Why Does RA Often Occur in the Joints of the Hands?

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Article featured on MedicalNewsToday

In people with rheumatoid arthritis (RA), the immune system attacks healthy tissues in the lining of the joints. It often affects the hands, wrists, and feet. Over time, these joints can become stiff and deformed. Here’s why RA often affects these areas, along with treatments that may help prevent and treat pain.

Why does RA affect the hand joints?

RA tends to affect many joints at once. Often, symptoms first appear in the small joints of the middle fingers and in the bases of the hands and toes. It usually occurs in the same joints on both sides of the body.

RA may affect small joints in the hands first because there are many more joints in the hands than in other parts of the body.

The hands have 29 joints each. These joints are supported by a complex network of muscles, ligaments, and tendons that has evolved to perform complex tasks.

In people with RA, the immune system attacks and causes inflammation in the joint lining, or synovium. The synovium produces a fluid that lubricates the cartilage covering the ends of bones, allowing the bones to glide smoothly against each other when a person bends the joint.

A person with RA may experience symptoms such as pain, swelling, and stiffness in the joints. Over time, chronic inflammation in the joints may cause the cartilage to gradually wear away.

The condition may also progress to larger joints, such as the knees, ankles, or elbows.

In addition to affecting the joints, RA can cause inflammation that can also impact a person’s:

  • heart
  • lungs
  • eye
  • kidneys
  • skin

Common symptoms

Some research suggests that RA has a slow onset in more than 50% of cases.

Around 25% of people have abrupt RA onset. Experts believe that it is linked to gum inflammation from bacteria called Porphyromonas gingivalis. People will not experience gum inflammation or gingivitis (gum disease) from this infection unless they smoke.

RA is progressive, which means that the symptoms get worse over time. Treatments such as disease-modifying antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs can help slow the progression of RA but cannot cure the condition.

Early signs and symptoms of RA include tenderness, pain, swelling, or stiffness in joints that:

  • affect more than one joint
  • usually start in small joints, such as the hands, wrists, or feet
  • affect the same places on both sides of the body
  • last for at least 6 weeks
  • may be accompanied by stiffness in the morning for 30 minutes or longer

The fingers may appear swollen, like sausages. Inflammation can eventually cause irregularities in the joints and an inability to properly bend or straighten these joints.

Some other common symptoms of RA include:

  • weight loss
  • fever
  • weakness
  • fatigue

Over time, inflammation can affect other parts of the body, leading to symptoms such as:

  • dryness, pain, and inflammation in the eyes
  • sensitivity to light
  • small bumps in the skin over bones called rheumatoid nodules
  • shortness of breath
  • a dry mouth
  • gum inflammation or infection
  • a low red blood cell count

Home remedies

Home remedies do not replace medical treatments such as DMARDs, which can help slow the progression of RA. A person should never stop or change their prescribed treatment plan before speaking with a doctor.

Several home remedies may help alleviate pain, swelling, or stiffness in the joints due to RA. These remedies include:

  • heating pads or warm baths, to loosen up stiff joints
  • ice packs, to relieve joint pain and swelling
  • meditation and deep breathing techniques, to help a person relax and take their mind off the pain
  • acupuncture
  • massage
  • splints for the fingers or wrists
  • assistive devices, such as ergonomic keyboards or jar openers
  • lotions with capsaicin, to help relieve localized pain

The following supplements have limited scientific evidence proving their benefits but are worth bringing up with a doctor:

  • cannabidiol (CBD) products
  • fish oil
  • turmeric
  • glucosamine
  • probiotics

Making certain dietary changes can also reduce inflammation throughout the body and help a person lose weight. This may help relieve RA symptoms. Having an anti-inflammatory diet includes eating:

  • less sugar
  • fewer processed foods
  • less red meat
  • less full fat dairy
  • more fresh fruits
  • more vegetables
  • whole grains
  • lean meat
  • fish
  • legumes
  • nuts
  • seeds

Some people with RA may find that avoiding gluten or eating more fermented foods, such as yogurt and sauerkraut, helps with symptoms.

A person should always talk with a doctor before trying any new supplements or making any major dietary changes.

Exercises

For people with RA hand pain, exercise may improve the symptoms and maintain joint mobility and function.

Some research suggests that performing therapist-recommended hand exercises may improve grip and hand function while also relieving RA symptoms.

A 2018 study in 841 people with RA suggests that hand exercises may improve mobility and function. The study also concludes that performing a hand exercise routine likely does not relieve pain or improve a person’s grip and strength in the short or long term.

  • Here are three simple hand exercises that a person can try:
  • Gently squeeze a small, squishy ball or a stress ball.
  • Place the hand out flat with the palm up. Bend each finger, one by one, into the palm. Hold, release, and repeat.
  • Place the hand flat on a table. Lift one finger off of the surface and release it back down. Repeat with each finger, one by one.
  • Getting regular, gentle, full body exercise helps increase strength and range of motion in the joints, which can improve daily functioning. It also helps a person maintain a moderate weight, which can improve RA symptoms.

A person should aim to incorporate the following into their routine:

  • cardiovascular exercises, such as walking or swimming
  • full body strengthening exercises
  • light stretching

Some exercise is always better than none. Although feeling some discomfort is OK, a person should stop exercising if they feel significant pain.

When to talk with a doctor

A person should talk with a doctor if they experience any early symptoms of RA, including:

  • persistent pain or stiffness in the joints
  • joints that are warm to the touch
  • difficulty moving or engaging in daily activities

For people who already have a diagnosis of and treatment plan for RA, a doctor visit is warranted if they:

  • experience any new symptoms
  • feel that their treatments are no longer managing their symptoms
  • develop any side effects from their medications

A person should also talk with a doctor before starting new supplements or a new diet. Also, they should always talk with a doctor before changing or discontinuing their medications.

  • A person should ask questions of their care team as needed. The team will often consist of the following healthcare professionals:
  • a primary care physician
  • a rheumatologist, who will specialize in treating musculoskeletal conditions such as RA
  • a rheumatology nurse, who can help educate the person about RA
  • a physical therapist, to help with mobility issues and teach hand exercises
  • an occupational therapist, to share devices and techniques that help a person live with their symptoms and go about their daily tasks
  • a mental health professional, to help with stress and anxiety, which are more common in people with RA
  • an orthopedic surgeon, to correct joint damage with surgery as necessary

The takeaway

RA is an autoimmune condition that affects many joints in the body. The condition causes the immune system to attack the lining in the joints, causing pain and swelling. Because there are many joints in the hands, people usually experience the first symptoms of RA in their hands.

Medications such as DMARDs help slow the progression of the condition. Several home remedies can also help manage the symptoms. Hand exercises may improve hand mobility, while full body exercise may relieve the symptoms and improve overall well-being.

A person’s healthcare team can help determine the best treatment plan to manage pain and improve functioning.

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