Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that can damage joints and lead to joint deformities. Joint deformities occur when the joints lose their shape and alignment. Deformities can lead to a loss of joint function and disability.

Although there’s no cure for RA, medications and treatments can slow its progression, including the development of joint deformities. If a joint deformity occurs, you may benefit from treatments to manage the associated chronic inflammation and symptoms. Joint replacement surgery may become necessary if there’s too much damage.

How Does Rheumatoid Arthritis Cause Joint Deformities?

Healthy joints are lined with a specialized membrane known as the synovium. The synovium produces synovial fluid that lubricates and protects the joints. In RA, immune cells attack the synovium and release certain proteins called cytokines that cause inflammation. This process causes symptoms like pain and swelling.

When inflammation occurs in the lining of a joint, the lining can increase in its size and become thick, rough, and uneven. This is called pannus. The inflamed pannus tissue needs somewhere to go, so it pushes between the joints and can even try to cover the surface of the bones.

The pannus releases chemicals that break down cartilage and bone. This produces erosions and can damage the joints and ligaments. The affected joints have many specialized bone cells called osteoclasts, which release proteins and acids that wear away the bone. The pannus can also produce too much synovial fluid, which contributes to joint swelling and pain.

Over time, this inflammation and damage can lead to joint deformities.

Which Joint Deformities Are Common in Rheumatoid Arthritis?

Rheumatoid arthritis typically affects the small joints in the hands, feet, and wrists. In the hands, the metacarpophalangeal joints (joints where the fingers meet the hand) and the proximal interphalangeal joints (joints in the middle of the fingers) are most often affected. The distal interphalangeal joints (outermost joints near the tips of the fingers) are not usually affected.

Several types of joint deformities may result, including the following:

• Boutonniere deformity — The middle joint of a finger becomes bent and won’t straighten, while the tip of the finger bends backward.
• Swan-neck deformity — The base of the finger and the outermost finger joint bend in, while the middle joint straightens out.
• Hitchhiker’s thumb — The thumb knuckle flexes outward abnormally, while the outermost thumb joint hyperextends. It’s also known as a Z-thumb because it creates a Z shape.
• Ulnar drift — Also known as ulnar deviation, this condition occurs when the fingers angle away from the thumb toward the ulna bone in the forearm. Ulnar drift is a sign of severe damage to the knuckles of the fingers.
• Claw-toe deformity — The toes bend either upward or downward from the joints at the ball of the foot. Sometimes, the toes may also bend and curl under the foot.

• Rheumatoid nodules — Rheumatoid nodules are firm lumps that develop in the bony joints of people with RA.

Can RA Joint Deformities Be Prevented?

There are currently no medications to prevent or cure rheumatoid arthritis, but there are drugs that can help reduce inflammation or even slow or stop disease progression. Disease-modifying antirheumatic drugs (DMARDs or conventional DMARDs) help slow disease progression. These drugs work by targeting inflammation at its source to help stop further joint damage and prevent disability.

Biologics are drugs that block specific immune cells or inflammatory proteins to dampen the immune system and decrease inflammation. These drugs are good at slowing or stopping disease progression. They may be used in addition to conventional DMARDs in certain conditions when conventional DMARDs don’t work enough.

Targeted synthetic DMARDs alter the signals from cells responsible for maintaining inflammation. By blocking these signals, they help decrease inflammation and slow disease progression. These medications may be used if conventional DMARDs don’t work well enough. Keep in mind that they can cause serious side effects and may carry higher risks for people over 65 or people with certain heart conditions.

Steroids (also known as corticosteroids) can also be used to manage acute symptoms of RA while reducing inflammation. Steroids work by mimicking the action of cortisol, the natural stress chemical that reduces inflammation. Your rheumatologist may prescribe corticosteroids to help manage RA symptoms for a short period while waiting for DMARDs or other medications to begin working.

How Are Joint Deformities Treated?

An RA treatment plan may help prevent joint deformities. However, once RA deformities occur, treatments mainly focus on controlling swelling and other symptoms, as well as preventing new deformities. Sometimes, surgery can address joint pain and help people with joint deformities regain some functionality.

Occupational Therapy

Joint deformities can limit the ability to use your hands and feet, making many tasks difficult. An occupational therapist can work with you to develop an exercise program to help improve function and slow the progression of deformities related to RA. The therapist may also suggest using splints to stabilize the affected joints in the hands, wrists, and fingers.

Surgery

If medications aren’t effective or if there’s too much joint damage, surgery may be a good treatment option. Surgery won’t cure RA, but it can remove and replace damaged joints and tissues to help you recover some use of those joints. Your healthcare provider may suggest one of several surgery options.

Total Joint Replacement

In this surgery, damaged joints or parts of joints are removed and replaced with synthetic parts. This is a major surgery that usually includes a hospital stay and months of rehabilitation to be able to use the joint effectively.

Most replacement joints last for between 10 and 20 years. You may have to have the same surgery again if your prosthetic joint wears out. Depending on the joint and the type of damage, you may not get full use of your joint even after it’s replaced.

Arthroscopy or Synovectomy

In this procedure, a surgeon removes the parts of your joint tissue that are inflamed and damaged. They do this by making a small incision in your skin and inserting a small camera with a light. It’s not as invasive as a joint replacement, so you usually don’t have to stay overnight in a hospital. You should, however, plan to rest at home for at least a few days. You may need to rest your affected joints longer if your doctor instructs you to.

Joint Fusion

If your healthcare provider suggests this surgery, they’ll remove a damaged joint and join the bones together. You won’t have the movement that you’re used to in the joint, but it should be more stable, and you should experience less pain. Keep in mind that in order to have this procedure, your opposite joint should be in good health to help maintain mobility. If you can’t have a joint replacement or your doctor doesn’t recommend it, this procedure may help you feel better.

While joint deformities from RA can impact your daily activities and quality of life, there are treatment options to help you. Talk to your rheumatologist or another healthcare provider about your options for recovery and how to prevent further joint damage with RA.

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