Rheumatoid arthritis pins and needles

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disorder that is characterized by inflammation, pain, and loss of function in the joints. It most often affects the wrist and hand, but sometimes it affects the elbows, shoulders, neck, knees, hips or ankles. The swelling, inflammation and damage to the joints occur when the body’s immune system attacks the tissue around the joints. Although not as common, rheumatoid arthritis may affect other parts of the body besides the joints. Rheumatoid arthritis may flare up and suddenly go into remission, or it can be a constant debilitating and painful condition.

Some rheumatoid arthritis patients will develop carpal tunnel syndrome or other mild forms of peripheral neuropathy. Symptoms tend to appear bilaterally, meaning that both sides of the body (i.e. both hands or both knees) are impacted in a similar way.

The cause of rheumatoid arthritis is unknown, but researchers believe that there are genetic, environmental and other factors that trigger the disease. Onset usually occurs in middle age, and is more likely to develop in women. Approximately 10 to 15 percent of patients suffering from rheumatoid arthritis will also develop Sjögren’s syndrome, an inflammatory disorder characterized by dryness in the eyes and mouth.

Early detection of rheumatoid arthritis positively impacts the ability to treat this disease and its symptoms. Early treatment may reduce the potentially crippling damage caused to bones. Unfortunately, rheumatoid arthritis is sometimes difficult to detect and diagnose because the symptoms vary from person to person and there is no one definitive test for the disease.

Symptoms & Signs

(Not all symptoms and signs may be present.)

  • Anemia
  • Fatigue, at times accompanied by fever
  • Loss of appetite
  • Tender, warm or swollen joints
  • Difficulty moving affected joints
  • Pain and stiffness
  • Stiffness
  • Rheumatoid nodules (lumps under the skin)

Evaluation & Tests

(Not all evaluation and tests may be necessary.)

  • Neurological exam
  • Electromyography
  • Nerve conduction velocity test
  • X-ray to determine joint damage
  • Blood tests (for presence of rheumatoid factor antibody, anemia and to measure white blood cell count)

Treatment & Therapy

(Not all treatments and therapies may be indicated.)

Treatment focuses on relieving pain by reducing inflammation, slowing joint and bone damage and improving the ability to function with the disease.

  • Rest and exercise programs
  • NSAIDs (aspirin, ibuprofen and Aleve®) to reduce joint inflammation and pain
  • Disease modifying anti-rheumatic drugs (DMARDs) to suppress the immune system and slow the onset of the disease (hydroxychloroquine (Plaquenil®), methotrexate (Rheumatrex®, Trexall®), leflunomide (Aravara®)
  • Surgery may be considered to replace or repair severely damaged joints and tendons
  • Take safety measures to compensate for loss of sensation
  • Ask your doctor about special therapeutic shoes (which may be covered by Medicare and other insurance)

Hand Numbness With Rheumatoid Arthritis: Symptom or Complication?

You might say it feels like pins and needles, a tingling, or as if a hand has gone to sleep.

While people with rheumatoid arthritis (RA) often experience these signs of numbness, especially in their hands, the sensations are not directly related to rheumatoid arthritis. Sometimes these symptoms are related to an RA complication: carpal tunnel syndrome, a painful condition caused by compression of the median nerve, which runs from the wrist to the fingers.

Carpal tunnel syndrome is somewhat common among those with RA; as many as 5 percent of people with RA will develop it.

So what’s the connection?

Think of it as a cascade or domino effect: A person has RA in her wrist and inflammation develops, which can lead to swelling in the lower arm or hand. Together, the inflammation and swelling increase pressure on the median nerve. Over time, the median nerve is compressed to the point that it partially or completely blocks the nerve and the impulses traveling through it. This can result in a mild to severe tingling, burning, or a numb feeling, as well as weakness, a loss of sensation, or even — in extreme cases — a loss of function.

Ask your rheumatologist about any numbness as soon as possible, and be prepared to answer questions, says Eric Ruderman, MD, professor of medicine-rheumatology at Northwestern University’s Feinberg School of Medicine in Chicago. Your rheumatologist will want to know about:

  • Location: Where do you feel numbness, specifically? In your wrist, palm, or certain fingers?
  • Timing: How frequently do you feel it? Is it sustained, or does sensation come and go?
  • Duration: How long do numbness episodes last?
  • Typical circumstances: Do you feel it more when you do certain activities, such as driving, typing, texting, or using a hair dryer?

Your rheumatologist might diagnose and treat you, or send you to a neurologist or orthopedic surgeon who specializes in treating such issues in the hands.

Is My Hand Pain Caused by Arthritis or Carpal Tunnel Syndrome?

Let’s say you wake up to find your hand numb and tingly. Did you sleep on it wrong? Is it your arthritis acting up? Or could it be carpal tunnel syndrome (CTS)?

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Carpal tunnel syndrome is one of several conditions that either results from or shares symptoms with inflammatory arthritis. Conditions Related to Inflammatory Arthritis

Both arthritis and CTS are potential culprits for hand pain and numbness. Arthritis raises the risk for carpal tunnel syndrome. Plus, CTS symptoms can be very similar to arthritis symptoms, so it’s important to know the characteristics of this condition.

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What is carpal tunnel syndrome?

The narrow space that’s formed between the bones and ligaments in the center of your wrist is called the carpal tunnel. The median nerve—which controls the sensation in your thumb, index finger, and middle finger—runs through this space.

When the tendons that also run through the carpal tunnel become inflamed, they can irritate the median nerve, causing pain, numbness, and tingling in your hand and arm. This is known as carpal tunnel syndrome.

