Some people with RA may be at increased risk for these deformities. For example, high levels of the inflammatory marker C-reactive protein (CRP) and a high rheumatoid factor (RF) may be risk factors. RF is an auto-antibody that is present in the majority of people with RA in varying amounts.

“Bone deformities are a sign of joint damage that is ultimately related to erosion of the joint structures,” explains David Pisetsky, MD, PhD, chief of rheumatology at Duke University Medical Center in Durham, N.C. “These are the end result of damage to the joint structures including the ligaments.”

If there is joint damage, there could be deformity, but the goal of RA therapy is to avoid this damage. “I don’t see deformities anywhere near as frequently,” Dr. Pisetsky says.

Treating Bone Deformity in RA

If joint or bone deformities do occur, however, treatment is available.

“If there is joint damage in the hands, we intervene earlier to prevent ligaments and tendons from getting eroded,” Dr. Pisetsky says. The reason that rheumatologists take finger and hand deformities so seriously is because hands are integral to daily functioning. You need your hands to do everything from writing and cooking to getting dressed and brushing your teeth.

Michael E. Weinblatt, MD, codirector of clinical rheumatology at Brigham and Women’s Hospital, division of rheumatology, immunology and allergy, in Boston, adds, “In patients with severe hand disease, it’s important that their rheumatologists refer them to an occupational therapist to provide an exercise program, as well as splinting, to improve function and perhaps, decrease the potential for deformity.”

Other treatment options include silver rings that serve as finger splints for finger deformities. These devices can help keep the fingers stable and stave off any hyperextension. “There was a lot of splinting that went on in the past for these deformities, but we don’t see that so much anymore,” Dr. Pisetsky says.

In extreme cases, finger joint replacement surgery is needed to correct some RA finger deformities. Your metacarpophalangeal joints are the knuckles that join your fingers to your hand. If this joint becomes deformed by RA, it can affect your ability to manipulate your fingers, and surgery may be recommended. Finger replacement surgery uses artificial joints to replace damaged joints. Dr. Weinblatt stresses that joint replacement surgery is NOT a cure; it is only therapeutic.