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炎症性关节炎和类风湿关节炎

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Rheumatoid, psoriatic and gouty arthritis affecting the hand, wrist and upper limb — what they are, how they are managed, and when surgery helps.

Updated Oct 2026
一只指节关节肿胀的手。
炎症性关节炎攻击关节内衬（滑膜），导致肿胀、僵硬，若不治疗则会造成关节损伤。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

炎症性关节炎（包括类风湿关节炎）是一种免疫系统攻击您自身关节内衬的疾病。在手部和腕部，它会引起手指小关节和腕关节本身的肿胀和疼痛。肿胀往往在早晨醒来时最严重，开始活动后可能会缓解。让手休息通常能使疼痛平息，而使用手则会使情况加重。

在日常生活中，这会体现在需要握力和手指精细动作的任务上。转动钥匙、打开罐子、握笔、扣纽扣或提水壶都可能变得更加困难。有些人会注意到某一根手指或某一个指节比其他的肿得更厉害。随着时间推移，关节可能会变形，负责伸直手指的肌腱可能会磨损断裂，无法再正常工作。

该病还可能影响其他关节，包括肘部和肩部，并且在发作时可能让您感到全身不适。皮下有时会出现肿块，称为类风湿结节，常出现在手背或肘部等受压部位。

有些警示信号需要迅速处理。如果某根手指、手或手臂变得发热、发红、肿胀和疼痛，尤其是伴有发烧时，请当天前往急诊科。如果您的手指或手变得苍白、发冷、发白或发紫，或者受伤后突然失去感觉或无法活动，请当天前往急诊科。

其他信号则需要就诊评估，而不必前往急诊科。如果症状没有缓解、在数周内逐渐加重、使您在夜间痛醒，或使您无法工作或使用您的手，请咨询您的全科医生（GP）或要求专科医生评估。

实际发生了什么

在健康的关节中，内衬薄而光滑，并分泌少量液体，使关节表面能够相互滑动。在类风湿关节炎中，您的免疫系统把这层内衬当作外来物并对其发起攻击。内衬变得增厚、发炎，并产生过多的液体。随后，这层肿胀的内衬开始侵蚀关节表面本身，磨损本应保护骨骼的光滑软骨。

损害并不止于关节。同样的发炎组织可能包裹住肌腱，即从前臂肌肉通向手指、使您能够弯曲和伸直手指的条索状组织。这种组织会削弱肌腱，直到肌腱磨损或断裂，这就是手指可能突然无法伸直的原因。它还可能使骨骼本身变软，使骨骼变弱、更容易被侵蚀，尤其是在腕部和手指小关节周围。

这解释了您的感受。晨僵和肿胀来自发炎的内衬所产生的多余液体。使用时的疼痛来自失去保护、变得粗糙的关节表面相互摩擦。随着磨损的关节表面和变弱的肌腱使手指偏离正常排列，关节形态就会改变。而皮下的肿块，即前面提到的类风湿结节，是同一疾病过程的一部分，而不是一个单独的问题。

这种疾病因人而异。有些人患的是较轻、进展较慢的类型，另一些人则患有更严重、对关节和肌腱损害更快的类型。您的手腕或手指恶化的速度，取决于您所患疾病属于哪种类型。这就是为什么在对手部进行任何手术之前或同时，先控制住炎症本身（通常依靠风湿科医生开具的药物），治疗效果才最好。

我们能做什么

除了药物治疗之外，您自己也可以做很多事情。温和而规律的锻炼能保持关节活动，随着时间推移还可能增强力量，不过对僵硬的缓解作用往往是短期的。如果您的类风湿关节炎控制良好，将力量训练与较高强度训练相结合的有监督锻炼计划通常耐受良好，并有助于您的整体身体健康。职业治疗师也可以教您保护关节的方法，让日常任务变得更容易。请用数周而不是数天的时间认真尝试这些方法，即使开始了其他治疗，也要坚持下去。

药物是治疗的主要手段，尤其是在早期。抗炎药物和皮质类固醇可以缓解疼痛和肿胀。其他药物，例如甲氨蝶呤，通过平息过度活跃的免疫系统来作用于疾病本身，而较新的生物制剂则针对炎症过程中的特定环节。这些药物已经改变了许多人的病程，以至于现在需要关节置换手术的人比过去少得多。代价是，抑制免疫系统的药物会增加感染风险，因此需要谨慎管理，尤其是在任何手术前后。

