Table of ContentsView AllTable of ContentsRA EffectsSymptomsRelated ConditionsTreatment
Table of ContentsView All
View All
Table of Contents
RA Effects
Symptoms
Related Conditions
Treatment
Rheumatoid arthritis cysts in the hands are one of the telltale symptoms of the condition. Others include pain, stiffness, swelling, discolored fingers, numbness, tingling, and joint deformity.
Rheumatoid arthritis (RA) is an inflammatory disease that can impact many joints and organs. More common in women than men and in people in their 30s to 60s, this type of arthritis can be particularly destructive on the joints in your hands.
Treatment may include medications, splinting, modifying activities, ice and heat therapy, and surgery.
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNet New Zealandwww.dermnetnz.org2023.
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Reproduced with permission from © DermNet New Zealandwww.dermnetnz.org2023.
How Rheumatoid Arthritis Affects the Hands
In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain and deformity (misshapenness) of the joints.
The hand joints most often affected include:
Cartilage damage and bony erosions frequently occur within the first two years of disease, so getting early treatment is essential.
What Is Tenosynovitis?Tenosynovitisis inflammation of the tendon sheath lining typically in the hand, wrist, or feet. Symptoms usually include pain with motion and tenderness when touched. Chronic deterioration or inflammation of the tendon or tendon sheath can cause scars that restrict motion.
What Is Tenosynovitis?
Tenosynovitisis inflammation of the tendon sheath lining typically in the hand, wrist, or feet. Symptoms usually include pain with motion and tenderness when touched. Chronic deterioration or inflammation of the tendon or tendon sheath can cause scars that restrict motion.
Common Symptoms
As RA progresses, it almost always becomes polyarticular (meaning it affects five or more of the body’s joints).At the start of the disease process, however, symptoms usually begin in one to two of the body’s smaller joints. The hand is a frequent starting location. The sections below detail common symptoms that may be seen in your hands or fingers if you have RA.
Pain
One of the hallmark signs of RA is pain and soreness in the hands and fingers. People with RA in their hands typically experience both soreness in the joints themselves and pain with different hand movements.
Rheumatoid arthritis pain may begin suddenly and can become quite intense within 24 to 48 hours of its initial onset. This same pain can also disappear just as quickly. Sometimes the pain affects the same joint with each RA flare-up, while other times it moves to other joints in the hand.
Most frequently, the finger joints that connect to the hand (the metacarpophalangeal or MCP joints) and the middle joint (the proximal interphalangeal or PIP joints) are impacted.
Stiffness and Swelling
RA causes chronic inflammation in the cells that cover and lubricate joints (known as thesynovialtissue). Swelling occurs wherever this inflammation arises, notably in the fingers and hands.
As the swelling and inflammation worsen, stiffness can result as the fluid takes up the space in the joints and limits the range of motion. Stiffness may be more noticeable in the morning and after long periods of hand use.
Chronic inflammation in the synovium of the hand joints can ultimately affect the muscles also, leading to tendon rupture.
In people with RA, this is especially common in the extensor tendons of the hand and can cause you to have difficulty opening your hands or straightening out your fingers.
Why Do My Hands Look Puffy?Swelling in the relatively small joints of the fingers and hands can significantly alter their appearance. The palm of the hand may look puffy and fingers may appear bloated over individual joints, depending on the degree of swelling.
Why Do My Hands Look Puffy?
Swelling in the relatively small joints of the fingers and hands can significantly alter their appearance. The palm of the hand may look puffy and fingers may appear bloated over individual joints, depending on the degree of swelling.
Weakness
A 25% to 70% reduction in muscular strength has been observed in people with RA when compared with age-matched healthy individuals.
Persistent mobility reduction in joints can limit the effectiveness of muscles in the area. Muscle weakness and reduced strength are thought to result from decreased muscle size due to wasting or thinning of muscle mass as a result of disuse.
Research also indicates that muscle weakness can result from faulty signaling within the muscle that allows the hands to contract and relax.
Numbness/Tingling
In some cases of RA, the inflammation and swelling that occurs in the hands can cause nerves in the area to become compressed. This can lead tonumbness and tingling, causing the hand to feel like it has “fallen asleep.”
The median nerve (which travels through thecarpal tunnelat the base of the hand) is commonly affected.This nerve provides sensation to the thumb-side or outer half of the palm. It also supplies feeling to the thumb, pointer, middle, and a portion of the ring fingers.
