In short, rheumatoid arthritis is an inflammatory disease which attacks joints in the body.  It can affect the alignment and positioning of those joints, even to the extent that they become stuck in a bent position or become dislocated.  Bone erosion caused by RA may make the ends of bones rough and irregular.  Patients may eventually notice that their fingers begin to shift toward the direction of their elbow.

In previous posts, we have discussed different types of surgery used in patients living with rheumatoid arthritis, including synovectomy, tendon repair, and carpal tunnel release.  Today’s discussion centers around joint replacement and implants.

What is Joint Replacement?

One would think that this is a simple question, right?  Take the joint out and put a fake or replacement one in.  But in researching this subject, I found it rather difficult to find information which went much beyond this simple concept without become extraordinarily technical.

Wonderful information aimed at the consumer exists regarding hip and knee replacements, but for surgery involving in the hands?   Not so much.  So I have decided not to discuss hip or knee replacements.  However, you may enjoy reviewing the following posts and articles which touch on the subject:

• Dr. Mark Borigini - Joint Replacement Surgery: Right for you?
• National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) - Joint Replacement Surgery and You
• American Academy of Orthopedic Surgeons (AAOS) offers a detailed article discussing Total Hip Replacement surgery 
• Interview with Dr. McCarthy - A Step in the Right Direction, Saturday Evening Post

The Joints of the Hand

Take a quick look at your hand.  You can see that each finger has three joints.  Even the thumb appears to have three joints when you include where the base of the thumb meets the wrist.  Finally, you have a wrist which hopefully moves in multiple directions.  I know that I’ve had a hard time remembering which joint is named what, so here is a brief rundown:

• Distal Interphalangeal (DIP) is the joint closest to the fingertip.
• Proximal Interphalangeal (PIP) is the second joint from the fingertip.
• Metacarpophalangeal (MCP) is the large knuckle joint, or third joint from the fingertip.
• Thumb basal joint is where the thumb meets the wrist.  The thumb has only one Interphalangeal joint and the Metacarpophalangeal joint.
• The outer joint of the wrist (on the side of the pinkie finger) which involves the ulnar head (from the arm) is called the Distal Radioulnar joint.

Common Problems of the Hands and Fingers

According to E-Hand.com, the Electronic Text Book on Hand Surgery, symptoms in the hands/fingers which may prompt a referral to a hand surgeon include:

• Persistent joint pain and swelling despite medication
• Pain when bending or straightening the fingers
• Numbness or tingling in the fingers
• Stiff, bent or locking fingers
• Inability to straighten the fingers