如果采取这些措施后您的症状仍然严重，您的全科医生或风湿科医生可能会将您转诊，对您的手和手腕进行专科评估。手术不是第一步，只有在疾病已经以药物无法逆转的方式损害了关节或肌腱时才会考虑。对于某些特定问题，手术偶尔可能有助于缓解疼痛或改善功能。任何决定都会考虑您的其他关节、您需要双手完成哪些事情以及您的生活方式。

预期情况

类风湿关节炎是一种长期疾病。它不会自行消失，如果炎症得不到控制，它往往会持续损害关节。关节损害通常在患病的第一年或第二年内开始，并从此持续发展。这就是早期治疗很重要的原因：平息炎症的药物可以在损害发生之前减缓或预防损害。

当疾病得到良好管理时，许多人的前景已经改变。现代药物已经减少了关节严重磨损以至于需要置换手术的情况。经过治疗，发作可以平息，您可以继续用双手完成日常任务。如果您的疾病控制良好，包括力量训练和较高强度训练在内的规律锻炼通常耐受良好，并有助于您的整体健康。

如果不加处理，发炎的内衬会持续侵蚀关节表面和肌腱。关节可能变形，手指可能偏离正常排列，负责伸直手指的肌腱可能磨损断裂。已经磨损断裂的肌腱不会自行愈合或好转，需要尽快接受专科评估。软骨和骨骼已经受到的损害无法通过药物逆转。

当损害已经发生时，手术可以有所帮助。因关节受损而接受关节置换的人报告术后疼痛减轻、功能改善。效果因人而异，长期来看可能会出现一定程度的退化，因此手术是在药物已无法控制问题时才采取的步骤。

请留意本页前面描述的信号。如果手指或手发热、发红、肿胀和疼痛，尤其是伴有发烧时，请当天前往急诊科。如果手指变得苍白、发冷、发白或发紫，或者受伤后突然失去感觉或无法活动，也请当天前往急诊科。如果症状没有缓解、在数周内逐渐加重、使您在夜间痛醒，或使您无法工作或使用您的手，请咨询您的全科医生（GP）或要求专科医生评估。

何时就医

这种疾病属于炎症性疾病，因此其警示信号与单纯磨损的关节不同。紧急信号已在本页前面介绍过：如果手指、手或手臂变得发热、发红、肿胀和疼痛，尤其是伴有发烧时，请当天前往急诊科。如果手指变得苍白、发冷、发白或发紫，或者受伤后突然失去感觉或无法活动，也请当天前往急诊科。

如果您的症状没有缓解、在数周内逐渐加重、使您在夜间痛醒，或使您无法工作或使用您的手，请咨询您的全科医生（GP）或要求专科医生评估。手指突然无法伸直也需要尽快接受专科评估，因为已经磨损断裂的肌腱不会自行愈合。

如果您注意到某个关节正在变形或偏离正常排列，或者肿胀和晨僵反复出现，请尽早要求评估。越早控制住炎症，就越有可能在损害发生之前保护好您的关节。

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • The success of treatment for patients with rheumatoid arthritis depends on a clear understanding of available drugs and what can be done at various stages of the disease [1].
  • Arthritic disorders have a profound importance to the general population as a health problem and for their social and economic impact [2].
  • Long-term results of radiolunate arthrodesis in the rheumatoid wrist are favorable as long as the rheumatoid process is under control [3].
  • Cy3-tilmanocept labeling of macrophages establishes a novel tool for pre-clinical research of early arthritis and has implications for early RA detection and monitoring of therapeutic efficacy in humans [4].
  • Economic, social, and cultural factors affect rheumatoid hand treatment in selected countries representing various regions of the world [5].
  • Patients with rheumatoid arthritis can differentiate between problems caused by their hands and other effects of their disease [6].
  • Complication rates are comparable between RA and non-RA cohorts in total elbow arthroplasty, but further investigation into the underlying mechanisms of increased revision rates in RA patients is warranted [7].
  • Surgery for rheumatoid arthritis involves medical considerations, surgical principles, and regional surgical considerations [8].
  • Rheumatoid nodules are often associated with the severe form of rheumatoid disease, which carries a poor prognosis [9].
  • Retrospective case reports and pictorial depictions question the belief that rheumatoid arthritis is a modern disease brought to the Old World from the New World after the discovery of America [11].
  • Rheumatoid wrist involvement in black patients was more or less the same as reported in other series, but finger joint involvement was considerably less [12].
  • Following total shoulder arthroplasty, RA patients should be considered at higher risk of systemic and joint-related complications compared to patients with primary osteoarthritis [13].
  • Clinical symptoms and radiologic appearances are often poor indicators of the source of pain in the shoulder joint complex in patients with rheumatoid arthritis [14].
  • Rheumatologists view rheumatoid hand surgery as significantly less effective than do hand surgeons, highlighting disagreements between the two specialties about the management of this clinical problem [15].
  • A system of radiographic grading for rheumatoid, psoriatic, and other similar arthritic conditions can be useful in evaluating cases for both medical and surgical treatment and epidemiologic studies [17].
  • Systemic inflammatory diseases other than rheumatoid arthritis affect the hand with skin, vascular, and musculoskeletal symptoms [18].
  • Surgery for rheumatoid arthritis and other inflammatory diseases is not disappearing [20].
  • The book 'Monoclonal antibodies, cytokines, and arthritis' presents concepts regarding the molecular biology and immunology of arthritides and a new rationale for treatment [26].
  • There is limited knowledge of anti-TNFa and no consensus of opinion amongst hand surgeons performing rheumatoid surgery in the UK with regard to its perioperative use [31].

