Symptoms of Rheumatoid Arthritis in Hands

Rheumatoid arthritis (RA) is an inflammatory form of arthritis that begins insidiously and can impact many of the body’s joints and organs. More common in women than men and in individuals in their third to their sixth decade of life, this type of arthritis can be particularly destructive on the joints in your hands. Several telltale symptoms can indicate that you may be experiencing this condition.

Common Symptoms

As RA progresses, it almost always becomes polyarticular (meaning it affects five or more of the body’s joints). At the start of the disease process, however, symptoms usually begin in one to two of the body’s smaller joints. The hand is a frequent starting location. The sections below detail common symptoms that may be seen in your hands or fingers if you have RA.

Pain

One of the hallmark signs of RA is pain and soreness in the hands and fingers. People with RA in their hands typically experience both soreness in the joints themselves and pain with different hand movements.

Rheumatoid arthritis pain may begin suddenly and can become quite intense within 24 to 48 hours of its initial onset. This same pain can also disappear just as quickly. Sometimes the pain affects the same joint with each RA flare-up, while other times it jumps from joint to joint in the hand.

Most frequently, the finger joints that connect to the hand (the metacarpophalangeal or MCP joints) and the lower finger joints (the proximal interphalangeal or PIP joints) are impacted.

Stiffness and Swelling

Along with pain in the hand, stiffness in the individual finger and hand joints is also quite common with RA. RA causes chronic inflammation in the cells that cover and lubricate your body’s joints (known as the synovial tissue). One byproduct of this inflammation is swelling in the area that it is occurring.

As the swelling and inflammation worsen, stiffness can result as the fluid takes up the space in the joints of the hand and fingers and limits their range of motion. This stiffness may be particularly noticeable in the morning when you wake up and after long periods of hand use.

The resultant movement limitations can also make activities like buttoning a shirt, holding a key, or tightly gripping an object quite challenging. Performing gentle hand movements (like repetitively opening and closing the fingers or making a fist) may help you loosen up your hands and prepare them for your daily tasks.

Cold or Discolored Fingers

People with RA are at a higher risk of developing another condition called Raynaud’s syndrome, which causes color and temperature changes in the fingers.

This issue occurs when the blood vessels in the fingers (which are already very small) narrow and decrease even further in size. As a result of this, less blood flow is able to get through to your hands and fingers. Typically the effects of the syndrome are more severe in people whose Raynauds is the result of another condition like RA.

Individuals with Raynaud’s become extremely sensitive to cold temperatures and may notice their fingers turning a white or blueish color as the blood flow diminishes. Numbness, tingling, or sensitivity in the hands may also accompany these changes. In severe cases, ulceration of the skin or even gangrene can develop if your Raynaud’s is not properly treated by a healthcare provider.

Numbness/Tingling

In some cases of RA, the inflammation and swelling that occurs in the hand can cause nerves in the area to become compressed. This compression can lead to numbness and tingling in the hands and fingers and cause the area to feel like it has “fallen asleep”.

One nerve that is commonly affected is the median nerve, which travels through the carpal tunnel in the base of the hand. This nerve provides sensation to the thumb-side or outer half of the palm of your hand. It also supplies feeling to the thumb, pointer, middle, and a portion of the ring fingers.

RA-caused inflammation can compress this nerve and cause numbness and tingling to develop in these areas. This type of neuropathy can also make holding or manipulating objects in your hand more challenging. 

Grinding

As your RA progresses and the lining of the joint (called the synovium) becomes inflamed, the cartilage and bones in the hand begin to break down and wear away. This erosion causes the boney surface to become irregular and impacts the movement of the hand and finger joints.

As a result, the joints in these areas no longer fit together smoothly, and moving your hands and fingers can become noisy and uncomfortable. This sensation of grinding or popping as you move your joints is called crepitus and is typically accompanied by pain. Because of how frequently you utilize your hands on a daily basis, this can cause significant disability and hinder your ability to perform everyday tasks like bathing, dressing, or preparing a meal.

Joint Deformity

The previously mentioned erosion of the cartilage and bone in the hand and finger joints can also cause physical deformities to occur in these areas. In some cases, splinting or bracing may even be necessary to correct these progressive boney changes. The most common types of deformities associated with RA are:

• Boutonniere deformity: The lower finger joint (PIP) flexes towards the palm side of the hand while the top finger joint (distal interphalangeal or DIP) extends away from the palm.
• Swan neck deformity: The MCP and DIP joints flex towards the palm while the PIP joint hyperextends.
• Hitchhiker’s thumb deformity: The lower thumb joint (MCP) flexes while the upper thumb joint hyperextends. This may also be referred to as a Z-shaped deformity.
• Ulnar deviation: As your RA progresses and the inflammation in the synovium becomes more chronic, the hand and finger joints can begin to deviate or shift away from the thumb side of the forearm. Known as ulnar deviation or ulnar drift, this deformity can have profound effects on your grip strength and finger movement.

