I've been told by my rheumatologist that my hand deformities from rheumatoid arthritis aren't affecting function so it's best to "leave well enough alone." But to be honest, the appearance of my hands matters to me. I'd like to do something about the drifting of my fingers. Would a splint or brace of some kind work?
You are not alone in your concern about how your hands look. Many patients (men and women) with rheumatoid arthritis make this same comment. You may think there's nothing you can do about this but experts in this field are taking a second look and offering some suggestions. Understanding the underlying cause of the developing hand deformities helps guide treatment decisions. Inflammation of the fluid inside the joint (a condition called synovitis) weakens the ligaments and other soft tissue support structures of the wrist. Without the support from these connective tissues, the bones of the wrist collapse. Dislocation of the wrist is the next step. Synovitis associated with rheumatoid arthritis often causes a shift of the fingers off to the side called ulnar deviation or ulnar drift. Conservative care with splinting, range-of-motion, and activity modification are important aspects of management of this disease. Surgery can be done early to realign the bones and reduce pain (when present). Correcting alignment and minimizing deformities may help improve motion and function. Surgery doesn't have to wait until the damage is done. The surgeon can take action once evidence is seen that the wrist bones are migrating (shifting). Partial fusion of the wrist may prevent shifting of the bones, thus reducing the risk of hand and finger deformities. Total fusion may be needed to decrease pain and stabilize the wrist. Fusion of the metacarpophalangeal (MCP) joints (the large knuckles across the back of your hand) doesn't work -- the loss of motion would only make daily functions even more difficult. Some surgeons are trying to remove the affected synovium (called a synovectomy) and transfer ligaments to hold the joints in place. The transfer procedure is called a cross-intrinsic transfer. It can be done if damage to the joints caused by the synovitis is not too great. It is possible to replace the MCP joints. This joint replacement surgery is recommended when the joints sublux (partially dislocate) or completely dislocate. When enough joint damage has been done that the joints can't recover or it's too late for reconstructive surgery, then joint replacement may be the next step. There are many ways to deal with drifting finger deformities associated with rheumatoid arthritis. But it takes a team of health care professionals including hand therapists, hand surgeons, and rheumatologists to find the best approach for each individual patient. You may want to seek the advice of others in these disciplines for further advice and counsel.