Background & Causes

  • Cy3-tilmanocept labeling of macrophages establishes a novel tool for pre-clinical research of early arthritis with implications for early RA detection and monitoring of therapeutic efficacy in humans [4].
  • Further investigation into the underlying mechanisms of increased revision rates in RA patients is warranted despite comparable complication rates between RA and non-RA cohorts in total elbow arthroplasty [7].
  • Data on total joint arthroplasty trends likely reflect skewed utilization of bDMARDs in rheumatoid arthritis patients with more severe disease and prolonged periods of joint degeneration because of prior treatment failure [10].
  • Following total shoulder arthroplasty, RA patients should be considered at higher risk of systemic and joint-related complications compared to patients with primary OA [13].
  • Denosumab demonstrates promising efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis [16].
  • Rheumatoid arthritis is characterized by maintained mineralization and no predominant periarticular osteopenia, which contrasts with gout [29].
  • Rheumatoid patients with diabetes had an increased risk of wound infection (33%) compared with patients without (3.3%) after elective rheumatoid hand and wrist surgery [33].
  • Hand involvement in psoriatic arthritis differs from rheumatoid arthritis, characterized by stiffness and spontaneous fusion rather than instability [38].
  • Inflammatory arthritis represents a distinctly morbid risk profile compared to osteoarthritis patients with multiple increased surgical and postoperative medical complications in patients undergoing aTSA and rTSA [40].
  • The ongoing rheumatoid process is responsible for the translocation observed after resection of the distal ulna in rheumatoid arthritis [41].
  • Inflammatory arthritis has a substantial effect in producing intracortical defects in metaphyseal bone, but the bisphosphonate zoledronate was considerably effective in preventing these changes from occurring [47].
  • In vivo, mechanically impaired tendons may play an important role in destabilization of the wrist in patients with rheumatoid arthritis [28].
  • Early in the disease process of rheumatoid arthritis, bone erosions may occur in the sigmoid notch of the distal radius [44].
  • Severe joint destruction in autoimmune arthritis caused by Candida septic arthritis may have been the result of prolonged sepsis, development of an autoimmune response to Candida breakdown products, or a combination of these factors [45].
  • The density of synovial cells increased after synovectomy in all control subjects and six of eight RA patients, which is indicative of a wound healing response [46].
  • Type II collagen was present in all attachment zones of the proximal interphalangeal joint, although there was little in rheumatoid fingers [48].
  • Invasive tenosynovium is more destructive than encapsulating tenosynovium at a molecular level, providing an explanation for the increased tendon rupture associated with invasive tenosynovitis in RA [68].
  • Surgery of the rheumatoid hand must take account of the severity of the disease, with sero-positive patients with high sedimentation rates being informed about and trained in principles of joint protection before operation [72].
  • Understanding which factors are associated with choosing rheumatoid hand reconstruction is an essential component of patient preoperative counseling [73].
  • There is a significantly lower incidence of Dupuytren's features in patients with rheumatoid diseases than there is in random control patients [74].

Symptoms & Presentation

General Clinical Presentation

  • Juvenile rheumatoid arthritis seldom involves the small joints of the hand, but proximal interphalangeal joint synovitis can be the initial manifestation [49].
  • Single-digit swelling may be a presenting feature of juvenile rheumatoid arthritis in 18% of cases [60].
  • A misdiagnosis of rheumatoid nodules was made secondary to the patient’s history of rheumatoid arthritis [23].
  • In rheumatoid arthritis, mineralization is maintained and there is no predominant periarticular osteopenia [29].

Mechanical and Structural Findings

  • Radiologic examination showed that all patients exhibited resorption of the distal ulna (mean 4.4 mm) and that resorption was worst in the group with rheumatoid arthritis [65].
  • The use of contrast arthrography can provide evidence as to the presence and prominence of rheumatoid synovitis at the elbow [67].

