Hand rheumatism: how to recognize the symptoms and when to see an orthopedic specialist

The term rheumatic hand encompasses chronic, progressive conditions affecting the joints, cartilage, tendons, tendon sheaths, and periarticular tissues of the hand.

From a clinical perspective, two major categories can be distinguished:

• degenerative conditions, primarily related to joint wear and tear;
• inflammatory conditions, linked to autoimmune mechanisms.

This distinction is crucial because it directly influences both disease progression and treatment strategies.

The causes of hand rheumatism vary depending on the specific condition involved.

Osteoarthritis

Osteoarthritis is the most common degenerative form and is characterized by the gradual deterioration of articular cartilage. It is generally associated with aging and joint use, with a higher prevalence among women over the age of 50, particularly after menopause.

The areas most commonly affected in the hand are:

• the base of the thumb (thumb carpometacarpal osteoarthritis, also known as rhizarthrosis);
• the distal interphalangeal joints.

Rheumatoid arthritis

Rheumatoid arthritis is a systemic autoimmune disease and one of the most common inflammatory conditions affecting the hands.

“Rheumatoid arthritis may also affect relatively young individuals, typically between 40 and 60 years of age. It tends to involve both hands symmetrically, without a predominance of the dominant hand,” explains Dr. Scalese.

Psoriatic arthritis

Another inflammatory condition is psoriatic arthritis, which is often associated with psoriasis of the skin. In many cases, patients are already aware of their dermatological condition but do not necessarily associate their joint symptoms with the same disease.

Other inflammatory disorders

Several systemic rheumatologic diseases may also involve the hands, including:

• systemic lupus erythematosus, which may cause joint pain and inflammation;
• systemic connective tissue diseases, such as systemic sclerosis, which can lead to skin tightening and limited finger mobility;
• Sjögren’s syndrome, which may cause joint pain in addition to symptoms affecting the exocrine glands;
• vasculitis, which can indirectly affect hand structures through inflammation of small blood vessels.

Symptoms depend on the underlying disease, although certain clinical signs are common and may worsen over time.

Symptoms in degenerative conditions

In degenerative disorders, the main symptom is mechanical pain, which occurs or worsens with hand use and tends to improve with rest.

“As the disease progresses, joint degeneration may also cause gradual structural changes, often affecting specific areas,” says Dr. Scalese.

Typical examples include:

• rhizarthrosis, which causes pain during gripping and pinching movements, such as opening a jar or grasping objects;
• Heberden’s nodes, small bony enlargements located at the distal interphalangeal joints.

Symptoms in inflammatory conditions

Inflammatory disorders are typically characterized by:

• joint pain;
• morning stiffness;
• joint swelling.

“Over time, progressive finger deformities may develop due to involvement of the capsular and ligamentous structures,” explains the specialist.

Common deformities include:

• ulnar deviation (“windblown deformity”), where the fingers progressively drift sideways;
• swan-neck deformity, characterized by hyperextension of the proximal interphalangeal joint and flexion of the distal joint;
• boutonnière deformity, characterized by flexion of the proximal interphalangeal joint and hyperextension of the distal joint;
• Z-thumb deformity, a progressive deformity involving the thumb.

The first specialist to consult is an orthopedic surgeon, particularly one specializing in hand surgery.

A specialist evaluation is recommended when the following symptoms occur:

• persistent pain;
• difficulty performing daily activities;
• joint stiffness, especially in the morning;
• changes in finger shape;
• reduced strength or hand function.

“Early intervention allows more effective treatment strategies and helps slow the progression of joint damage,” emphasizes Dr. Scalese.

An orthopedic hand evaluation is the first step toward establishing the correct diagnosis and distinguishing between degenerative and inflammatory conditions.

The assessment typically includes:

• a detailed medical history;
• physical examination of the hand;
• evaluation of joint function;
• diagnostic imaging when necessary (X-rays, ultrasound).

“The goal is to determine whether we are dealing with a degenerative condition or a suspected inflammatory disorder. This distinction is essential because the treatment pathway changes completely,” explains Dr. Scalese.

If findings suggest an inflammatory disease, the orthopedic specialist may order screening blood tests and refer the patient to a rheumatologist for further diagnostic evaluation and treatment planning.

Treatment depends on both the underlying cause and the stage of the disease.

Treatment of degenerative conditions

“The treatment plan is highly individualized, taking into account the patient's needs, disease severity, and functional expectations,” says Dr. Scalese.

Conservative therapies

The first-line approach, particularly effective in the early stages, is conservative and may include:

• custom-made splints or braces;
• physiotherapy;
• muscle-strengthening exercises;
• physical therapy modalities;
• targeted nutritional supplements.

Injections and regenerative medicine

When conservative treatment is insufficient, injections may be used to reduce inflammation and improve joint function. These may include:

• hyaluronic acid injections;
• platelet-rich plasma (PRP) injections.

Such procedures are often performed under ultrasound guidance.

Hand surgery

In advanced cases, when pain and functional limitations become significant, surgery may be considered. Options include:

• corrective procedures;
• reconstructive surgery;
• joint replacement implants.

In some cases, surgery can be definitive; in others, additional treatments may be required over time.

Treatment of inflammatory diseases

For inflammatory disorders, the rheumatologist plays the primary role, while the orthopedic specialist contributes to the initial diagnosis and management of joint complications. Treatment may include:

• anti-inflammatory medications;
• corticosteroids;
• immunosuppressive drugs;
• biologic therapies.

Managing hand disorders often requires collaboration among several specialists, including orthopedic surgeons, rheumatologists, and physiotherapists.

“Close cooperation between specialists is essential. It allows us to create a truly personalized treatment pathway that is more effective for the patient,” concludes Dr. Scalese.