Hands and wrists

Hands are characteristically affected in RA.

♦ The metacarpophalangeal, proximal interphalangeal, thumb interphalangeal and wrist joints are typically involved. Distal interphalangeal joints is much less common and only occurs if there is co-existing disease in other hand joints.

♦ Tenosynovitis of flexor tendons can reduce finger flexion and strength.

♦ Tenosynovitis of extensor tendons can lead to swelling of the dorsum of the hand and wrist

♦ Nodular thickenings in flexor tendon sheaths can lead to 'trigger finger'.

Figures 1.3 and 1.4 show examples of RA involving the hands and wrists.

Damage to the wrists causes compaction of bone at the small wrist joints.

In late disease this damage may progress to bony ankylosis and the distinctive deformities of RA develop.

Hand deformity in RA typically comprises:

♦ ulnar deviation of the fingers;

♦ subluxation of the metacarpophalangeal joints;

♦ hyperextension of the proximal interphalangeal with flexion of the distal joints (swan-neck deformity);

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