Wrist Rheumatoid Arthritis – Causes, Symptoms, Treatment

Wrist Rheumatoid Arthritis means the pain, swelling, tenderness, stiffness of the hand, and interphalangeal joint, and pain may be aggravated or loss of movement rest especially during the morning. Wrist arthritis may affect multiple functions of daily life and in that reason, its causes, seeking a proper diagnosis to identify the basic causes, and finding effective long-term treatments are necessary to avoid permanent disability in the future life.

Causes of Wrist Rheumatoid Arthritis

According to the American Academy of Orthopedic Surgeons (AAOS), three primary types of arthritis affect the human wrist: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.[rx]

• Osteoarthritis (OA) – This is one of the most common causes of wrist pain in the elderly population, although it can affect any time off and age group population. Furthermore, aging, hereditary factors, high BMI, joint abnormal anatomical abnormalities, and gender are the risk factors that are linked to the development of osteoarthritis. In young adults, it usually happens secondary to preceding joint injury.
• Rheumatoid arthritis (RA) – It is one of the most dangerous causes of inflammatory condition that affects the peripheral joints symmetrically or both hand leg. The exacted causes of rheumatoid arthritis remain unknown, but it is thought to be a multifactorial problem that is working behind it.[rx][rx]
• Post-traumatic arthritis – It is another cause of the development of rheumatoid arthritis of the hand because of traumatic reasons or time such as injuries to the ligaments, capsule, tendon, or may fracture of the wrist bones. Due to the loss of adequate proper treatment, the damaged bone and joints to bones increase the risks of developing arthritis over time and in near future[rx].
• Swelling – It is one of the most common causes of hand rheumatoid arthritis, morning stiffness, tenderness. It basically occurs inpatient every patient with hand rheumatoid arthritis
• Blood deficiency _ Blood deficiency is one of the major side effects of hand rheumatoid arthritis, The patient total count of blood may increase that are leads to rheumatoid arthritis.
• Decrease the range of motion – The affected joint range of motion gradually decreases due to abnormal immunity systems.
• Change the joint normal structure – The normal structure of the joint of the hand are become abnormal or bend on the different side.  With this condition, synovial fluid is decreased in the affected joint.
• Muscle wasting – The most important cause of hand rheumatoid arthritis symmetrical affected joint muscle is waste for the abnormal nodule around the joint.
• Other causes – may be defined as wrist arthritis, pain, swelling is due to infection (septic arthritis), crystal-induced arthritis, reactive arthritis, and systemic symptoms of diseases like sarcoid arthropathy, myelodysplastic, and leukemic disorders and bone disease, cancer, etc.

Symptoms of Wrist Rheumatoid Arthritis

• Pain swelling, tenderness with redness in the asymmetrical joints
• Morning stiffness or pain increase in the morning
• Decrease the range of motion in the affected joint of hand.
• Edema or abnormal nodule are found during joint palpation
• Pain may be an increase during the time of rest
• Creations sound are may hear during hand bending or extending
• The deformity may occur in small fracture and the formation os osteoarthritis are also seen weakness, and instability.
• Pain may be accompanied by fatigue, sleep disturbance, emotional liability, and symptoms of pain illness are also may be increased.
• Pain from arthritis is usually worse by activities and at the end of the day or during the rest hand.
• Hand rheumatoid arthritis with inflammatory arthritis will also cause pain and stiffness in the morning and at rest that may initially improve with activity, but subsequently gets worse with prolonged use hand, joint with others and day to day activity.
• Constitutional symptoms such as fevers, chills, fatigue, night sweats, and weight loss may be associate with wrist rheumatoid arthritis. The systemic cause may be a systemic rheumatological associate disease, malignancy, or infectious septic arthritis.

