Rheumatoid arthritis (RA) is an autoimmune condition that results in swelling and pain in joints throughout the body. One of the first signs of RA that patients start noticing is swelling in the hands and wrists. Both hands are affected nearly symmetrically, but usually one hand is worse than the other. The index finger MCP and DRUJ are generally the first joints affected. Early diagnosis and management is key to maintaining joint range of motion and prevent irreversible deformity.
Flare-up management
Goal: minimize the time that your joints spend in the flare up state.
- Apply compression to affected joints: using Coban wrap, silicone finger sleeves, and/or compression gloves. If the swelling is significant, apply compression day and night. If it’s milder, then apply at night time and as needed during the day.
- Ice: 2-3x/day or more often as needed
- Rest joints in neutral alignment: with custom fabricated splints or pre-fabricated orthoses recommended by your hand therapist
- Avoid heat during severe flare-ups
- Avoid aggressive range of motion or gripping/lifting activities
Routine management – not during flare-up state
Goal: maintain/improve range of motion; prevent joint deformity
- Apply heat in the morning to relieve stiffness and ice in the evening to reduce any swelling/pain
- Perform gentle passive range of motion exercises after heat to improve/maintain range of motion – make sure there is no pain with any exercises
- Practice good ergonomics and joint conservation techniques to prevent joint deformity
- Day time – use soft pre-fabricated braces to help support joints in neutral alignment.
- Night time – use custom fabricated orthoses to rest joints in neutral alignment
Joint conservation
Goal: use tools instead of using your hands as tools
- Jar openers – automatic options available
- Non-slip grip material – Dycem(TM)
- Wide grip handles on utensils and tools
- Foam support tubing