Thumb Deformities with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic disease (affects the entire body) but has its greatest effect on the joints. The hands are often involved causing painful deformities of the thumbs and fingers.

In this article, Dr. T. D. Rozental reviews four stages of rheumatoid disease of the hand and thumb. Treatment is discussed, including nonsurgical and surgical options. Photos of thumb deformities, X-rays, and results of treatment are presented.

The four stages of RA are: 1) synovitis or inflammation of the joint lining for less than six months, 2) synovitis present more than six months, 3) thumb and hand deformities develop, and 4) arthritis mutilans (loss and collapse of bone).

Conservative care is recommended for stage 1 and 2 disease. This includes medication, steroid injections, and splinting. Sometimes it takes a period of trial and error to find the drug or the right combination of medications that works best for each patient.

A physical or occupational hand therapist is part of the team from the beginning. Patients are taught how to protect their joints. Splints may be used to maintain joint alignment and prevent loss of motion or deformity. Inflamed joints need the right mix of rest and exercise. The therapist helps the patient find the best program of exercise for the entire body.

Surgery is more likely for stages 3 and 4. Repair of tendon rupture and restoration of function are two goals of surgical treatment. Six types of tendon and joint deformity common with RA are boutonnière deformity (two types), swan-neck deformity, joint contractures (joint gets stuck and can't move), joint instability, and arthritis mutilans.

The author describes repair techniques for each of these problems. If the bone is intact but the joint is destroyed, a joint replacement called arthroplasty may be advised. Patients with advanced disease and major bone destruction may require joint fusion called arthrodesis.

Reference: 

Tamara D. Rozental, MD. Reconstruction of the Hand. In Journal of the American Academy of Orthopaedic Surgeons. February 2007. Vol. 15. No. 2. Pp. 118-125.

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