Question: Rheumatoid Arthritis Hand Deformity - Inevitable or Preventable?
Hand deformities, joint problems, and joint damage caused by rheumatoid arthritis can include:
- rheumatoid nodules
- joint swelling
- joint stiffness
- ulnar drift / ulnar deviation
- wrist subluxation
- other hand, finger, thumb, and wrist problems
Are the aforementioned hand problems and deformities inevitable with rheumatoid arthritis?
Hand deformity is a common but significant complication of rheumatoid arthritis. For example, one of the more recognizable rheumatoid arthritis hand deformities occurs when the hand deviates to the ulnar (pinkie side). Also, a finger can lose function due to rupture of tendons. Once these deformities occur, they are not reversible medically and may require surgery.
Some of the indications for hand surgery include pain, limited function, cosmetic, as well as a way to prevent further injury to other joints.
Early treatment of rheumatoid arthritis is the best way to control the disease and prevent deformity, as well as disability which often occurs when joints get damaged.
Even at later stages of the disease, there is evidence that treating patients with active disease may help. In early or mild rheumatoid arthritis, DMARDs (disease-modifying anti-rheumatic drugs), such as Plaquenil (hydroxychloroquine) and Azulfidine (sulfasalazine) may be effective.
Moderate to Severe Rheumatoid Arthritis
Moderate to severe rheumatoid arthritis typically requires treatment with potentially more effective DMARDs including methotrexate (Rheumatrex, Trexall) and Arava (leflunomide), or one of the TNF blockers.
- Early, Aggressive Arthritis Treatment for Newly Diagnosed Patients
- Methotrexate for Rheumatoid Arthritis
- Facts About DMARDs (Disease-Modifying Anti-Rheumatic Drugs)
In many cases, two or even three DMARDs may be combined to help patients. Some common examples include:
- Methotrexate and one of the TNF blockers
- Methotrexate, Plaquenil, and Azulfidine
- TNF Blockers (Enbrel, Remicade, Humira) - Test Your Knowledge
- Combination Treatment for Rheumatoid Arthritis
Dr. Zashin is clinical assistant professor at University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospitals of Dallas and Plano. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is useful for anyone on one of the biologic drugs or considering the biologic drugs.