Rheumatoid Arthritis

An Overview of Rheumatoid Arthritis

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What Is Rheumatoid Arthritis

In its most literal sense, arthritis means “inflamed joint.” Arthritis describes any condition where cartilage in the joint breaks down. Normal joints consist of two smooth, cartilage-covered bone surfaces that fit together as a matched set and glide against one other. Arthritis can result when these smooth surfaces become irregular as the cartilage breaks down and don’t fit well together anymore, essentially “wearing out.” Arthritis can affect any joint in the body, and it can be debilitating when it affects the hands and fingers.

Rheumatoid arthritis is one of the most common forms of arthritis in the hand, in addition to osteoarthritis and post-traumatic arthritis. Rheumatoid arthritis affects the cells that line and normally lubricate the joints (synovial tissue). This is a systemic condition (can affect the whole body), which means that it may affect multiple joints, usually on both sides of the body.

The joint lining (synovium) becomes inflamed and swollen and erodes the cartilage and bone. The swollen tissue may also stretch the surrounding ligaments, which are the connective tissues holding the bones together, resulting in deformity and instability. The inflammation may also spread to the tendons, which are the rope-like structures linking muscles to bones. This can result in fraying and eventual breaking of the tendons.

Rheumatoid arthritis of the hand is most common in the wrist and the finger knuckles (the MP and PIP joints (see Figure 1)).

Signs & Symptoms of Rheumatoid Arthritis

Stiffness, swelling and pain are symptoms common to all forms of arthritis in the hand. In rheumatoid arthritis, some joints may be more swollen than others. There is often a sausage-shaped swelling of the finger. Other symptoms of rheumatoid arthritis of the hand include:

  • A soft lump over the back of the hand that moves when straightening the fingers
  • A creaking sound during movement
  • Fingers shifting away from the direction of the thumb (see Figure 2)
  • Swelling and inflammation of the tendons that bend the fingers, resulting in clicking or triggering of the finger as it bends, sometimes causing numbness and tingling in the fingers (carpal tunnel syndrome)
  • Inability to straighten or bend certain fingers or the thumb
  • A bent middle finger (Boutonnière Deformity (see Figure 3))
  • An over-extended middle joint and bent fingertip (Swan-Neck Deformity (see Figure 3))

Diagnosis

Your doctor will examine you to determine whether you have similar symptoms in other joints and to assess the impact of the arthritis on your life and activities. The appearance of the hands and fingers helps to diagnose the type of arthritis. X-rays will show certain characteristics of rheumatoid arthritis such as narrowing of the joint space or erosions of the bone. If your doctor suspects rheumatoid arthritis, he or she may request blood or other lab tests to confirm the diagnosis.

Treatment

Rheumatoid arthritis is primarily treated with medication. Typically, medications for this condition are prescribed by your primary care provider or a rheumatologist.  Steroid injections are sometimes helpful, particularly when the condition is more active. Surgery may be needed to relieve pain or improve function during the course of the disease, but it is not needed in all cases of rheumatoid arthritis.

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Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

Psoriatic Arthritis

What Is Psoriatic Arthritis & How Do You Treat It?

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What is Psoriatic Arthritis

Arthritis describes any condition where cartilage in the joint breaks down. Normally, a joint consists of two smooth, cartilage-covered bone surfaces that fit together as a matched set and glide against one other. Arthritis can result when these smooth surfaces become irregular as the cartilage breaks down. This results in surfaces that don’t fit well together anymore, essentially “wearing out.

Psoriatic arthritis is a condition in which the lining of the joint gets inflamed and swollen.  Because this inflammation stretches the tissues that keep the joint strong, the joint may become loose or crooked.  Also, the smooth ends of the bones wear out, and the bone may lose its normal shape.  Psoriatic arthritis can affect any joint in the body, and it affects men and women equally.

Psoriasis is a skin condition where people’s skin becomes dry, red, and flaky (Figure 1).  It can affect any part of the body. Up to 30% of people with psoriasis develop psoriatic arthritis, according to the National Psoriasis Foundation.

Arthritis can be debilitating when it affects the hands and fingers.  The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infections, gout, and psoriasis.

The changes in the joints with psoriatic arthritis are a lot like those in rheumatoid arthritis. These symptoms can include:

  • Red and swollen joints
  • Joints that sometimes feel warm
  • Decreased joint motion and stiff-feeling joints

With this condition, the hands may not be affected equally.  It may be hard to tell psoriatic arthritis from other types of arthritis because most types of arthritis have symptoms of stiffness, swelling, and pain.  In psoriatic arthritis, the swelling often affects the whole finger but more at the middle joint (figure 2).  There may be pitting, ridging or crumbling of the fingernails.  The joint at the end of the finger may become deformed (figure 3).  Other parts of the hand and wrist are not usually affected.

Diagnosis

Psoriatic arthritis is suspected when people have psoriasis and develop problems with their joints.  The doctor will mainly look at and feel the hand and look at x-rays.  X-rays may show loss of the normal shape of the bone, mainly at the end joint.  X-rays may also show swelling around the bone, and the space between the bones may become narrow.  The bones may fuse together at a joint.  There is no special blood test to find out if one has this arthritis.  A piece of skin can be removed to help find out if a person has psoriasis.

Treatment

There is no cure for psoriatic arthritis, but there are medications available to help lessen swelling, redness, and pain to keep the hands functioning as well as possible.  Different medical specialists usually work together to help with the treatment of this arthritis, including physicians and therapists.

Surgery may help treat the problems of psoriatic arthritis.  The type of surgery needed depends on the problems one has with use and pain.  A hand surgeon will help guide you to the best treatment for your particular concerns.

Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.