Prognostic and Outcome Indicators

  • FPL rupture in patients with rheumatoid arthritis gives short term dysfunction but, in most cases, not substantial medium-term dysfunction [27].
  • Age, disease duration, disease activity score and deformity were associated with the lowest bMHQ scores in RA patients [34].
  • The severity of the patient's disease and the degree of articular involvement had a great effect on the outcome of surgery [63].
  • Overall functional results often were affected by the status of disease in other joints, but in general were acceptable [71].

Management

General Principles and Multidisciplinary Care

  • The goal of medical and surgical management for patients with rheumatoid arthritis is to maintain or improve functional capacity [43].
  • Surgery for rheumatoid arthritis requires a comprehensive team approach that includes medical considerations, surgical principles, and regional surgical considerations [8].
  • In all facets of treatment or evaluation, the rheumatoid patient must be handled gently with respect to tissue response and pain [52].
  • All care plans for the rheumatoid hand should be made with thoughtful consideration to the patient's other joint involvement, functional needs, and lifestyle [50].
  • Rheumatologists view rheumatoid hand surgery as significantly less effective than do hand surgeons, highlighting disagreements between the two specialties regarding management [15].
  • Two-thirds of patients with rheumatic conditions visiting a multidisciplinary hand clinic reportedly followed the treatment advice, with an overall trend toward a beneficial effect on hand function [54].

Medical Management and Pharmacology

  • Pharmacologic agents used in rheumatoid arthritis include nonsteroidal antiinflammatory drugs, corticosteroids, methotrexate, and biologic agents [43].
  • Biologic agents are recombinant proteins that generally target an inflammatory cytokine, such as tumor necrosis factor [43].
  • Biologic agents have shown excellent results in rheumatoid arthritis treatment [43].
  • Biologic agents inhibit the immune system and cause an increased risk of infection in patients taking them [43].
  • There is preclinical evidence for an antioxidant, anti-inflammatory, antinociceptive, cartilage- and bone-protective effect of calcitonin in rheumatoid arthritis and osteoarthritis [59].
  • Tectochrysin may be a novel rheumatoid arthritis therapeutic agent, likely acting via macrophage JAK/STAT pathway inhibition, with promising clinical potential [53].
  • Cy3-tilmanocept labeling of macrophages establishes a novel tool for pre-clinical research of early arthritis and has implications for early rheumatoid arthritis detection and monitoring of therapeutic efficacy in humans [4].

Perioperative Considerations

  • Patients who are on corticosteroids generally require preoperative “stress” dosages of hydrocortisone [43].
  • Agents that inhibit the immune system should be withheld at least 1 week before and 1 week after a surgical procedure for rheumatoid arthritis patients [43].
  • Rheumatoid patients with diabetes had an increased risk of wound infection (33%) compared with patients without diabetes (3.3%) [33].
  • Among patients with rheumatoid arthritis undergoing elective hand surgery, perioperative biologic disease-modifying antirheumatic drug continuation was not associated with significant increases in risks of wound healing failures or surgical site infections [56].

Non-Operative Rehabilitation and Exercise

  • There is not strong research evidence for or against the value of hand exercise in the treatment of persons with rheumatoid arthritis, although results suggest that appropriate exercise might lead to long-term strength changes and very short-term changes in stiffness [19].
  • Supervised high-intensity interval training and strength exercise appear to be feasible and well tolerated by patients and could be recommended to improve cardiovascular and physical health in patients with well-controlled rheumatoid arthritis [51].
  • No outcome studies on the effectiveness of joint protection programs for unstable metacarpophalangeal joints in rheumatoid arthritis were found [58].

