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Rheumatoid Arthritis

At the Hand Center of Louisiana, we often treat patients with rheumatoid arthritis (RA). One of the most common conditions treated at our New Orleans, LA facility, it can lead to hand and wrist problems that can diminish your quality of life and make it difficult to perform daily tasks. Understanding this injury, including its causes, symptoms, and resulting treatments, can help you decide if you need to see a rheumatologist for evaluation.

What is Arthritis?

Arthritis means an inflamed joint. A joint normally consists of two cartilage-covered bone surfaces that glide smoothly against one another. When joints become inflamed, the joint swells and does not move smoothly. Over time, the gliding surface wears out. There are many types of arthritis. Rheumatoid arthritis is just one type. Wear and tear arthritis (osteoarthritis), gouty arthritis, and psoriatic arthritis are three other common types. Rheumatoid Arthritis is considered a systemic disease. That is, it can affect many parts of the body. Patients often awaken with stiff and swollen joints. Early on, many patients feel tired. Two-thirds of patients with rheumatoid arthritis have wrist and hand problems.

Rheumatoid Arthritis of the Hand

Rheumatoid arthritis affects the cells that lubricate and line joints. This tissue – synovium- becomes inflamed and swollen. The swollen tissues stretch supporting structures of the joints such as ligaments and tendons. As the support structures stretch out, the joints become deformed and unstable. The joint cartilage and bone erode. Often the joints feel hot and look red. Rheumatoid arthritis of the hand is most common in the wrist and knuckles. The disease is symmetric, thus what occurs in one hand usually occurs in the other.

Signs and Symptoms of Rheumatoid Arthritis of the Hand

While stiffness, swelling, and pain are symptoms common to all forms of arthritis, there are some symptoms that are classic features of rheumatoid arthritis. They are:

  • Firm nodules along fingers or the elbow
  • Soft lump on the back of the hand that moves as the fingers straighten
  • Angulation or collapse of fingers
  • Sudden inability to straighten or bend a finger because of a tendon rupture
  • Deformity in which the middle finger joint becomes bent (Boutonniere deformity)
  • Deformity where the end of the finger is bent and the middle joint over extends (Swan-neck deformity)
  • Prominent bones in the wrist

In addition, patients with rheumatoid arthritis often have problems with numbness and tingling in their hand (carpal tunnel syndrome) because the swelling of the tendons causes pressure on the adjacent nerve. They may make a squeaky sound as they move joints (crepitus) and sometimes the joints snap or lock because of the swelling.

How Arthritis is Diagnosed

The diagnosis of rheumatoid arthritis is made based on clinical examination, X-rays, and lab tests. Your doctor will ask questions about your symptoms and how the disease has affected your activities. Rheumatoid arthritis may have a hereditary component, thus your physician will ask whether other family members have had rheumatoid arthritis or symptoms similar to yours. Your doctor will do a detailed examination of your hands. The clinical appearance helps to diagnose the specific type of arthritis. X-rays are often helpful; certain findings are characteristic for rheumatoid arthritis. These findings include swelling of non-bony structures, joint space narrowing, decreased bone density, and erosions near joints. There are several blood tests that are often ordered to confirm the clinical diagnosis. These are the rheumatoid factor, sedimentation rate and sometimes the anti-CCP (cyclic citrullinated peptide). MRI—a special imaging study—has also been used to help confirm the diagnosis.

When to See a Rheumatologist

You should see a rheumatologist in one or more of the following cases:

  • You have already been diagnosed with arthritis or rheumatic disease
  • You experience joint pain and/or swelling, which may be the first symptoms of RA
  • Blood tests for rheumatic disease return abnormal results. Depending on your signs and symptoms, your primary care physician may order certain blood tests to screen for rheumatic disease, including antinuclear antibodies (ANA), rheumatoid factor (RF), and erythrocyte sedimentation rate (ESR). Testing positive for any of these tests may warrant seeing a rheumatologist.
  • The cause of your signs and symptoms remain unclear. Rheumatologists treat rare diseases that may present difficulties in diagnosing.

If you any of the previous cases describe your health status, consider speaking with your primary care physician about seeing a rheumatologist. Early diagnosis and treatment of RA are one of best ways to optimize health outcomes.