Diagnosis of Wrist Rheumatoid Arthritis

Wrist rheumatoid arthritis treatment is following

• History – The most common symptoms of wrist arthritis are pain, swelling, a tenderness that is diffuse in the whole wrist joint. The character of pain may differ for pain due to osteoarthritis and the joint swelling is worse with joint use and is relieved by rest. Pain is often associated with stiffness, tenderness, and worse in the morning and gets better as the day goes on. Symmetric involvement or the same types of joints pain is also the most common in hand rheumatoid arthritis. Other than pain, swelling is an important feature of hand arthritis. Swelling can be due to effusion or synovial hypertrophy may occur for women for a special reason.
• Redness and warmth –  of the joints, tenderness with swelling in a non-traumatic wrist joint also suggest inflammation or inflammatory arthritis and infectious septic arthritis. Patients may also see the presence of limitations in range of motion and can even feel weakness and worm, tenderness.
• Inspection – Swelling, and deformities both are the two most important findings associated with arthritis pain. Swelling and tenderness are important to identify between a joint effusion, swelling from tenosynovitis, or a localized abnormal mass formation may be found. Hand rheumatoid arthritis usually produces a diffuse circumferential swelling. Chronic inflammation in diseases like hand rheumatoid arthritis can cause the deformities such as volar subluxation of the carpus, carpal collapse, and radial deviation of the carpus.
• Palpation – Palpation is the manual test that helps in identifying the specific affected area by the underlying pathological condition. In hand rheumatoid, the wrist is best palpated in slight flexion and feeling the dorsal surface of the wrist with the support of thumb with wrist and fingers of both the hands. Dorsal instability is a common sign of joint swelling and effusion. The instability can be also tested by looking for transmission of pressure from one hand placed at one side of the joint to the second hand placed on the opposite side.
• Range of Motion – The doctor or clinicians must test the active range of motion first for hand rheumatoid arthritis. They should be seen if there is any limitation to look for any important improvement. The range of motion tested at the wrists is flexion, extension, radial, and ulnar deviation. The normal range of flexion is 65 to 80 degrees of flexion in hand, 55 to 75 degrees of extension, 30-45 degrees of ulnar deviation, and 15 to 25 degrees of radial deviation.
• Special tests – It is called the manual test that is tinsel sign, Carpal compression test, Phalen test, Finkelstein test, etc, in excluding causes of hand rheumatoid arthritis and other than arthritis in a patient with wrist pain with the associate condition.

Lab Tests

• Laboratory tests- Leukocytosis is one of the most important tests for hang rheumatoid arthritis that supports the possibility of infection and bone-related disease. Blood cultures, urine examination, or other possible primary sites of bone infection that obligatory when a septic infectious joint is being considered for examination. The and elevated inflammatory condition markers like ESR or CRP include suggesting an infectious or inflammatory disease condition.
• Rheumatoid factor and anti-CCP – cyclic citrullinated peptide antibodies test should be increased if there is clinical abnormality for rheumatoid arthritis are found.
• A serum uric acid level – It is often considered by clinicians and doctors when gout, pseudogout is suspected, but it is not a reliable and dangerous condition as it may be spuriously elevated or high in acute inflammatory conditions or acutely during a true gout attack or not.
• Synovial fluid analysis – A joint arthrocentesis or the system of aspiration of synovial fluid with blood and synovial fluid analysis that are mandatory if an infection is suspected or dangerous. Such patients should also be started properly treatment by using empiric antibiotic therapy as soon as possible if the synovial fluid sample is obtained from the joint. The fluid analysis or any kinds of abnormalities is also helpful in diagnosing crystal formation with osteophyte induced arthritis. The degree of the high elevation of synovial fluid are founded by WBC count can be useful in differentiating inflammatory abnormality or from non-inflammatory causes of hand rheumatoid arthritis.

Imaging

• Radiographs of the joint – Conventional x-ray and radiography is the most widely used imaging modality and allows for the detection of bone fractures, osteoporosis, and abnormal pathologies condition like fracture, osteoporosis, erosions, osteonecrosis, osteoarthritis, or a juxta-articular bone tumor, neoplasm. Characteristic features of hand rheumatoid arthritis include marginal osteophytes formation, joint space gradually narrowing, subchondral sclerosis formation, and cysts.
• CT Scan – High contrast ct scan is more effective to diagnose hand rheumatoid arthritis. Abnormal tendon, ligament, cartilage, muscle and osteophyte, synovial fluid. It also helps to identify the bone tumor, necrosis, abnormal joint condition, etc.
• MRI – It is called magnetic radical imaging is also helpful to find the bone conditions, abnormal tendon, ligament, cartilage, muscle and osteophyte, synovial fluid. It also helps to identify the bone tumor, necrosis, abnormal joint condition, etc. It is the final stage test to confirm that all joint abnormality.

