Hand Therapies for Rheumatoid Arthritis

With its 29 joints and intricate network of muscles, ligaments and tendons to support them, the human hand is capable of exacting tasks such as performing surgery or playing the violin. But with arthritis, even the simplest of tasks can become difficult or painful. For rheumatoid arthritis (RA) of the hands, treatment includes good medical management, along with occupational therapy interventions for some. This could mean using splinting and adaptive aids to reduce deforming stresses on the joints of the hands and maintain mobility. Finally, if joint damage has occurred, surgery may be an option.

The medications you take to relieve pain and control arthritis throughout your body are crucial to controlling inflammation and preventing damage to the joints of your hands. Depending on the severity of your arthritis and other factors, these may include disease-modifying antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines  are available as pills and injections. NSAIDs are also available in topical forms.
 
If these treatments don’t completely control inflammation or inflammation is confined to just one or a few joints, corticosteroid injections may be another option. These medications are similar to a hormone your body makes naturally. Corticosteroids are often injected directly into affected joints to relieve inflammation, along with a long-lasting anesthetic to provide pain relief. Injections may be repeated if needed; however, doctors typically limit them to three or four per joint per year to reduce the risk of side effects.

Injections are often combined with splinting to support and ease stress on the affected joint and help prevent deformity. Some splints are designed so that you can use your hands while wearing them. However, you should only wear a splint as directed by your occupational therapist, because immobilizing joints too long can lead to wasting of the muscles that support them.
 
Whether readymade or specially fitted, splints are only one treatment provided by occupational therapists. Others include education about ways to perform tasks that put less stress on the affected joints and tools and devices that spare the joints, like adaptive knives, jar openers and key holders.  These devices and others help you do tasks with less force.

In many cases, strengthening and stretching exercises, as prescribed by an occupational or physical therapist can also help relieve symptoms and improve function. In a 2016 study published in Arthritis Care & Research, 242 people with hand RA were randomly assigned to continue their regular treatment, while 246 were assigned to a program of exercises designed to improve a variety of hand and wrist movements. Researchers found improvements in grip strength at 4 months predicted improved hand function at 12 months. 

If conservative treatments fail to relieve symptoms or persistent inflammation leads to tendon ruptures or joint deformity that hinders function, surgery may be necessary. Surgical treatments for common problems of the hand include:

• Silicone Metacarpophalangeal Joint Arthroplasty (SMPA): Replacement of damaged joints at the bases of the fingers with prostheses made of silicone to correct deformities, pain and lost function.
• Arthroscopic Wrist Synovectomy: Removal of the membrane lining the wrist joint to ease pain and stiffness of the wrist caused by persistent inflammation.
• Tendon Transfers: Replacing tendons damaged by inflammation with healthy tendons to restore hand function.
• Wrist Arthrodesis: Immobilizing the wrist – often using plates, rods or pins – to stabilize it and relieve pain. Commonly referred to as joint fusion, arthrodesis may also be used to stabilize the thumb if the tendon that enables you to flex your thumb ruptures.