.
How Do I Know If I Have Rheumatoid Arthritis?
There is no single test for rheumatoid arthritis, and RA can be hard to diagnose in its early stages because its symptoms overlap with other conditions. To find out for sure, your primary care physician, a rheumatologist (a doctor who specializes in arthritis) or a hand specialist will likely use a combination of the following:
- Physical exam—Your doctor checks your joints for swelling, warmth, tenderness and changes in shape, tests your grip strength and range of motion, and asks how long your symptoms have lasted. Symptoms that last six weeks or longer are one of the factors in the classification criteria rheumatologists use for RA.
- Blood tests—Tests for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies can point toward RA, while the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests measure inflammation in the body.
- Imaging—X-rays show changes in the joints and help your doctor track the disease over time, even if your first X-rays look normal. Ultrasound and MRI give a more detailed look at the joints and can help with diagnosis.
- Health history—Your doctor will ask about smoking and whether anyone in your family has RA or another autoimmune condition, since both can raise your risk.
In some cases, your doctor may monitor your symptoms for a while before making a definite diagnosis.
When to See a Doctor: Make an appointment if you have joint pain and swelling that does not improve after several weeks, morning stiffness in your hands or wrists that lasts longer than 30 minutes, the same joints hurting on both sides of your body, or numbness and tingling in your fingers. The sooner RA is diagnosed, the sooner treatment can start protecting your joints.
What Is the Best Treatment for Rheumatoid Arthritis?
There is no cure for rheumatoid arthritis, but treatment has improved dramatically. Today, the goal is to calm the disease until it is in remission, or as close to it as possible. The best plan for you depends on how active your RA is and which joints are involved, and it often brings together a rheumatologist, a hand specialist and a physical or occupational therapist.
“It’s best to diagnose and treat RA early to avoid joint damage and worsening symptoms and complications.”
— Centers for Disease Control and Prevention (CDC)
- Medications—Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are usually the first treatment for RA because they slow the disease and help protect the joints from long-term damage. If DMARDs alone do not control the inflammation, your rheumatologist may add a biologic drug or a newer targeted medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can ease pain and swelling.
- Splints, exercise and therapy—A physical or occupational therapist can teach you exercises that keep your joints moving. Splints or braces for the hands and wrists can reduce stress on the joints and help prevent deformity. A steady routine of gentle stretching can also improve flexibility and make everyday tasks easier.
- Surgery—Thanks to better medications, fewer people with RA need surgery today. But when joint damage becomes painful or a tendon ruptures, surgery can relieve pain and restore function. Hand and wrist procedures for RA include synovectomy (removing the inflamed joint lining), tendon repair, joint fusion and joint replacement, including artificial knuckle and wrist joints.
Frequently Asked Questions (FAQs) About Rheumatoid Arthritis
Get Answers About Rheumatoid Arthritis Hand Pain at Fort Worth Hand Center
Living with stiff, swollen, painful hands can make every part of your day harder. If you are noticing early signs of rheumatoid arthritis, do not wait for the pain to get worse. The sooner you have answers, the sooner you can start protecting your joints and getting back to the things you love.
From fingertips to elbows, Fort Worth Hand Center offers expert diagnosis of injuries, chronic conditions, and degenerative diseases. Our team of orthopedic surgeons at Fort Worth Hand Center is here to help when you need it most. If surgery is your best treatment option, our orthopedic physicians operate at state-of-the-art, accredited surgery centers.
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Before starting any new treatment or if you have questions regarding a medical condition, always seek the advice of your doctor or other qualified health provider. This information is not a substitute for professional medical advice.
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