Nonsurgical Treatment of Rheumatoid Arthritis

Treatment for rheumatoid arthritis aims to decrease inflammation, relieve pain and maintain function. While there is no cure for rheumatoid arthritis, medications are available that slow the progression of the disease. Optimal care involves a team approach among the patient, physicians, and therapists. The care of the rheumatoid patient requires not only a hand surgeon but also a hand therapist, rheumatologist, and the patient’s primary care physician. The rheumatologist is often the physician that monitors and decides the specific type of medicine that is felt to be the most effective for the patient’s stage in the disease process.

The hand therapist will provide instruction on how to use your hands in ways that help relieve pain and protect joints. Therapists also can provide exercises, splints, and adaptive devices to help you cope with activities of daily living.

Rheumatoid Arthritis Surgery

Rheumatoid arthritis can be a progressive disease. Surgical interventions need to be appropriately timed in order to maximize function and minimize deformity. In certain cases, preventive surgery may be recommended. Preventative surgery may include removing nodules, decreasing pressure on joints and tendons by removing inflamed tissue, or removing bone spurs that may rub on tendons or ligaments. If a tendon ruptures, a hand surgeon may be able to repair the tendon with a tendon transfer or graft.

There are several types of procedures to treat joints affected by rheumatoid arthritis, including removal of inflamed joint lining, joint replacements, and joint fusions. The specific procedure(s) chosen depends on many factors. These factors include the particular joints involved, the degree of damage present, and the condition of surrounding joints. The appropriate surgical procedure may include one of the following:

Synovectomy

A surgical procedure that removes inflamed joint tissue (synovium) that causes pain or limits range of motion. The procedure may be performed using arthroscopy.

Arthroplasty

A surgical procedure that reconstructs or replaces a disease joint to restore function to a joint or fix a deformity in patients with RA. In this procedure, bones in the joint may be reshaded or replaced with artificial materials (metal, plastic parts, or ceramic). Total joint replacement can be performed through an open or minimally invasive approach.

Arthrodesis

A surgical procedure that removes a damaged joint and fuses the neighboring bones together. This procedure is indicated in cases when patients have limited mobility, severe joint damage, or damage to ligaments and/or tendons surrounding the joint.

One of the most important factors in deciding the most appropriate surgical procedure is the needs of the patient. There are often many ways to treat hand deformities in rheumatoid arthritis. Your hand surgeon can help you decide on the most appropriate treatment for you.

What is a Rheumatologist?

A rheumatologist is an internist (internal medicine physician) or pediatrician with specialized training and certification in the diagnosis and treatment of rheumatic illnesses, arthritis, and other complex conditions. Rheumatologists may work closely with other medical specialists, including orthopaedic surgeons and physical therapists.

Our Rheumatologist

John F. Nitsche, M.D., RMSK, RhMUS is a Rheumatologist, Immunologist, and registered Musculoskeletal Ultrasonographer at Hand Center of Louisiana.

  • Graduated from Hahnemann Medical College – Philadelphia, PA
  • Completed an Internal Medicine residency at Tulane Affiliated Hospitals – New Orleans, LA
  • Completed an NIH-sponsored Rheumatology Fellowship at Scripps Clinic – La Jolla, CA
  • Completed an Allergy and Immunology Fellowship at Rush Medical Center – Chicago, IL
  • Diplomat of the American Board of Internal Medicine and the Rheumatology Subspecialty
  • Diplomat of the American Board of Allergy and Immunology
  • Member of the American College of Rheumatology
  • Registered Musculoskeletal Sonographer

Additionally, Dr. Nitsche’s practice is currently the only accredited facility in Louisiana by the American Institute of Ultrasound Medicine (AIUM) in Dedicated Musculoskeletal Ultrasound. Dr. Nitsche passed the registry examination in Musculoskeletal Sonography administered by the American Registry for Diagnostic Medical Sonography (ARDMS), and is credentialed with RMSK (Registry Musculoskeletal Ultrasound) designation. He remains the only Rheumatologist in Louisiana who has received The American College of Rheumatology Musculoskeletal Ultrasound Certification in Rheumatology (RhMUS).

Why Choose the Hand Center of Louisiana?

The Hand Center of Louisiana continues a four-decade legacy of providing exceptional hand and upper extremity care for patients across the Gulf South. Our integrated healthcare facility includes our Rheumatology and Neurological Testing Center, which specializes in the evaluation and treatment of complex conditions in the broad field of Rheumatology.

Contact us today to schedule your appointment with Dr. Nitsche, who can evaluate your condition to determine the best course of treatment. After using the appointment for below, our friendly staff will help book your initial consultation.

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