Therapy for Rheumatoid Arthritis in the Hand

It is easy to take hand function for granted until rheumatoid arthritis causes pain and swelling in the fingers, thumbs, and wrists. Therapy can help decrease hand pain and improve hand function so that daily activities, such as getting dressed, using a laptop, and sleeping, are more comfortable. Therapy can also slow down or prevent joint damage and the development of hand deformities.

Therapy may be provided by a licensed occupational therapist or certified occupational therapy assistant. Physicians often prescribe occupational therapy to patients who have rheumatoid arthritis, but a prescription is not always needed. Rules vary from state to state.

Read more about Hand Pain and Rheumatoid Arthritis

What Occupational Therapists Do

The field of occupational therapy is rooted in helping people participate in any activities that are important to them, including work, hobbies, sports, and everyday tasks, such as driving and household chores.

A professional occupational therapist is trained to:

• Look at the interaction between a person’s body, environment, and required daily activities
• Work collaboratively with patients to improve their ability to perform specific tasks and accomplish goals
• Address both the physical and emotional effects of arthritis and other chronically painful conditions

Occupational therapists’ coursework and professional training place special emphasis on how to recognize and help people coping with emotional and mental health issues.¹Brown C, Stoffel VC, Munoz JP. Occupational Therapy in Mental Health: A Vision for Participation. 2nd Ed. EA Davis Company; 2019.^,2Scheinholtz MK. Occupational Therapy in Mental Health: Considerations for Advanced Practice. 1st Edition. AOTA Press; 2010.^,3Egan BE, Cahill SM (2017). National Survey to Identify Mental Health Topics in Entry-level OT and OTA Curricula: Implications for Occupational Therapy Education. Journal of Occupational Therapy Education, 1 (1). Retrieved from http://encompass.eku.edu/jote/vol1/iss1/6 For example, an occupational therapist can suggest ways to decrease the stress and fatigue associated with autoimmune arthritis. Such guidance can boost an individual’s sense of well-being and improve their quality of life.

See Hand Rheumatoid Arthritis Signs and Symptoms

This article discusses 5 ways occupational therapy can help people who have rheumatoid arthritis symptoms in their hands. It also includes instructions for several hand exercises that may be done at home.

1. Protect the Hand from Pain and Deformities

Using specific strategies and techniques to protect the joints may decrease hand pain and prevent deformities from appearing years later.⁴Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil. 2004 Aug;18(5):520-8. PMID: 15293486 doi: 10.1191/0269215504cr766oa An occupational therapist is trained to teach joint-protection techniques.

Joint protection typically involves distributing weight across many joints, rather than putting stress on just one or two joints. For example, a therapist may demonstrate the best way to pick up an infant without hurting the wrists or how to hold a coffee mug without straining the thumb.

An occupational therapist may also recommend other joint-protection strategies and techniques, such as:

• Using warm and cold therapy. Applying a warm compress may ease joint stiffness, particularly in the morning. Applying a cold compress may help relieve discomfort in hot, tender, inflamed joints.

  See Applying Heat vs. Cold to an Arthritic Joint

• Preventing and adapting to deformities. Once a deformity has occurred it cannot be reversed. However, an OT can help a person recognize a developing deformity and suggest ways to possibly prevent it or slow down its progression, which may include splinting (see #4 below).
• Wearing compression gloves. An occupational therapist can suggest gloves that provide gentle compression, which may reduce swelling and pain in the hand joints.⁵Nasir SH, Troynikov O, Massy-Westropp N. Therapy gloves for patients with rheumatoid arthritis: a review. Ther Adv Musculoskelet Dis. 2014 Dec;6(6):226-37. PMCID: PMC4239152 DOI: 10.1177/1759720X14557474

It is worth noting, not all research studies support the use of compression gloves, and not all therapists will recommend them.⁶Hammond A, Jones V, Prior Y. The effects of compression gloves on hand symptoms and hand function in rheumatoid arthritis and hand osteoarthritis: a systematic review. Clin Rehabil. 2016 Mar;30(3):213-24. Epub 2015 Mar 23. PMID: 25802424. doi: 10.1177/0269215515578296^,7Hammond A, Prior Y, Cotterill S, et al. Clinical and cost effectiveness of arthritis gloves in rheumatoid arthritis (A-GLOVES): randomised controlled trial with economic analysis. BMC Musculoskelet Disord. 2021;22(1):47. Published 2021 Jan 8. PMID: 33419426 doi:10.1186/s12891-020-03917-8 Compression gloves are generally safe to use and a patient can try them and decide if they provide benefit.

2. Cope with the Psychosocial Effects of Pain

Living with hand pain and/or hand deformities can be a frustrating, isolating experience. In addition to suggesting ways to decrease and prevent hand pain, an occupational therapist may help address the mental and social effects of the pain.