Outcomes and Prognosis

  • Patients with rheumatoid arthritis who underwent Swanson Metacarpophalangeal Joint Arthroplasty had significant improvements in patient-reported outcomes at the 1-year interval [21].
  • Following total shoulder arthroplasty, rheumatoid arthritis patients should be considered at higher risk of systemic and joint-related complications compared to patients with primary osteoarthritis [13].
  • Shoulder arthroplasty in patients with rheumatoid arthritis reduces pain and improves function [35].
  • Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, patients can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary total hip arthroplasty [22].
  • Total knee arthroplasty in patients who have rheumatoid arthritis yields significant improvement in physician- and patient-reported outcomes [36].
  • In the largest single-institution study to date, patients with rheumatoid arthritis reported poorer patient-reported outcome scores compared with the osteoarthritis and posttraumatic arthritis groups but experienced functional outcome improvement from the preoperative baseline following total ankle arthroplasty [24].
  • Patient-reported functional outcomes at 6 months for total elbow arthroplasty were significantly lower in the fracture group compared to osteoarthritis and rheumatoid arthritis groups [25].
  • Despite comparable complication rates between rheumatoid arthritis and non-rheumatoid arthritis cohorts, further investigation into the underlying mechanisms of increased revision rates in rheumatoid arthritis patients undergoing total elbow arthroplasty is warranted [7].
  • Age, disease duration, disease activity score, and deformity were associated with the lowest brief Michigan Hand Outcomes Questionnaire scores in rheumatoid arthritis patients [34].
  • Patients with rheumatoid arthritis can differentiate between problems caused by their hands and other effects of their disease using a visual analogue scale [6].
  • In rheumatoid arthritis trials, grip strength should be assessed at the same time of the day [57].
  • A 48% decrease in the number of primary arthroplasties performed for rheumatoid arthritis was found in a review of the Finnish Arthroplasty Register covering 1995 to 2010, attributed to the effectiveness of improved medical management [43].

Key Considerations

General Management and Assessment

  • A system of radiographic grading for rheumatoid, psoriatic, and other similar arthritic conditions is useful in evaluating cases for medical and surgical treatment and epidemiologic studies [17].
  • Rheumatoid arthritis is not a modern disease and was not brought to the Old World from the New World after the discovery of America [11].

Non-Operative Considerations

  • There is not strong research evidence for or against the value of hand exercise in the treatment of persons with rheumatoid arthritis, although results suggest appropriate exercise might lead to long-term strength changes and very short-term changes in stiffness [19].

Operative Considerations

  • Although there is good reason to intervene early in the disease, there are no long-term studies with sufficient control to provide clear evidence of significant long-term benefits from synovectomy [37].
  • Long-term results of radiolunate arthrodesis are favorable as long as the rheumatoid process is under control [3].
  • Radiolunate arthrodesis in patients with rheumatoid arthritis maintained good clinical results and corrected alignment during long-term follow-up [79].
  • Silicone rubber implant arthroplasty of the metacarpophalangeal joint in rheumatoid arthritis is useful despite some deterioration of results during long-term follow-up [78].
  • In view of the paucity of long-term results for total elbow replacement, radial-head excision and synovectomy may retain a role in younger patients or in those whose symptoms are related mainly to the radiohumeral joint [39].
  • The long-term clinical results of elbow interposition arthroplasty in rheumatoid arthritis are good in terms of pain relief but only fair in terms of joint mobility and stability, and are probably inferior to those of total elbow replacement [81].
  • Total elbow replacement arthroplasty for rheumatoid arthritis appears durable at long-term follow-up [80].
  • The Kudo type-5 prosthesis demonstrated satisfactory results in patients with rheumatoid arthritis, although failures occurred to some extent over a long-term follow-up period [70].
  • Despite comparable complication rates between rheumatoid arthritis and non-RA cohorts, further investigation into the underlying mechanisms of increased revision rates in rheumatoid arthritis patients is warranted [7].
  • In the largest single-institution study to date, patients with rheumatoid arthritis reported poorer patient-reported outcome scores compared with osteoarthritis and posttraumatic arthritis groups but experienced functional outcome improvement from the preoperative baseline after total ankle arthroplasty [24].
  • Comparative outcomes of robot-assisted versus conventional total knee arthroplasty provide important evidence for selecting surgical methods in rheumatoid osteoarthritis [30].
  • Flexor pollicis longus rupture in patients with rheumatoid arthritis gives short-term dysfunction but, in most cases, not substantial medium-term dysfunction [27].
  • Clinical and radiological assessments at 22 months of follow-up for surgical reconstruction of an unstable rheumatoid thumb deformity revealed good outcomes [75].

Radiographic and Pathologic Findings

  • Bone destruction in both the humerus and the olecranon appears to be a late consequence of rheumatoid elbow involvement [82].
  • The distal radioulnar joint showed a rapid increase in Larsen score and was involved in 78% of patients on late x-rays in longitudinal radiographic analysis of rheumatoid arthritis in the hand and wrist [83].
  • Rheumatoid nodules are often associated with the poor prognosis for the severe form of rheumatoid disease [9].
  • A misdiagnosis of rheumatoid nodules can occur secondary to the patient’s history of rheumatoid arthritis, as seen in cases of multiple epidermal inclusion cysts [23].

