The first symptoms of rheumatoid arthritis are warmth and moisture of the hands. Pain and stiffness of the fingers then occurs. The wrist is also often affected at the radioulnar joint or one of the tendon sheaths. On examination, there may be swelling of the metacarpophalangeal and PIP joints. There is more or less symmetrical involvement of both hands. There is diminished joint mobility and grip strength.
As the disease progresses the characteristic deformities associated with rheumatoid arthritis affecting the hand become present, e.g. swan neck and boutonniere deformities, ulnar deviation of the fingers. If these deformities become fixed then the patient may need help with activities involving fine finger movements, e.g. washing, dressing and feeding.
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