Rheumatoid Arthritis
What is it?
Rheumatoid arthritis (RA) is is one of a family of autoimmune diseases, such as Psoriatic arthritis, Scleroderma and Lupas. Having an autoimmune disease means your own immune system is faulty and starts attacking healthy parts of your body that have thin membranes instead of helping them fight off bacterial and other types of infection. 
This leads to inflammation in the areas targeted such as  joints and internal systems like the cardiovascular system. Other flue like symptoms including muscle weakness, loss of appetite, aches and pains and increased fatigue levels are very common and can have  a high impact on your quality of life. 

Although the hands and fingers may be the first joints affected, the whole body needs to be treated to calm the immune system back to normal levels. There are many types of medicines available to treat autoimmune diseases and it is best to discuss this topic with a Clinical Nurse Specialist or your Consultant.
What is happening to my joints?
Like many joints in the body, the joints in the hand are synovial joints. These joints are flexible and surrounded by a thin, pliable membrane called synovium. The synovium produces synovial fluid, a thin, clear, viscous substance that normally nourishes and lubricates the joint, enabling movement.

In people who have rheumatoid arthritis, however, the joints of the hand can become inflamed when the body’s immune system malfunctions and attacks healthy tissue in the fingers and wrists.

The immune system sends white blood cells, called leukocytes, to invade one or more hand joints. These cells trigger inflammation in the hand joints’ synovium. When synovium is inflamed it is called synovitis.

The inflamed synovial tissue may continue to react to the white blood cell invasion by adding layers of new synovial cells at a very rapid pace. This new, abnormal tissue is called pannus.

The rheumatoid pannus tissue squeezes into the joint space between bones and releases proteins that degrade the hand joints’ articular cartilage and bone further. Is is common to have osteoarthritis affecting the thumb and fingers at the same time as RA in elder groups.

Rheumatoid Arthritis
How is it diagnosed?
There is no single test that detects RA.  Diagnosis is almost always made or confirmed by a Consultant rheumatologist who is trained to identify synovitis, the swelling of joints. This can be very difficult for the untrained eye to see. 
Some people describe pain but have no sign of swollen joints so the Rheumatologist will take other information into account:

What symptoms have you been having? (e.g. joint pain, stiffness and swelling). It is important to tell the Consultant everything as some minor signs can help identify what kind of autoimmune disease you may have. For example, a rash or dry skin, a broken nail that doesn't grow, stiffness that is worse in the morning or difficulty going to the toilet.
Blood tests may show signs of inflammation (a raised ESR or CRP). One sign is something called rheumatoid factor in the blood (Rheum factor), but it isn’t conclusive.  About 30% of people with RA don’t have rheumatoid factor, and people with some other conditions can have rheumatoid factor too. Another blood test, for something called anti-CCP antibody, is more specific for RA.  But blood tests don’t tell the whole story.

X-rays may show signs of joint damage already which means you have had inflammation for a very long time. Sometimes an ultrasound or Magnetic Resonance Imaging (MRI) scans, are needed to help with the diagnosis as these can detect inflammation and damage more accurately and earlier than x-rays.

You can’t directly inherit RA, but if it’s in your family you may be more susceptible to getting it when an environmental trigger occurs.  A trigger could be a traumatic life event like a death, moving house, changing job or having an unrelated illness. These very emotional and stressful experiences can upset the immune system  
Rheumatoid Arthritis
If RA is not treated or is inadequately treated, it can cause irreversible damage to joints and lead to disability – and this used to happen often.  But today, the management of RA is very good, far better than it was even 15 years ago.  Although there is no cure, most people diagnosed today can expect to lead pretty full and active lives once the disease is under control.

The main complication is finding the right medication and treatment method that works for you. It can be very frustrating when you think you have it figured out and then you have a flare-up. 

Flare-ups typically result in synovits and swelling in the joints. If not treated, swelling can cause irreversible damage to muscles, ligaments and tendons surrounding the joint and eventually change the way they are able to move, even when the swelling has reduced.  

Joints need to treated with care during a flare as well as in between flares to prevent accidentally stretching or tearing ligaments and cartilage. That is why it is important to learn joint protection techniques and ways to manage joint fatigue. Cold hands are also a common problem alongside RA and it will need treated as well.
Rheumatoid Arthritis
Treatment at Hand Kinetics
At Hand Kinetics we treat you as a whole person. Hand joints that are very stiff need special treatment because you rely on them for all aspects of daily living. That is why we look at your individual circumstances and agree a treatment target to aim towards with you. This is called "Treat the Target".

As part of your treatment we can teach you how best to protect your joints and show you the best exercises to keep them moving.

We can make you a very comfortable hand resting splint that will keep your joints safe from deforming positions. Evidence shows that splinting and staying active and exercising regularly are super beneficial. 
Some people are afraid to exercise during a flare but this can lead to additional muscle wasting and loss of movement. 
At Hand Kinetics we can show you exactly what to do and when to do it so you don't need to worry about doing too much or too little. We will get it just right.

Hand Kinetics Telephone: 0044 28 417 72301

15 The Avenue, Burren, Warrenpoint. Co. Down. BT34 3XJ

0044 28 4176 7238
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