Grinding
As RA progresses and the lining of the joint becomes inflamed, the cartilage and bones in the handbegin to break down and wear away.
This erosion causes the bony surface to become irregular and impacts the movement of the hand and finger joints.
As a result, the joints in these areas no longer fit together smoothly, and moving your hands and fingers can become noisy and uncomfortable. This typically painful grinding or popping sound is calledcrepitus.
Joint Deformity
The previously mentioned erosion of the cartilage and bone in the hand and finger joints may cause physical deformities to occur. In some cases, splinting or bracing may even be necessary to correct these progressive bony changes.
Numerous conditions can cause joint deformity and make hand and finger functioning difficult.
Cysts and Nodules
In about a quarter of RA patients, doughy lumps or nodules begin to grow just underneath the skin in various places throughout the body.
While these nodes are frequently seen on the back of the knuckles or fingers, they can also be found in the elbows, knees, forearms, or heels.
It is not completely understood why these nodules develop, however they are usually more of a visual annoyance than a true health concern.
In rarer instances, the skin that covers the nodule can become infected or a nodule can develop in a sensitive area leading to pain.
Comparing Nodules
RA nodules are typically firm but springy to the touch. In osteoarthritis, however, the finger nodes that develop as a result of bony swelling (calledBouchard’s nodesat the PIP joints andHeberden’s nodesat the DIP joints) may be slightly more solid and rigid-feeling.
The growths associated with RA should also not be confused with another variety, called amucous cyst, which affects the DIP joint on the top of the fingers. This cyst typically occurs as a result of trauma or osteoarthritis, but can also occur spontaneously without a known cause.
Bone Spurs in RA or Just OA?While it is certainly possible to have both RA andosteoarthritis (OA), the fluid-filled nodules or nodes seen in RA are different frombone spurs, which primarily occur with osteoarthritis (OA).In OA, the cushioning cartilage at the end of a bone begins to thin and break down, leading to an irregular surface. As this arthritic joint repetitively moves, new bone (also known as a bone spur) develops in the joint and further limits normal movement.Unlike the nodules associated with RA, bone spurs are typically hard and non-pliable.
Bone Spurs in RA or Just OA?
While it is certainly possible to have both RA andosteoarthritis (OA), the fluid-filled nodules or nodes seen in RA are different frombone spurs, which primarily occur with osteoarthritis (OA).In OA, the cushioning cartilage at the end of a bone begins to thin and break down, leading to an irregular surface. As this arthritic joint repetitively moves, new bone (also known as a bone spur) develops in the joint and further limits normal movement.Unlike the nodules associated with RA, bone spurs are typically hard and non-pliable.
While it is certainly possible to have both RA andosteoarthritis (OA), the fluid-filled nodules or nodes seen in RA are different frombone spurs, which primarily occur with osteoarthritis (OA).
In OA, the cushioning cartilage at the end of a bone begins to thin and break down, leading to an irregular surface. As this arthritic joint repetitively moves, new bone (also known as a bone spur) develops in the joint and further limits normal movement.
Unlike the nodules associated with RA, bone spurs are typically hard and non-pliable.
Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS)is a neurological disorder that occurs when the median nerve, which runs from your forearm into the palm, becomes pressed or squeezed at the wrist.
You may feel numbness, weakness, and pain in your hand and wrist, and your fingers may become swollen and difficult to use.
Raynaud’s Syndrome
People with RA are at a higher risk of developing a condition calledRaynaud’ssyndrome, which causes color and temperature changes in the fingers.
In this condition, blood vessels in the hands and fingers (which are already very small) narrow and decrease in size, reducing blood flow. Typically the effects of the syndrome are more severe in people whose Raynaud’s is the result of another condition, like RA.
Individuals with Raynaud’s become sensitive to cold temperatures and often notice their fingers turning a white or blueish color as blood flow diminishes. Numbness, tingling, or sensitivity may also accompany these changes.
In severe cases, ulceration of the skin or even gangrene can develop if Raynaud’s is not properly treated.
Trigger Finger
Trigger finger is a condition affecting tendons that flex the fingers and thumb, typically causing a sensation of locking or catching when you bend and straighten your digits.
Ulnar Deviation
Known as ulnar deviation or ulnar drift, this deformity can have profound effects on your grip strength and finger movement.