Key Evidence

  • [L5] The success of treatment of patients with rheumatoid arthritis depends on a clear understanding of the drugs available and of what can be done at various stages of the disease. [1] (10.1016/s0363-5023(83)80240-8)
  • [Paper] The Arthritis Committee recognizes the profound importance of arthritic disorders to the general population, not only as a health problem, but for their social and economic impact. [2] (10.1016/s0363-5023(83)80245-7)
  • [L4] Long-term results are favorable, as long as the rheumatoid process is under control. [3] (10.1016/s0363-5023(86)80034-x)
  • [L4] These data establish a novel tool for pre-clinical research of early arthritis and have implications for early RA detection and monitoring of therapeutic efficacy in humans. [4] (10.1002/jor.24900)
  • [L5] The purpose of this study was to determine how economic, social, and cultural factors affect rheumatoid hand treatment in selected countries representing various regions of the world. [5] (10.1016/j.jhsa.2004.11.012)
  • [L4] Patients with rheumatoid arthritis can differentiate between problems caused by their hands and other effects of their disease. [6] (10.1016/s0894-1130(04)00197-8)
  • [L3] Despite comparable complication rates between RA and non-RA cohorts, further investigation into the underlying mechanisms of increased revision rates in RA patients is warranted. [7] (10.1016/j.jse.2024.12.032)
  • [Paper] Surgery for Rheumatoid Arthritis provides a comprehensive yet concise review of medical considerations, surgical principles, and regional surgical considerations as they apply to the patient with rheumatoid arthritis. [8] (10.1016/0363-5023(93)90415-y)
  • [L5] This is in contrast to the poor prognosis for the severe form of rheumatoid disease with which rheumatoid nodules are often associated. [9] (10.1016/s0363-5023(84)80232-4)
  • [L4] These data likely reflect skewed utilization of bDMARDs in rheumatoid arthritis patients with more severe disease and prolonged periods of joint degeneration because of prior treatment failure. [10] (10.5435/jaaosglobal-d-22-00209)
  • [L5] These retrospective case reports, in conjunction with other pictorial depictions of probable rheumatoid arthritis, question the belief of some clinicians that rheumatoid arthritis is a modern disease and that it was brought to the Old World from the New World after the discovery of America. [11] (10.1016/s0894-1130(96)80080-9)
  • [L4] Rheumatoid wrist involvement in black patients was more or less the same as reported in other series, but finger joint involvement was considerably less. [12] (10.1016/s0266-7681(03)00096-2)
  • [L3] Following TSA, RA patients should be considered at higher risk of systemic and joint-related complications compared to patients with primary OA. [13] (10.5397/cise.2024.00374)
  • [L4] Clinical symptoms and radiologic appearances are often poor indicators of the source of pain in the shoulder joint complex in patients with rheumatoid arthritis. [14] (10.1016/s1058-2746(09)80111-0)
  • [L4] Rheumatologists view rheumatoid hand surgery as significantly less effective than do hand surgeons, which highlights the disagreements between the 2 specialties about the management of this clinical problem. [15] (10.1053/jhsu.2003.50034)
  • [L1] Denosumab demonstrates promising efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis. [16] (10.1186/s12891-025-08688-8)
  • [Paper] This system of radiographic grading for rheumatoid, psoriatic, and other similar arthritic conditions can be useful in evaluating cases for both medical and surgical treatment and epidemiologic studies. [17] (10.1016/s0363-5023(83)80241-x)
  • [L5] This review outlines the skin, vascular and musculoskeletal symptoms affecting the hand during systemic inflammatory diseases other than rheumatoid arthritis. [18] (10.1016/j.main.2014.01.008)
  • [L1] There is not strong research evidence for or against the value of hand exercise in the treatment of persons with rheumatoid arthritis, although results of this review suggest that appropriate exercise might lead to long-term strength changes and very short-term changes in stiffness. [19] (10.1197/j.jht.2004.02.006)
  • [L5] Surgery for RA and other inflammatory diseases is not disappearing. [20] (10.1016/j.main.2014.09.003)
  • [L2] Our data show that patients with RA who underwent SMPA had significant improvements in patient-reported outcomes at the 1-year interval. [21] (10.1016/j.jhsa.2004.03.004)
  • [L3] Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, patients can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary THA. [22] (10.5435/jaaos-d-24-00656)
  • [L5] A misdiagnosis of rheumatoid nodules was made secondary to the patient’s history of rheumatoid arthritis. [23] (10.1053/jhsu.2000.8641)