Occupational therapists may:

• Use cognitive behavior therapy techniques to encourage helpful thought patterns and behavioral responses to hand pain.
• Address the way hand pain affects relationships. For example, hand pain may affect sexual intimacy or shared, cherished hobbies, such as gardening or dancing.

If appropriate, occupational therapists may also recommend that patients obtain additional guidance from mental health counselors.

3. Use Tips and Tricks to Accomplish Everyday Tasks

One of the advantages of working with an occupational therapist is that they can tailor recommendations for an individual’s habits and home and work environments. Customized recommendations can boost independence, productivity, and confidence.

An occupational therapist may also recommend personalized adaptive equipment, ranging from specially designed scissors to ergonomic computer keyboards. The therapist can help determine what equipment will work best for an individual and demonstrate how to use it.

4. Use Customized Hand Splints

An occupational therapist can perform an in-depth evaluation of the many muscles and structures in the hand and recommend custom or prefabricated orthotic devices, particularly hand splints. Splints can:

• Prevent or discourage certain movements that trigger pain
• Encourage and help maintain hand positions
• Improve the ability to do daily activities

For example, an occupational therapist may recommend a new parent wear a splint to stabilize the thumb and wrist, which can minimize hand pain while picking up and holding a baby.

5. Improve Hand Strength

An occupational therapist may suggest a customized home exercise program to improve hand strength. Research suggests that hand exercise programs:

• Improve hand function, such as grip strength.⁸Lamb SE, Williamson EM, Heine PJ, Adams J, Dosanjh S, Dritsaki M, Glover MJ, Lord J, McConkey C, Nichols V, Rahman A, Underwood M, Williams MA; Strengthening and Stretching for Rheumatoid Arthritis of the Hand Trial (SARAH) Trial Team. Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial. Lancet. 2015 Jan 31;385(9966):421-9. Epub 2014 Oct 9. PMID: 25308290. doi: 10.1016/S0140-6736(14)60998-3^,9Bergstra SA, Murgia A, Te Velde AF, Caljouw SR. A systematic review into the effectiveness of hand exercise therapy in the treatment of rheumatoid arthritis. Clin Rheumatol. 2014 Nov;33(11):1539-48. Epub 2014 Jun 22. PMID: 24952308. doi: 10.1007/s10067-014-2691-2.^,10Rønningen A, Kjeken I. Effect of an intensive hand exercise programme in patients with rheumatoid arthritis. Scand J Occup Ther. 2008 Sep;15(3):173-83. PMID: 19180723. doi: 10.1080/11038120802031129. Performing tasks using the hands may become easier and more comfortable.
• Increase people’s confidence in their ability to successfully accomplish tasks. Having a sense of control over symptoms has positive mental benefits.¹¹Gutman, S. A., Kerner, R., Zombek, I., Dulek, J., & Ramsey, C. A. (2009). Supported education for adults with psychiatric disabilities: Effectiveness of an occupational therapy program. American Journal of Occupational Therapy, 63, 245–254. PMID: 19522133 DOI: 10.5014/ajot.63.3.245^,12Noyes S, Sokolow H, Arbesman M. Evidence for Occupational Therapy Intervention With Employment and Education for Adults With Serious Mental Illness: A Systematic Review. Am J Occup Ther. 2018 Sep/Oct;72(5):7205190010p1-7205190010p10. PMID: 30157005. doi: 10.5014/ajot.2018.033068.
• Will not increase stiffness and pain,⁹Bergstra SA, Murgia A, Te Velde AF, Caljouw SR. A systematic review into the effectiveness of hand exercise therapy in the treatment of rheumatoid arthritis. Clin Rheumatol. 2014 Nov;33(11):1539-48. Epub 2014 Jun 22. PMID: 24952308. doi: 10.1007/s10067-014-2691-2.^,13Srikesavan C, Williamson E, Thompson JY, Cranston T, Swales C, Lamb SE. The online version of an evidence-based hand exercise program for people with rheumatoid arthritis: A mixed-method, proof-of-concept study. J Hand Ther. 2020 Oct 26:S0894-1130(20)30190-3. Epub ahead of print. PMID: 33279362 doi: 10.1016/j.jht.2020.10.011 and may even reduce them.¹⁰Rønningen A, Kjeken I. Effect of an intensive hand exercise programme in patients with rheumatoid arthritis. Scand J Occup Ther. 2008 Sep;15(3):173-83. PMID: 19180723. doi: 10.1080/11038120802031129.^,14Louise Crowley (2009) The effectiveness of home exercise programmes for patients with rheumatoid arthritis: a review of the literature, Physical Therapy Reviews, 14:3, 149-159, DOI: 10.1179/174328809X435277

It is important to get a personalized evaluation and treatment plan from a qualified health care practitioner, such as a licensed occupational therapist or a physical therapist who has special training in the hand. A personalized plan can help maximize benefits and minimize future joint damage.

See Treatments for Rheumatoid Arthritis in Hands

While a personalized hand exercise plan is recommended, a few general exercises are okay for most people with rheumatoid arthritis.