Rheumatoid arthritis (RA) stands as the most common autoimmune systemic inflammatory joint disease, typically manifesting between ages 30-60 and affecting women 2-3 times more frequently than men. While medical management through disease-modifying antirheumatic drugs (DMARDs) and biologics remains the cornerstone of treatment to limit joint involvement and prevent organ damage, orthotic intervention plays a crucial role in hand symptom management.

Feehan et al. (2023) suggest that as RA symptoms fluctuate throughout the day and across disease stages, our orthotic approaches must be equally dynamic and versatile to accommodate this fluctuation and the functional needs of our patients. This is where relative motion orthoses (RMOs) present a compelling therapeutic option for the management of symptoms caused by RA.

Initial Presentation

The earliest manifestations of RA typically affect the smaller joints of the hands, presenting with pain and swelling. During this acute phase, protective or resting orthoses have traditionally been the standard approach for symptom management.

Disease Progression

As the condition advances, patients commonly experience:

Decreased grip and pinch strength
Reported hand instability during functional tasks
Variable pain and swelling patterns
Progressive joint deformities

Common Presentations of RA in the Hand

Therapists should be aware of these joint deformities:

Ulnar drift at the MCP joints
PIP hyperextension leading to swan-neck deformity with dynamic instability, clicking, snapping, or locking
PIP extensor tendon disruption with potential for boutonniere deformity

And these common presentations:

PIP lateral instability
Sagittal band laxity
Trigger finger at the A1 pulley
Localized tenderness and thickness along tendon sheaths
Morning stiffness and post-inactivity rigidity

Moving with Rheumatoid Arthritis: How Relative Motion Orthoses Support Hand Function

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