  • [L3] In the largest single-institution study to date, patients with RA reported poorer PRO scores compared with the OA and posttraumatic arthritis groups but experienced functional outcome improvement from the preoperative baseline. [24] (10.2106/jbjs.24.00048)
  • [L3] Patient-reported functional outcomes at 6 months were significantly lower in the fracture group compared to osteoarthritis and rheumatoid arthritis groups. [25] (10.1016/j.jse.2026.01.019)
  • [Paper] The book 'Monoclonal antibodies, cytokines, and arthritis' presents the latest concepts regarding the molecular biology and immunology of arthritides, as well as a new rationale for treatment. [26] (10.1016/0363-5023(93)90283-9)
  • [L4] FPL rupture in patients with RA gives short term dysfunction but, in most cases, not substantial medium-term dysfunction. [27] (10.1016/j.hansur.2020.08.002)
  • [L4] In vivo, mechanically impaired tendons may play an important role in destabilization of the wrist in patients with rheumatoid arthritis. [28] (10.1002/jor.1100160412)
  • [L4] These findings contrast with rheumatoid arthritis, where mineralization is maintained and there is no predominant periarticular osteopenia. [29] (10.1016/j.hansur.2018.10.169)
  • [L3] This provides important evidence for selecting surgical methods in rheumatoid osteoarthritis. [30] (10.1186/s13018-026-06703-9)
  • [L4] The results of our survey suggest that there is limited knowledge of anti-TNFa and no consensus of opinion amongst hand surgeons performing rheumatoid surgery in the UK with regard to its perioperative use. [31] (10.1016/j.jhsb.2006.04.006)
  • [L4] Rheumatoid patients with diabetes had an increased risk of wound infection (33%) compared with patients without (3.3%). [33] (10.1053/jhsu.2002.32958)
  • [L4] Age, disease duration, disease activity score and deformity were associated with the lowest bMHQ scores in RA patients. [34] (10.1016/j.hansur.2016.09.003)
  • [L3] Shoulder arthroplasty in patients with rheumatoid arthritis reduces pain and improves function. [35] (10.1186/s13018-025-06109-z)
  • [L3] Total knee arthroplasty in patients who have RA yields significant improvement in physician- and patient-reported outcomes. [36] (10.1016/j.arth.2026.03.021)
  • [L5] Although there is good reason to intervene early in the disease there are no long-term studies with sufficient control to provide clear evidence of significant long-term benefits from synovectomy. [37] (10.1016/0266-7681(92)90125-l)
  • [L4] Hand involvement in psoriatic arthritis differs from rheumatoid arthritis, characterized by stiffness and spontaneous fusion rather than instability. [38] (10.1016/s0363-5023(82)80090-7)
  • [L3] In view of the paucity of long-term results for TER, RHES may retain a role in younger patients or in those whose symptoms are related mainly to the radiohumeral joint. [39] (10.1016/s1058-2746(99)90147-7)
  • [L3] Inflammatory arthritis represents a distinctly morbid risk profile compared to osteoarthritis patients with multiple increased surgical and postoperative medical complications in patients undergoing aTSA and rTSA. [40] (10.1016/j.jse.2023.09.014)
  • [L4] This supports the concept that the ongoing rheumatoid process is responsible for the translocation. [41] (10.1016/j.jhsb.2003.10.007)
  • [L4] When subjects with rheumatoid arthritis were analyzed, it was determined that early in the disease process bone erosions may occur in the sigmoid notch of the distal radius. [44] (10.1016/s0363-5023(05)80140-6)
  • [L5] The severe joint destruction that subsequently occurred may have been the result of prolonged sepsis, development of an autoimmune response to Candida breakdown products, or a combination of these factors. [45] (10.1016/s1058-2746(05)80041-2)
  • [L4] In parallel, the density of synovial cells increased after synovectomy in all control subjects and six of eight RA patients, which is indicative of a wound healing response. [46] (10.1002/jor.21233)
  • [Paper] Inflammatory arthritis has a substantial effect in producing intracortical defects in metaphyseal bone, but the bisphosphonate zoledronate was considerably effective in preventing these changes from occurring. [47] (10.1002/jor.1100150610)
  • [L4] Type II collagen was present in all attachment zones, although there was little in rheumatoid fingers. [48] (10.1016/0266-7681(93)90067-p)
  • [L4] Juvenile rheumatoid arthritis seldom involves the small joints of the hand, but proximal interphalangeal joint synovitis can be the initial manifestation. [49] (10.1016/s0363-5023(86)80148-4)
  • [L5] All care plans should be made with thoughtful consideration to the patient's other joint involvement, functional needs, and their lifestyle. [50] (10.1097/00130911-200003000-00010)