Unfortunately, both of the most common types of arthritis raise the risk for CTS—particularly rheumatoid arthritis, which causes inflammation of the carpal tunnel tendons. Osteoarthritis of the wrist may be a culprit too.

See When Hand Pain Is Osteoarthritis

Symptoms that are unique to carpal tunnel syndrome

Since arthritis already causes symptoms like pain and tingling of the hand, it can be confusing to distinguish arthritis from carpal tunnel syndrome. However, there are some distinctive symptoms of CTS.

Carpal tunnel syndrome causes numbness and tingling that:

  • Affects your thumb and first 2 or 3 fingers, but not your pinky finger
  • Wakes you up at night or is worse in the morning
  • Gets better if you shake your hand (in the early stages of CTS)
  • Is triggered by holding a phone or driving
  • Is triggered by repetitive motion
  • Extends up your forearm

Carpal tunnel syndrome is treatable with splinting, medications, injections, or (in severe cases) surgery. So don’t hesitate to talk with your doctor if you suspect that your symptoms may be due to carpal tunnel syndrome.

Watch: Treatment for Carpal Tunnel Syndrome Video

There are also several ways to treat symptoms in the hands from arthritis.

See Treatments for Osteoarthritis in Hands

Learn more:

Get a Grip on Rheumatoid Arthritis in the Hands and Wrists

15 Survival Tips for Managing an RA Flare-Up

What Causes Hand Pain and Numbness?

Hand pain accompanied by tingling and/or numbness is typically experienced in only part of the hand, such as the thumb or a few fingers, but it can be felt in the entire hand.

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Three common causes of chronic hand pain and numbness include cervical radiculopathy, carpal tunnel syndrome, and rheumatoid arthritis.

This page reviews some of the more common causes of pain and neurological symptoms in the hand—starting with problems in the neck or cervical spine and comparing with other likely causes.

See All About Neck Pain

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Common Causes of Chronic Hand Pain and Numbness

Three common causes of hand pain and numbness that lingers or becomes chronic include:

  1. Cervical radiculopathy. When a cervical nerve root in the neck becomes inflamed or compressed, such as from a bone spur or herniated disc, neurologic deficits of tingling, numbness, and/or weakness may be felt in the shoulder, arm, hand, and/or fingers. Cervical radiculopathy may sometimes be accompanied by shock-like pain. It is possible for the primary symptoms to be pain and numbness in the hand.

    See What Is Cervical Radiculopathy?

  2. Carpal tunnel syndrome. This condition involves the median nerve becoming irritated or compressed in the carpal tunnel, which is a bundle of tendons and ligaments running through the wrist and into the hand. Carpal tunnel syndrome can feel similar to cervical radiculopathy because both may cause symptoms in the hand and wrist. However, cervical radiculopathy is more likely to be accompanied by other symptoms higher up the arm, such as additional pain, tingling, numbness, and/or weakness.

    See Carpal Tunnel Syndrome vs. Cervical Radiculopathy

  3. Rheumatoid arthritis. This autoimmune disease can cause pain, tingling, and/or numbness in the hands, but it is usually felt symmetrically. So if a certain joint in the left hand is affected, then that same joint in the right hand is also probably affected. Cervical radiculopathy, however, is typically only felt on one side of the body.

    See Hand Pain and Rheumatoid Arthritis on Arthritis-health.com

Sometimes more than one problem can be responsible. For example, if rheumatoid arthritis progresses long enough, the swelling in the wrist can cause carpal tunnel syndrome.

In This Article:

  • Understanding Hand Pain and Numbness
  • What Causes Hand Pain and Numbness?
  • Cervical Radiculopathy Interactive Video

Other Causes of Hand Pain and Numbness

Some other problems that can cause nerve dysfunction—also known as neuropathy—with symptoms of pain and numbness in the hand include:

  • Diabetes. If diabetes progresses or isn’t managed with diet and/or medications, various complications can develop. One of the more serious complications of diabetes is neuropathy. For people who have diabetes, these symptoms of tingling and numbness usually start in the feet, but they can also occur in the hands.

    See Anatomy Of Nerve Pain

  • Vitamin B12 deficiency. Some people don’t get enough vitamin B12, whether through gaps in their diet, inability to naturally absorb enough of it, or as a side effect of a medical condition or treatment. Vitamin B12 is critical for nerve health, so low levels can harm the nerves and result in numbness and/or weakness. If a blood test confirms vitamin B12 deficiency, a doctor might recommend dietary changes or B12 supplements. Beef, fish, eggs, and fortified cereals tend to be good sources of vitamin B12. Vegetarians and vegans can get enough B12 with careful planning.1
  • Alcohol abuse. Excessive amounts of alcohol can harm nerves. The manner in which the nerves are damaged by alcohol isn’t always known, but experts suspect that multiple factors could be at work, including increased difficulties with nutrient absorption and associated poor diet. Long-term alcohol abuse can also increase the risk for vitamin B12 deficiency.2

See Understanding Neuropathy Symptoms

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In addition, various diseases or a traumatic injury to the hand, such as a broken bone or deep cut, could lead to nerve damage that leaves part of the hand painful, numb, tingling, and/or weak. In rare cases, a problem in the brain or spinal cord could also cause hand pain and numbness.

See Spinal Cord Anatomy in the Neck

  • 1.Vitamin B12 Health Professional Fact Sheet. US Department of Health & Human Services, National Institutes of Health website. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional. Updated November 2018.
  • 2.Laufer EM, Hartman TJ, Baer DJ, et al. Effects of moderate alcohol consumption on folate and vitamin B(12) status in postmenopausal women. Eur J Clin Nutr. 2004. 58(11):1518-24

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