Treatment of Wrist Rheumatoid Arthritis

Non-pharmacologic treatments of wrist rheumatoid arthritis

• Physiotherapy – It is one of the most common and effective non-pharmacological treatments in the world. It has a variety of treatment module to erase acute and chronic pain. It is especially helpful in muscle spasticity, spasms related to hand and shoulder or backs pain. Inflammatory and noninflammatory pain is treated by ultrasound, MRI, Shortwave, microwave, wax therapy, IRR, laser therapy, interferential current therapy.
• Exercise – Different types of exercise may be done under the supervision of a physiotherapist or healthcare provider. It falls into the active range of motion, tapping, isometric movement, active range of movement, or passive range of motion.
• Stretching – It is one of the most helpful treatments to reduce muscle pain, spasm, spasticity that is gradually increasing due to old age and not perform daily workouts or activities.
• Bracing – It is one of the most important self-help devices that is used in hand rheumatoid arthritis, maintaining proper joint position, reducing swelling, improve the range of motion exercise.
• Acupuncture – It is the China-oriented acute and chronic treatment system where are needle is used to stimulate the pain receptor to reduce pain. It is also helpful in some spasticity formation pain, stroke, hemiplegia and chronic rheumatoid arthritis pain in hand.
• Diet – Diet may be normal or according to the doctor mentions food you can take it for you, such as papaya, banana, potato, nut cereal, seasonal fruits, and drink of water

Medication

• NSAIDs – It is considered to be the fast-acting nonsteroidal anti-inflammatory drugs (NSAIDs) such as including acetylsalicylate, naproxen, ibuprofen, and etodolac. Aspirin is also an effective anti-inflammatory for hand rheumatoid arthritis when used at high doses, due to the decrease or inhibition of prostaglandin synthesis. It is also called one of the oldest NSAIDs used for multiple joint pain. NSAIDs work by inhibiting cyclo-oxygenase to prevent the synthesis of prostaglandins, prostacyclin, and thromboxanes. It has also some side effects of aspirin at high doses when used are including tinnitus, hearing loss, and gastric intolerance.
• Muscle relaxant – It is important for patients with chronic muscle spasms, wasting, and muscle cramping releasing drugs. The drugs are tolperisone HCL, eperisone, baclofen, dantrolene, etc.
• Nerve relaxant –  It is basically used to reduce neuropathic pain, inflammation, nerve root entraption, myalgia, neuralgia. Your doctor may prescribe gabapentin, pregabalin, vitamin B1, B6, B12, etc. Major side effects are abdominal pain, nausea- vomiting
• Calcium & vitamin D3 – to improve bone health and healing fractures and osteoporosis, osteonecrosis. Your doctor may prescribe to take calcium and vitamin D3 supplementation to prevent thinning of the bone and muscle pain.
• Glucosamine & Diacerein – It is one of the most important supplements that can help to tighten the loose tendon, cartilage, and regenerate cartilage or inhabit the further degeneration of cartilage.
• Corticosteroid injections –  Corticosteroids to healing the nerve inflammation and clotted blood in the joints that are accumulated in the joint. The injections may provide temporary pain relief anywhere from days to several months. With repeated injections, several times the patient may experience a more permanent improvement in their symptoms.^[rx] The steroid injections are typically used in severe conditions when normal treatment can not respond.^[rx] Common side effects muscle cramping, increase metabolism, dry mouth, vertigo, blurred vision.
• Dietary supplement – Especially seasonal fruit vitamin B complex, vitamin b12, etc to remove general weakness & improved health.
• Biological drug – The biological drugs are metathorax, sulfasalazine, azathioprine, etanercept, adelumub. It is causing some side effects are abdominal bloating, nausea- vomiting.
• Epidural Injections – For patients with severe pain, especially leg pain, epidural steroid injections may be a reasonable treatment option. The injections are effective in helping to reduce pain and increase a patient’s function and mobility. If a steroid injection does work to relieve the patient’s pain, it can be done up to three times per year.
• Facet Joint Injections – Your doctor injects cortisone into the affected joint to give you temporary relief from the pain and inflammation.

References