Rheumatoid arthritis (RA) is a chronic autoimmune condition that primarily affects the joints, leading to inflammation, pain, stiffness, and, over time, structural damage. The small joints of the hands and wrists are commonly affected, and the impact can be significant, limiting daily activities such as cooking, writing, dressing, and personal care.

At London Bridge Orthopaedics, we provide specialist assessment and personalised treatment, including both medical and surgical options. Our goal is to relieve pain, preserve hand function, and improve quality of life.

What happens in RA of the hand?

RA occurs when the body’s immune system mistakenly attacks the synovium, the lining of the joints, leading to inflammation.

In the hands, this inflammation can:

• Cause pain, swelling, and warmth around the joints
• Lead to thickening of tendons and ligament damage
• Result in deformities such as ulnar deviation, swan-neck, and boutonnière deformities
• Reduce grip strength and fine motor control

If left untreated, the disease can cause progressive joint destruction, permanent deformity, and functional limitation.

Who is affected?

RA can affect adults of any age but typically develops between 30 and 60 years. Women are three times more likely to be affected than men. Factors that increase the likelihood of hand involvement include:

• Family history of autoimmune disease
• Smoking, which can exacerbate disease severity
• Existing inflammatory conditions
• Delayed initiation of disease-modifying treatments

Hands are often the first area affected, and symptoms are usually symmetrical, involving the same joints on both hands.

Symptoms

Symptoms may develop gradually over weeks or months and often include:

• Persistent pain in finger or wrist joints
• Swelling and warmth over affected joints
• Morning stiffness lasting over an hour
• Numbness or tingling if tendons or nerves are compressed
• Weakness and difficulty gripping objects
• Visible deformities as the disease progresses

Many patients report difficulty performing routine tasks, leading to frustration and reduced independence.

Assessment and diagnosis

Diagnosis is made through a combination of:

• Clinical evaluation – checking for swelling, tenderness, deformities, and range of motion
• Blood tests – including rheumatoid factor (RF), anti-CCP antibodies, and markers of inflammation such as ESR and CRP
• Imaging – X-rays, ultrasound, or MRI to assess joint damage and tendon involvement

Accurate assessment is critical to tailor treatment plans and determine whether surgical intervention may be appropriate.

Aggravating factors

Symptom severity may increase with:

• Repetitive hand use
• Inflammatory flares
• Cold or damp weather in some patients
• Delay in initiating or adjusting disease-modifying therapy

Understanding aggravating factors helps guide activity modification, splinting, and timing of surgical intervention.

Conservative and medical management

Most patients initially manage RA with non-surgical strategies:

• Disease-modifying anti-rheumatic drugs (DMARDs) – e.g., methotrexate, leflunomide
• Biologic therapies – for patients with inadequate response to DMARDs
• Analgesics and anti-inflammatory medication – for symptomatic relief
• Hand therapy – including splints, exercises, and joint protection techniques

Conservative management aims to reduce inflammation, slow disease progression, and maintain hand function.

In early RA, these measures are often sufficient to prevent severe deformity. However, surgery may be required when pain persists, deformities progress, or tendons are damaged.

Surgical treatment

Surgery is considered when pain, functional limitation, or deformity persists despite optimal medical management.

Unlike medical therapy, surgery addresses structural damage, restores alignment, and improves hand function.

Common surgical procedures

• Synovectomy – removal of inflamed synovial tissue to reduce pain and prevent further tendon damage
• Tendon repair or reconstruction – for ruptured or weakened tendons, restoring grip and finger movement
• Joint fusion (arthrodesis) – used in severely damaged or unstable joints, providing pain relief and stability at the cost of some movement
• Joint replacement (arthroplasty) – most often performed in the knuckles (metacarpophalangeal joints) to restore alignment, preserve movement, and relieve pain

What surgery involves

Surgery is usually elective, performed under regional or general anaesthetic, and often as a day-case or short-stay procedure depending on complexity. Post-operative care typically involves:

• Immobilisation – splints or bandaging to protect repairs
• Hand therapy – exercises to restore strength, movement, and function
• Gradual return to daily activities – depending on the procedure, normal hand use may resume over weeks to months

Recovery times vary: synovectomy and tendon procedures may allow gradual use within 2 – 4 weeks, while joint replacements or multiple procedures may require longer rehabilitation.

Surgical Outcomes and prognosis

Evidence from NICE guidance shows that surgical intervention in RA:

• Significantly reduces pain
• Improves alignment and grip strength
• Restores function and independence
• Has high patient satisfaction when timed appropriately

Surgery does not cure RA or prevent future flare-ups, but it allows patients to maintain independence and quality of life even with ongoing disease activity.

When to seek specialist advice

A hand specialist should be consulted if:

• Persistent pain or swelling is affecting daily life
• There is visible deformity in fingers or wrists
• Grip strength or fine motor skills are declining
• Symptoms persist despite optimized medical therapy
• Tendon rupture or nerve involvement is suspected

Early referral allows careful planning of surgical or non-surgical interventions to maximise hand function and quality of life.

FAQs – Rheumatoid Arthritis of the Hand

Can surgery cure rheumatoid arthritis in the hand?

No. Surgery does not cure RA, but it addresses structural damage, reduces pain, and improves function.

When is surgery considered?

Surgery is recommended when pain, deformity, or functional limitation persists despite optimal medical management.

What are the risks of hand surgery?

Complications are uncommon but can include infection, stiffness, nerve injury, or delayed healing. These are minimised under specialist care.

How long is recovery after RA hand surgery?

Recovery depends on the procedure; simple tendon repairs may take a few weeks, while joint replacements or multiple procedures may require several months.

Will surgery improve hand appearance?

Yes. Corrective procedures can restore alignment, reduce visible deformity, and improve overall function.

Can I maintain function after surgery?

With appropriate hand therapy and ongoing RA management, most patients achieve significant improvements in grip, dexterity, and daily function.