Rheumatoid arthritis is a long-term chronic inflammatory disease in which the immune system attacks the joints as a result of an autoimmune disorder. This inflammatory disease causes joint deformities, pain and dysfunction. The highest incidence is in people between the ages of 35 and 50, with significantly more women than men. Although family inheritance can be an important factor in the development of the disease, many patients do not have a clear family history of inheritance. Current theories suggest that rheumatoid bone is an autoimmune disease with an unexplained trigger of an overactive immune response to the body’s own. It causes destruction of bone and joint tissue by triggering synovial inflammation and hyperplasia and releasing a variety of molecular mediators, including tumor necrosis factor-alpha (TNF-alpha), multiple white mediators, transforming growth factor-beta, fibroblast growth factor, and platelet-derived growth factor. Direct invasion of cartilage, subchondral bone and osteoarthritis occurs through synovial inflammation. The hands with rheumatoid arthritis The hands are one of the areas well invaded by rheumatoid arthritis. Although rheumatoid can develop symmetrically, in the early stages of the disease, the affected joints can be asymmetrical. The fingers will usually be biased toward the little finger (i.e., ulnar side). The metacarpophalangeal joints appear painful and subluxated. Button deformity (i.e. hyperflexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint) and gooseneck deformity (hyperextension of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint) occur in the interphalangeal joints. The thumb may develop into a Z-shaped thumb deformity. Rheumatoid arthritis may also involve the wrist, forearm, and elbow joints, which can have a serious impact on life. Diagnostic criteria The American College of Rheumatology defined rheumatoid arthritis in 1987 as the following: 1. morning stiffness; 2. arthritis in 3 or more joints; 3. arthritis in the metacarpophalangeal, wrist and proximal interphalangeal joints; 4. symmetrical arthritis; 5. rheumatoid nodules; 6. positive rheumatoid factor; 7. radiographic (X-ray) testing.