  • [L1] Supervised HIIT and strength exercise appear to be feasible and well tolerated by patients and could be recommended to improve cardiovascular and physical health in patients with well-controlled RA. [51] (10.1136/bjsports-2024-108369)
  • [L5] In all facets of treatment or evaluation, the rheumatoid patient must be handled gently with respect of tissue response and pain. [52] (10.1016/s0894-1130(96)80074-3)
  • [L5] Tectochrysin may be a novel RA therapeutic agent, likely acting via macrophage JAK/STAT pathway inhibition, with promising clinical potential. [53] (10.1186/s13018-025-06481-w)
  • [L3] Two-thirds of patients with rheumatic conditions visiting a multidisciplinary hand clinic reportedly followed the treatment advice (recommendations), with an overall trend toward a beneficial effect on hand function. [54] (10.1197/j.jht.2007.04.004)
  • [L2] Among patients with RA undergoing elective hand surgery, perioperative bDMARD continuation was not associated with significant increases in risks of wound healing failures or SSIs. [56] (10.1016/j.jhsa.2026.03.003)
  • [L4] In rheumatoid arthritis trials, grip strength should be assessed at the same time of the day. [57] (10.1016/s0363-5023(09)91074-7)
  • [Paper] No outcome studies on the effectiveness of joint protection programs for unstable MCP joints in RA were found. [58] (10.1197/j.jht.2006.04.009)
  • [L1] There is preclinical evidence for an antioxidant, anti-inflammatory, antinociceptive, cartilage- and bone-protective effect of CT in RA and OA. [59] (10.1530/eor-23-0133)
  • [L4] Single-digit swelling may be a presenting feature of JRA in 18% of cases. [60] (10.1016/s0363-5023(97)80124-4)
  • [L4] The severity of the patient's disease and the degree of articular involvement had a great effect on the outcome of surgery. [63] (10.1016/0363-5023(88)90260-2)
  • [L4] Radiologic examination showed that all patients exhibited resorption of the distal ulna (mean 4.4 mm) and that resorption was worst in the group with rheumatoid arthritis. [65] (10.1016/0363-5023(90)90099-d)
  • [L5] The use of contrast arthrography can provide evidence as to the presence and prominence of rheumatoid synovitis at the elbow. [67] (10.1016/0266-7681(86)90032-x)
  • [Paper] These results show that invasive tenosynovium is more destructive than encapsulating tenosynovium at a molecular level, providing an explanation for the increased tendon rupture associated with invasive tenosynovitis in RA. [68] (10.1053/jhsu.2002.36516)
  • [L4] Although the Kudo type-5 prosthesis demonstrated satisfactory results in patients with RA, failures occurred to some extent over a long-term follow-up period. [70] (10.1016/j.jse.2024.10.025)
  • [L4] Overall functional results often were affected by the status of disease in other joints, but in general were acceptable. [71] (10.1016/s0363-5023(78)80002-1)
  • [L5] Surgery of the rheumatoid hand must take account of the severity of the disease, with sero-positive patients with high sedimentation rates being informed about and trained in principles of joint protection before operation. [72] (10.1016/0266-7681(89)90078-8)
  • [L2] Understanding which factors are associated with choosing rheumatoid hand reconstruction is an essential component of patient preoperative counseling. [73] (10.1016/j.jhsa.2005.10.005)
  • [L4] It is shown that overall there is a significantly lower incidence of Dupuytren's features in patients with rheumatoid diseases, than there is in random control patients. [74] (10.1016/s0266-7681(84)80020-0)
  • [L5] Clinical and radiological assessments at 22 months of follow-up revealed good outcomes. [75] (10.1016/j.main.2015.02.004)
  • [L4] Despite some deterioration of the results during the long-term follow-up, we found that this method of prosthetic replacement of the MP joints in RA is useful. [78] (10.1016/s0363-5023(86)80138-1)
  • [L4] Radiolunate arthrodesis in patients with RA maintained good clinical results and corrected alignment, even during long-term follow-up. [79] (10.1016/j.jhsa.2022.11.014)
  • [L4] The results appear durable at long term followup. [80] (10.1016/s1058-2746(96)80507-6)
  • [L4] The long-term clinical results of elbow interposition arthroplasty in rheumatoid arthritis are good in terms of pain relief but only fair in terms of joint mobility and stability and as a whole are probably inferior to those of total elbow replacement. [81] (10.1016/s1058-2746(96)80001-2)
  • [L3] Bone destruction in both the humerus and the olecranon appears to be a late consequence of rheumatoid elbow involvement. [82] (10.1067/mse.2002.123903)
  • [L4] The distal radioulnar joint showed a rapid increase in Larsen score and was involved in 78% of patients on late x-rays. [83] (10.1053/jhsu.2003.50070)

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g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.