Rheumatoid Arthritis Health Center

Hand and Finger Rheumatoid Arthritis

What is a boutonniere deformity?

Boutonniere deformity, also called buttonhole deformity, can occur as a result of rheumatoid arthritis.

With a boutonniere deformity, the middle finger joint will bend toward the palm while the outer finger joint may bend opposite the palm. This deformity may be the result of chronic inflammation of the finger's middle joint.

Treatment for boutonniere deformity may include splinting to keep the middle joint extended. Surgery may be needed.

What's the treatment for hand and finger RA?

Treatment for rheumatoid arthritis is a multifaceted regimen that includes:

• Medications.
• Rest and exercise.
• Splints and special arthritis aids that help take pressure off painful joints.
• Self-managing stress.
• Dietary changes, such as eliminating foods that may trigger inflammation and including foods that may help decrease inflammation, such as omega-3 fatty acids found in cold-water fish, vitamin D, and flax oil.
• Regular medical checkups.
• Physical therapy
•  Surgery to help restore function.

Which medications are used to treat hand and finger RA?

Medications commonly prescribed for RA include:

Disease-modifying anti-rheumatic drugs (DMARDs). These drugs are used with NSAIDs and /or corticosteroids in low doses. DMARDs include:

• methotrexate (Rheumatrex, Folex)
• leflunomide (Arava)
• hydroxychloroquine (Plaquenil)
• sulfasalazine (Azulfidine)
• gold (Myochrisine injected into muscles; Auranofin -- given orally)
• minocycline (Minocin, Vectrin, Dynacin)
• azathioprine (Imuran)
• cyclosporine (Neoral, Sandimmune)

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may be over-the-counter or prescription strength.

Biologic response modifiers (also in the category of DMARDs); these are usually used with methotrexate. Biologic agents include:

• adalimumab (Humira)
• anakinra (Kineret)
• etanercept (Enbrel)
• infliximab (Remicade)
• abatacept (Orencia)
• rituximab (Rituxan)
• tocilizumab (Actemra)
• tofacitinib (Xeljanz)

What are some tips to relieve hand and finger joint pain?

Regular exercise is extremely important to increase flexibility in the hands and fingers. It's also important to rest the painful joints. Hand or finger splints may help ease pressure during painful flares. In addition, arthritis aids and devices can help make daily living skills easier so you can avoid pain and injury. Here are some easy tips:

• To exercise your hands and fingers, you can use a soft foam ball like a Nerf ball (not a hard tennis ball). This helps to increase dexterity and reduce stiffness.
• Activities such as knitting or playing the piano can keep your fingers nimble and reduce pain associated with finger arthritis or hand arthritis.
• To protect your hands from injury, use as many joints as possible to share the load in any activity you do. Avoid favoring a particular finger or position with the hands.
• Seek help from an occupational therapist with arthritis aids and devices. These are available at most medical supply stores, pharmacies, and on the Internet.
• Use hook and loop fasteners to replace buttons on clothing.
• Add accessories to doorknobs for easier turning.
• Use rotary lamp switches that require just a touch to the lamp base rather than twisting a small knob switch.
• Try a long-handled shoehorn to put on your shoes without bending over and stretching your hands.
• Use lightweight household utensils, pots, and pans.
• Use lightweight plastic cups and dishes instead of heavy china.
• Try foam padding around your pen or pencil; these are available at most office supply stores.