Rheumatoid arthritis (RA) can result in structural changes to the joints and ligaments in the hands. Treatment for RA typically includes medications that help prevent these changes.

While the inflammation caused by RA can occur throughout your body, the effects of the disease are often most noticeable in the hands of people with RA.

This damage can result in twisted joints, gnarled ligaments, and, ultimately, joint destruction in the later stages of the disease.

Joint damage that results in an atypical shape in people diagnosed with RA is becoming less frequent and less severe, thanks to earlier diagnosis and more effective treatments.

However, besides being painful, these changes in the hands can make it difficult to perform everyday tasks.

Your hands contain many small bones connected by joints. These joints control the movement of your fingers.

In people with RA, immune system cells attack the synovium, the lining of these joints. The synovium normally produces fluid that allows the joints to glide smoothly on their cartilage covers.

When inflammation causes the synovium to swell, a fibrous layer of abnormal tissue, called pannus, forms. This releases chemicals that cause:

  • bone erosion
  • cartilage destruction
  • ligament damage

The destruction makes ligaments and the connective tissue around the joint less able to support the joints. This causes joints to lose their shape and alignment.

As a result, your joints:

  • become dysfunctional
  • cause pain
  • undergo visible structural changes

People with RA generally have high levels of certain markers of inflammation in their bodies. These can include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

People with RA can also have positive antibodies, such as rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibodies. Anti-CCP antibodies are associated with a risk of more severe disease.

Individuals with RA may experience different types of hand conditions, depending on the rate and manner in which their joints and ligaments deteriorate due to the disease.

The most common manifestations of RA-caused hand concerns identified by researchers include the following:

Boutonniere deformity

Boutonniere deformity occurs when the middle finger joint of a finger bends toward the palm, and the distal joint may bend in the opposite direction.

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Boutonniere deformity is caused by rheumatoid arthritis and inflammation of the joint. Alborz Fallah, CC BY-SA 3.0

Swan-neck deformity

Swan-neck deformity occurs when a ligament is weakened or torn due to inflammation. This results in the straightening of the middle joint of the finger and the bending of the outermost joint and the base of the finger.

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Swan-neck deformity starts with joint inflammation and can progress to the destruction of the tendon, which is seen in the progressive disease rheumatoid arthritis. Phoenix119, CC BY-SA 3.0

Hitchhiker’s thumb

Hitchhiker’s thumb occurs when the thumb bends at the joint connecting the thumb to the palm and hyperextends at the joint just below your thumbnail.

This is sometimes also called the Z-shaped deformity.

Rheumatoid nodules

Rheumatoid nodules are hard lumps that form under the skin near the joints. These are a common symptom of RA in the hands.

They can also occur in multiple areas, most commonly near your elbows. The nodules usually aren’t painful or debilitating, but some people might not like how they look.

Heberden nodes and Bouchard nodes are less common among people with RA. These are visible bumps at the joints that are more typical of osteoarthritis.

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Osteoarthritis can cause inflammation of the joints in the hands. Heberden nodes are present in the joint at the end of the finger, called the distal interphalangeal joint. Bouchard nodes are present in the middle joint of the finger, called proximal interphalangeal joint. J. Lengerke 21:37, 27. Mai 2009 (CEST), CC BY-SA 3.0 DE

The availability of effective drugs that limit the progression of RA has helped reduce the severity of RA-related structural changes in the hands.

Doctors commonly prescribe disease-modifying antirheumatic drugs (DMARDs) to treat RA. These include:

A subset of DMARDs, called biologic response modifiers, specifically target the areas of the immune system that trigger inflammation and joint damage. Doctors usually prescribe them in combination with other RA medications. Some examples include:

Rheumatoid nodules may be more common in people receiving methotrexate treatment. Changes in treatment may help reduce their size. This can include:

  • changes to your medications
  • corticosteroid injections
  • surgery

Occupational therapy

Occupational therapy can slow the progression of hand deformities caused by RA and improve the function of your hands, fingers, and wrists. It may involve exercise and splinting.

Splints, including specially designed rings, can stabilize affected finger joints.


With the current treatment options available, doctors no longer recommend surgery as often for people with RA.

RA-related nodules often return after surgery, and surgery can cause complications.

But if you have severe hand conditions, especially if they affect your dominant hand, doctors may recommend surgery, such as finger joint replacement. Surgery can restore some functionality in the joints and improve appearance.

Wrist surgery may reduce ligament tension on the fingers. Doctors can also surgically fuse the wrist to keep it straight and reduce pain, though it may affect strength and function. Wrist replacement surgery may result in greater retention of wrist motion.

The damage from the systematic inflammation caused by RA can be visible, painful, and debilitating.

Earlier diagnosis and effective RA treatment, such as DMARDs, have made structural changes to the hands from RA less common. If you have pain, loss of function, or visual changes to your hands due to RA, a doctor may recommend medications or occupational therapy.

Though less common, doctors may treat some severe hand conditions with surgery.