As RA progresses and the inflammation in the synovium becomes more chronic, the hand and finger joints can begin to deviate or shift away from the thumb side of the forearm.
Hitchhiker’s Thumb Deformity
Hitchhiker’s thumb deformity (also Z-shaped deformity) can occur with RA. The lower thumb joint (MCP) flexes while the upper thumb joint hyperextends.
Swan Neck Deformity
Swan neck deformityis common with RA, and occurs when the MCP and the top finger joint (distal interphalangeal or DIP) flex towards the palm while the lower finger joint (PIP) hyperextends.
Boutonniere Deformity
Boutonnieredeformity is a common joint deformity associated with RA. It occurs when the lower finger joint (PIP) flexes towards the palm side of the hand while the top finger joint (DIP) extends away from the palm.
Treatments for RAcan help reduce inflammation in the joints, relieve pain, prevent or slow down joint damage, reduce disability, and enable you to be as active as possible.
Lifestyle Changes
Lifestyle factors can reduce inflammation and pain and slow joint damage. Examples include:
Medications
Medications can help relieve pain, control inflammation, and prevent damage to the joints in your hands. Medications include:
Advances in medication have improved the chances of continuing your daily activities despite your RA. New treatments have also increased your odds of living a normal lifespan.
Splinting
Wearing the splint for too long can lead to muscle deterioration (atrophy). Muscles can assist in stabilizing injured joints, so atrophy should be avoided.
Surgery
If other treatments do not relieve symptoms or chronic inflammation leads to tendon ruptures or joint deformity that prevents function, then surgery may be recommended.
Surgical treatments of the hand include:
Summary
Rheumatoid arthritis in the hands is an inflammatory form of arthritis that can impact many of the body’s joints and organs. RA in the hands and fingers can cause pain, stiffness, swelling, discolored fingers, numbness, tingling, and joint deformity.
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20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Arthritis Center.Rheumatoid arthritis signs and symptoms.Centers for Disease Control and Prevention.Rheumatoid arthritis.Johns Hopkins Medicine.Rheumatoid arthritis treatment.Merck Manual.Tendonitis and tenosynovitis.American Society for Surgery of the Hand.Rheumatoid arthritis.Yamada T, Steinz MM, Kenne E, Lanner JT.Muscle weakness in rheumatoid arthritis: the role of ca 2+ and free radical signaling. EBioMedicine. 2017;23:12-19. doi: 10.1016/j.ebiom.2017.07.023Arthritis Foundation.Possible Joint Disfigurements in Rheumatoid Arthritis.Rheumatoid Arthritis Support Network.Rheumatoid nodules: Are rheumatoid nodules dangerous?American Osteopathic College of Dermatology.Digital mucous cyst.University of Pittsburgh Medical Center.Bone spur.National Institute of Arthritis and Musculoskeletal and Skin Diseases.Carpel tunnel syndrome.Arthritis Foundation.Raynaud’s disease.American Academy of Orthopaedic Surgeons.Trigger finger.Arthritis Foundation.6 self-care tips for RA.Hall AM, Copsey B, Williams M, et al.Mediating Effect of Changes in Hand Impairments on Hand Function in Patients With Rheumatoid Arthritis: Exploring the Mechanisms of an Effective Exercise Program. Arthritis Care Res (Hoboken). 2017 Jul;69(7):982-988. doi: 10.1002/acr.23093Levitsky A, Brismar K, Hafström I, et al.Obesity is a strong predictor of worse clinical outcomes and treatment responses in early rheumatoid arthritis: results from the SWEFOT trial. RMD Open 2017;3:e000458. doi:10.1136/rmdopen-2017-000458Agnoli C, Sieri S, Ricceri F, et al.Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort. Nutr Diabetes. 2018 Apr 25;8(1):22. doi: 10.1038/s41387-018-0023-3Aletaha D, Smolen JS.Diagnosis and management of rheumatoid arthritis: a review.JAMA. 2018;320(13):1360-1372. doi:10.1001/jama.2018.13103American Academy of Orthopaedic Surgeons.Arthritis of the hand.Arthritis Foundation.Hand therapies for rheumatoid arthritis.