Arthritis In Hands, Starring - My Own Hands
Hands down - the best compliment I've ever received from a doctor
A few weeks ago, I visited one of the world's top hand surgeons (faculty in Mount Sinai) after randomly meeting him at the Arthritis Foundation's annual gala in NY. Well, as a hand surgeon, he could not ignore my hands, or rather, the damage my RA (Rheumatoid Arthritis) has left in my hands and invited me to come to his practice to see if any corrective action can be taken.
We took an x-ray, and I thought it would be a good opportunity to clinically visualize and share what can be the outcome of RA over one's hands if the disease is not controlled properly.
I'll share the surgeon's compliment soon, but first let's discuss my hands.
So (drumroll), without further ado, please accept my hands!
As discussed previously, RA (Rheumatoid arthritis) is a chronic inflammatory disorder that affects the joints. It typically causes pain, stiffness, and swelling in the wrists, knuckles, elbows, and other parts of the body. RA can lead to irreversible joint damage if not treated correctly or on time.
I also discussed in previous blog posts how the joints of the hands and fingers are most often the first joints to be affected by RA (Rheumatoid Arthritis), and usually, the condition will advance symmetrically across both hands.
Happens to be that with 27 small joints, 27 bones, and many muscles, tendons, and ligaments the hands are also among the most complex joint structures in our body. Therefore, small joint replacement is not as effective as larger joint replacements, like a hip replacement or shoulder replacement.
With so many bones and joints, the hands are a feast for Rheumatoid Arthritis and there are a lot of specific clinical conditions that are typical to arthritis hands, and my hands are no strangers to those.
Rheumatoid arthritis damage
In general, when a person has rheumatoid arthritis, the lining (called synovium) that covers their joints is overwhelmed by inflammation. This causes an excess of joint fluid and results in synovitis. The increased fluid combined with inflammatory chemicals released by the immune system creates swelling, damaged cartilage, and softens bones within the joint.
To add to the difficulty, this swelling may stretch surrounding ligaments which leads to deformity and instability. Additionally, inflammation can weaken and damage tendons that connect muscle to bone.
Now let's dive into the specific conditions that are typical to arthritic hands
For reference, first, an x-ray of healthy hands (below).
And here are my hands in tandem (below)
See how my hands (on the left) are drifting toward the sides of the pinkies (circled in red)? Also known as Uinar Drift, this deformation is classic and unique to RA. This is the result of when the large knuckle bones become very damaged and swollen and end up being pushed and bent abnormally sideways toward the pinky side.
Also known as buttonhole deformity, this happens when the middle joint of a finger gets bent in toward the palm and the finger joint at the top is bent out away from the palm (circled in yellow).
This one is by far the most painful one and, for me, it was a process that spanned over a few very painful years. Medically, the formal name of trigger finger is stenosing tenosynovitis. It is a result of tenosynovitis, which is when the protective lining around the tendon becomes inflamed and the name trigger finger describes what's to follow: inflammation gets in the way of the normal smooth gliding motion of the tendon within the protective lining and the related finger will eventually get stuck in a bent or straight position.
This movement becomes unsmooth and the finger "jumps" in the middle, it's a bit hard to explain but the pain is just excruciating. RA poses a big risk to experience trigger fingers and the fingers eventually may become locked in a bent position.
Personally, I haven't had those in years but in general, this is a condition that is not unique only to the finger joints, but it's very common in those joints as well.
These nodules are hard lumps that form under the skin around pressure points and can appear on wrists and fingers. These are usually not painful, but create great discomfort.
Other finger joints' RA conditions
There are a few more conditions that may occur in relation to RA, but thankfully, those spared me. Among those are:
- Carpal tunnel syndrome - RA can make this condition more severe since the inflammation and swelling in the wrist, can compress the median nerve which may lead to the condition
- Swan’s neck deformity - this is similar to the Boutonniere deformity mentioned above, however, in this case, the middle finger joint bends back excessively (hyperextends), and the top joint bends down. The shape is like a swan's neck.
- Hitchhiker’s thumb - happens when the large knuckle of the thumb bends excessively and the top joint bends back more than normally. This creates a 'Z' shape.
There are definitely a handful of symptoms relating to RA in the finger joints. :)
In general, you can clearly see (in the photo above) that my joints (on the left) are not as "clean" as those with the healthy hand (on the right). All those gaps between the bones (black cracks) are healthy joints that have full movement.
With RA, joints, especially when not being used and moved, can eventually "disappear" and movement range is lost. Sounds scary, and this is exactly why it's extremely important to get the condition under control and quickly, as I explained in a former blog post about the importance of getting early treatment with RA.
Trust me - I've seen some severe RA cases in my life of people who lost so much movement in their joints that they seem to almost be frozen straight, like a rock.
How is RA joint damage and associated pain treated? Best practices
Take your medications
First and foremost, take your medications and stick to the regimen your doctor instructed. This, of course, is a lot about the prevention of future irreversible damage. I've seen many RA patients who decide to be creative with not taking their medications, or not taking as instructed, and this can not only result in pain but worse, irreversible deformations and loss of movement range in joints. It's far easier to take a pill than to undergo joint replacements surgery.
Even if painful, keep moving. This is a must since RA will "eat" those unused joints with a great appetite. If you don't have an active lifestyle, go to a professional physiotherapist or some occupational therapist.
If you are sitting all day in front of the computer, take a break once in a while to shake those joints. You don't want to turn into a fossil, right?
As a last resort, you can go for surgery, and usually, doctors will recommend it if there's unrelenting pain or severe loss in movement range that interfere with normal life.
The goal of surgery and the severity of the case will define the actual procedure.
Surgery can prevent or eliminate pain, correct structural deformities, improve function, or all of those.
Types of surgery may involve opening the joint and cleaning the inflamed joint lining, tendon repair, or a complete joint replacement. In severe cases, where there's no joint left and joint replacement is not an option, doctors will resort to what's known as bone fusion. You heard it. This basically means completely removing the joint and affixing two bones together. I guess that sometimes it's better than pain.
So, what about me and what's that compliment I got from the hand surgeon?
Well, the doctor looked at my x-rays and then looked at me and basically said that there was no correlation between the clinical findings and my level of hands functionality.
Clinically, he said, my x-rays show severe and extensive joint damage that would be indicative of someone with acute pain and very limited hand functionality, while in reality, this is not the case.
Thankfully, I've been pain-free for quite a few years now, and my hand functionality is not affected in any way by those clinical changes. I mean, visually, you can see the damage, but this is where it ends. Well, not completely true, since I cannot fully straighten out some fingers in my right hand, I can't do high-fives and give the middle finger. I'll live with that.
And as for surgery, it's not even an option for me, or as they say: if it's not broken, don't fix it.
How CBD helped with my RA
And as always, I will end by recommending giving my 2800mg Broad Spectrum CBD-rich hemp oil a chance to help you. It's formulated specifically to help with countering inflammation and pain and systemically works to support a healthy immune system. I keep on getting emails from customers who attest that my CBD products are real life changers.
And if you want to get inspired, you can always read my story of how I went off steroids after 23 years straight and alleviated my arthritis.
And also, remember to be patient. Cannabinoids like CBD take time to work and interact with our bodies, especially with systemic conditions. Give it some time to give it a real chance to help you.