People with rheumatoid arthritis (RA) often have symptoms in their wrists. A range of exercises can help reduce these symptoms, which include pain and stiffness.

RA affects over 1.3 million Americans. The hands, wrists, and knees are the areas commonly affected.

In this article, we look at how RA affects the wrists, along with its symptoms, diagnosis, and treatments.

How does rheumatoid arthritis affect the wrists?

RA often causes inflammation in one or both wrist joints, leading to pain and swelling in the area. People also notice joint stiffness, which can impair the movement of the wrist.

The wrist is a complex joint that contains many smaller joints. It is made up of two large bones and eight smaller ones.

RA is a progressive condition that usually starts in small joints, such as the fingers and toes, and in medium joints, including the wrist, before spreading to larger joints. While symptoms are mild initially, they can become very painful.

As it progresses, RA can affect the range of motion and flexibility of the wrist joints. A person with the condition likely experiences stiffness and a limited range of motion.

Symptoms come and go over time, in episodes called flares. If RA affects one wrist, it is likely to affect the other eventually.

RA can damage the cartilage, which usually cushions the joint and allows it to move smoothly. When the condition breaks down the cartilage, the bones of the joint can rub together, resulting in permanent damage.

This can cause further problems. For example, the tendons responsible for movement in the fingers can rupture, preventing a person from fully extending their fingers.

Symptoms of RA in the wrists

RA can cause swelling and pain in the wrist joints. Over time, this inflammation can lead to permanent damage, resulting in changes to the shape of the wrist joints.

A person with RA may also notice nodules forming near the wrists. These are small, firm bumps. Nodules are more likely to develop around other affected joints, such as those in the fingers or elbow.

At first, the symptoms of RA are usually mild. A person may only feel discomfort at certain times, when putting pressure on the wrist joints, such as when making a turning motion with the hand.

In the early stages, the joints' range of motion is usually only mildly restricted.

Over time, the pain becomes more severe and persistent. People may feel discomfort even when they are not having a flare.

Beyond the joint-related symptoms, RA can cause:

• fatigue
• weight loss
• a low-grade fever
• muscle weakness

Diagnosis

To diagnose RA, a doctor will perform a physical examination of the area and take a person's medical history. They will assess physical changes in the wrist and its range of motion.

Doctors may also recommend imaging tests, such as x-rays, ultrasounds, or MRI scans. These will help determine the extent of the damage and the exact locations affected.

Blood tests can show whether a person has RA or another type of arthritis, based on the composition of antibodies in the blood.

Treatment

There is no cure for arthritis, so treatment aims to manage symptoms, reduce pain, prevent joint damage, and increase mobility.

Treatments for RA in the wrists can include:

Reducing pressure on the wrists

Limiting activity that puts pressure on the wrists can be an effective way to reduce pain.

It is difficult to completely avoid using the wrists, but splints and other devices can provide support.

Exercises

It is essential to keep the wrist joints mobile to prevent additional damage.

Exercising the wrists can improve the flexibility, range of motion, and strength in the muscles, which can reduce discomfort.

The following exercises can help:

• Stretching and bending the wrists regularly to promote circulation and improve flexibility and range of motion.
• Squeezing a stress ball every day to keep the tendons in the wrist active and to build up the hand muscles.
• Placing the hands palm-up on the table, flipping them palm-down, then repeating. This will promote strength and flexibility in the wrist.

Other exercises that can help with whole-body symptoms of RA include:

• swimming, as the water supports the body, placing less pressure on the joints
• forms of exercise that involve flowing movements, such as tai chi and yoga
• walking, because it is a low-impact exercise, and people can use canes or walkers, if needed

Physiotherapists can recommend other exercises to improve mobility in the wrists.

Medication

Medications can help relieve pain, reduce inflammation, and slow the progression of RA.

Doctors often recommend nonsteroidal anti-inflammatory drugs (NSAIDs) to control inflammation. This is an important step toward limiting pain and helping to restore the range of motion in the wrists.

Other types of medication that can reduce inflammation include:

• disease-modifying antirheumatic drugs (DMARDs)
• biologic drugs
• painkillers
• corticosteroid injections

Surgery

If RA has caused permanent damage in the wrist joint, or if other treatments have not worked, a doctor may recommend surgery. The aim is usually to remove or replace damaged parts of the joint.

Some types of surgery may involve fusing parts of bone in the joint that are rubbing against each other.

People with RA in the wrist have an increased risk of developing a condition that affects the tendons, called dorsal tenosynovitis.

If inflammation extends to the hands and there is a risk of tendon damage, a doctor may refer a person to a specialist hand surgeon, because ruptured tendons are difficult to manage.

Otherwise, doctors may recommend an injection of steroids into the synovial tissue, which can also be a preventive measure.

Outlook

RA often affects the wrists. As the condition progresses, the symptoms usually become worse, and people may need to use exercises, medication, or a combination of therapies to alleviate the symptoms.

RA is a chronic condition. Over time, it can cause permanent damage and limited mobility in the wrists.

If a doctor detects it early, and a person has the right combination of treatments, RA may cause only mild symptoms for many years.