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Johns Hopkins Arthritis Center.Rheumatoid arthritis signs and symptoms.Centers for Disease Control and Prevention.Rheumatoid arthritis.Johns Hopkins Medicine.Rheumatoid arthritis treatment.Merck Manual.Tendonitis and tenosynovitis.American Society for Surgery of the Hand.Rheumatoid arthritis.Yamada T, Steinz MM, Kenne E, Lanner JT.Muscle weakness in rheumatoid arthritis: the role of ca 2+ and free radical signaling. EBioMedicine. 2017;23:12-19. doi: 10.1016/j.ebiom.2017.07.023Arthritis Foundation.Possible Joint Disfigurements in Rheumatoid Arthritis.Rheumatoid Arthritis Support Network.Rheumatoid nodules: Are rheumatoid nodules dangerous?American Osteopathic College of Dermatology.Digital mucous cyst.University of Pittsburgh Medical Center.Bone spur.National Institute of Arthritis and Musculoskeletal and Skin Diseases.Carpel tunnel syndrome.Arthritis Foundation.Raynaud’s disease.American Academy of Orthopaedic Surgeons.Trigger finger.Arthritis Foundation.6 self-care tips for RA.Hall AM, Copsey B, Williams M, et al.Mediating Effect of Changes in Hand Impairments on Hand Function in Patients With Rheumatoid Arthritis: Exploring the Mechanisms of an Effective Exercise Program. Arthritis Care Res (Hoboken). 2017 Jul;69(7):982-988. doi: 10.1002/acr.23093Levitsky A, Brismar K, Hafström I, et al.Obesity is a strong predictor of worse clinical outcomes and treatment responses in early rheumatoid arthritis: results from the SWEFOT trial. RMD Open 2017;3:e000458. doi:10.1136/rmdopen-2017-000458Agnoli C, Sieri S, Ricceri F, et al.Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort. Nutr Diabetes. 2018 Apr 25;8(1):22. doi: 10.1038/s41387-018-0023-3Aletaha D, Smolen JS.Diagnosis and management of rheumatoid arthritis: a review.JAMA. 2018;320(13):1360-1372. doi:10.1001/jama.2018.13103American Academy of Orthopaedic Surgeons.Arthritis of the hand.Arthritis Foundation.Hand therapies for rheumatoid arthritis.
Johns Hopkins Arthritis Center.Rheumatoid arthritis signs and symptoms.
Centers for Disease Control and Prevention.Rheumatoid arthritis.
Johns Hopkins Medicine.Rheumatoid arthritis treatment.
Merck Manual.Tendonitis and tenosynovitis.
American Society for Surgery of the Hand.Rheumatoid arthritis.
Yamada T, Steinz MM, Kenne E, Lanner JT.Muscle weakness in rheumatoid arthritis: the role of ca 2+ and free radical signaling. EBioMedicine. 2017;23:12-19. doi: 10.1016/j.ebiom.2017.07.023
Arthritis Foundation.Possible Joint Disfigurements in Rheumatoid Arthritis.
Rheumatoid Arthritis Support Network.Rheumatoid nodules: Are rheumatoid nodules dangerous?
American Osteopathic College of Dermatology.Digital mucous cyst.
University of Pittsburgh Medical Center.Bone spur.
National Institute of Arthritis and Musculoskeletal and Skin Diseases.Carpel tunnel syndrome.
Arthritis Foundation.Raynaud’s disease.
American Academy of Orthopaedic Surgeons.Trigger finger.
Arthritis Foundation.6 self-care tips for RA.
Hall AM, Copsey B, Williams M, et al.Mediating Effect of Changes in Hand Impairments on Hand Function in Patients With Rheumatoid Arthritis: Exploring the Mechanisms of an Effective Exercise Program. Arthritis Care Res (Hoboken). 2017 Jul;69(7):982-988. doi: 10.1002/acr.23093
Levitsky A, Brismar K, Hafström I, et al.Obesity is a strong predictor of worse clinical outcomes and treatment responses in early rheumatoid arthritis: results from the SWEFOT trial. RMD Open 2017;3:e000458. doi:10.1136/rmdopen-2017-000458
Agnoli C, Sieri S, Ricceri F, et al.Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort. Nutr Diabetes. 2018 Apr 25;8(1):22. doi: 10.1038/s41387-018-0023-3
Aletaha D, Smolen JS.Diagnosis and management of rheumatoid arthritis: a review.JAMA. 2018;320(13):1360-1372. doi:10.1001/jama.2018.13103
American Academy of Orthopaedic Surgeons.Arthritis of the hand.
Arthritis Foundation.Hand therapies for rheumatoid arthritis.
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