Nodules and Cysts

In about a quarter of RA patients, doughy lumps or nodules begin to grow just underneath the skin in various places throughout the body. While these nodes are frequently seen on the back of the knuckles or fingers, they can also be found in the elbows, knees, forearms, or heels.

It is not completely understood why these nodules develop, however they are usually more of a visual annoyance than a true health concern. In rarer instances, however, the skin that covers the nodule can become infected or a nodule can develop in a sensitive area leading to pain.

The growths associated with RA should also not be confused with another variety, called a mucous cyst, which affects the DIP joint on the top of the fingers. This style of cyst typically occurs as a result of trauma or osteoarthritis, but can also occur spontaneously without a known cause.

While mucous cysts are generally harmless, they can cause the beds of your nails to appear indented or ridged and may even cause them to fall off. Occasionally, this type of cyst may need to be drained or removed by a dermatologist if it causes issues.

Weakness

Another frequently seen complaint with RA is hand or finger weakness. This impactful symptom can occur for a variety of reasons. Persistent finger or hand swelling can reduce motion in your joints and limit the effectiveness of the muscles in the area.

Furthermore, the joint deformities described above can also permanently move or displace your muscle tendons. This alteration significantly affects the ability of the finger and hand muscles to contract normally, leading to finger and grip weakness.

In addition, chronic inflammation in the synovium of the hand joints can ultimately affect the muscles themselves and lead to tendon rupture. In people with RA, this is especially common in the extensor tendons of the hand and can cause you to have difficulty opening your hands or straightening out your fingers.

Bone Spurs

As mentioned earlier, RA and the associated inflammation in the body’s synovial tissue can lead to nodules and nodes developing on the backside of the hand near the finger joints. These fluid-filled sacs are different from bone spurs, which are primarily seen in osteoarthritis.

In osteoarthritis (OA), the cushioning cartilage at the end of a bone begins to thin and break down, leading to an irregular surface. As this arthritic joint repetitively moves, new bone (also known as a bone spur) develops in the joint and further limits normal movement. Unlike the nodules associated with RA, bone spurs are typically hard and non-pliable.

Complications

Unfortunately, because RA is a disease that affects you systemically (instead of locally like osteoarthritis), its effects are not limited to the hand. On the contrary, this debilitating condition can have wide-reaching complications throughout the body.

One potential issue caused by RA is pleurisy, which occurs when the tissue separating the lungs from the chest wall becomes inflamed. The condition may be accompanied by swelling in the lungs and can reduce your lung capacity. The chronic inflammation associated with the disease can also lead to increased atherosclerosis, the buildup of blood flow-reducing plaque in the body’s arteries. In fact, this complication is the leading cause of death in people with RA.

In addition, RA and its associated inflammation can also impact other areas. In the eyes, it can cause excessive dryness or redness in the corneas. It can also impact the function of your nerves in your lower legs and result in peripheral neuropathy, a painful condition that causes burning, numbness, and tingling in the feet.

Finally, about 10 to 15% of people with RA can develop an autoimmune issue called Sjogren’s syndrome. This condition affects the body’s exocrine gland and can lead to decreased tear production, lower amounts of saliva and dry mouth, and reduced vaginal secretions.

When to See a Healthcare Provider               

If you suspect you may have RA or if you have any of the symptoms listed above, it is important to speak to your healthcare provider. As mentioned previously, RA can lead to significant issues in the lungs, eyes, nerves, and blood vessels. In fact, it may even lead to death overtime if left untreated.

Fortunately, RA can be effectively treated with the proper medication in a large percentage of individuals. Because of this, it is crucial to be evaluated by a qualified practitioner who is skilled in treating the disease.

A Word From Verywell

While coping with RA and the associated effects that it can have on your body may seem scary, don’t give up hope. Working with a rheumatologist can help you mitigate the many symptoms caused by the disease and reduce the impact that the condition has on your life. In fact, recent advances in medication have improved the chances of continuing your daily activities in spite of your RA. In addition, new treatments have also increased your odds of living a normal lifespan in spite of this issue.