Home > Hand CareArthritis for the Hand
Arthritis is the name of any of more than 300 inflammatory joint disorders.
What is Arthritis of the Hand?
The two most common types of arthritic disease to affect the hands are osteoarthritis and rheumatoid arthritis. Arthritis in some form is suffered by more than 31 million people of all ages. Children are sometimes affected by juvenile rheumatoid arthritis, also known as Still¡¯s Disease.
Osteoarthritis, or degenerative joint disease, most commonly affects the elderly. As its name suggests, the joints begin to degenerate, often simply as a result of the aging process. The cartilage cushioning the surfaces of bones begins to wear out, causing crepitation, or the grinding of bones against each other. Osteoarthritis usually strikes the weight-bearing joints first (the knees, hips, and spine), putting those who are overweight at risk.
Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes pain, stiffness, and swelling in the joints, usually in a symmetrical pattern (if one hand has it, the other one will also). In RA, the joint lining (synovium), normally smooth and shiny, becomes inflamed, painful and swollen. The disease, which lasts over a long period of time, can cause damage to cartilage, bone, tendons and ligaments. RA can also cause inflammation in the blood vessels and the outer lining of the heart and lungs.
Rheumatoid arthritis often results in deformities of the hand and the destruction of smaller joints of the body. It frequently develops in the prime of life, affecting more women than men. Because it tends to flare up periodically and then progress variably over time, this disease requires long-term systemic management.
Causes of Arthritis of the Hand?
The cause of primary arthritis is not known. Secondary arthritis is sometimes the long-term result of joint injuries, mechanical trauma, or preexisting lesions. Sometimes arthritis develops as the result of an infection in a joint, resulting in septic arthritis.
Symptoms of Arthritis of the Hand?
All arthritic conditions of the hand result in stiffness, swelling, and the loss of motion in the fingers. With osteoarthritis, the distal interphalangeal (DIP) joint at the tip of the finger and the proximal interphalangeal (PIP) joint at midfinger are most often involved. Osteoarthritis of the hand is characterized by bony nodules in the joints of the fingers:
Heberden's nodes are bony nodules in the DIP joint. These may be red, swollen, and painful as they develop, but the pain usually resolves over time.
Bouchard's nodes are nodules at midfinger, in the PIP joint.
With degenerative joint disease, there is usually little or no damage
to the metacarpophalangeal (MP) joint at the base of the finger, unless there has been previous trauma to the hand.
Rheumatoid arthritis usually affects the metacarpophalangeal (MP) joints. It also damages the joint at the wrist. Tenosynovitis, an infection affecting the synovial lining of the tendon sheaths, is often present as well. There is frequently symmetrical involvement of the joints (if it affects one hand, it will most likely affect the other hand). Other symptoms include:
Spindle-shaped (fusiform) swelling of multiple joints, with some more swollen than others.
A boggy mass over the back of the hand.
Crepitation with movement, indicating the destruction of cartilage.
Drift of the fingers away from the direction of the thumb at the MP joint (ulnar drift).
Contracture of the fingers at the PIP joints.
Swan neck deformity or hyperextension at the PIP joint with flexion at the DIP joint.
Treatment of Arthritis of the Hand?
- If you are suffering from some form of arthritis of the hand, consult a doctor for tests, diagnosis, and pain management. Treatment is generally aimed at relieving painful symptoms and controlling the inflammatory process.
- Your doctor will inquire about your medical history and any other previous or persistent conditions affecting the hands, arms, and other joints of your body. X-rays of the hand in various positions can help locate the problems within particular joints. Blood studies help identify rheumatoid arthritis.
- Doctors routinely prescribe NSAIDs (non-steroidal anti-inflammatory drugs) or other salicylate drugs such as aspirin for osteoarthritis. Sometimes a joint is splinted temporarily to assist in pain relief.
- There is no cure for rheumatoid arthritis. Cortisone injections directly to the hand can be very helpful in relieving pain and improving flexibity, and they are sometimes given in addition to the systemic rheumatoid treatment. Cortisone (a steroid drug) must be used judiciously, however, both because it appears to be less effective over time, and because it may cause the rupture of a tendon, especially an extensor tendon in a finger. Injections of gold compounds, hydroxychloroquine, penicillamine, and immune suppressents are also widely used.
Patients with ulnar drift of the fingers at the MP joint are often fitted with a special splint. Wearing the splint can slow the deformation process but not prevent it from occurring.
- Hand surgery for patients with various forms of arthritis has progressed rapidly in recent years. Sometimes surgery is recommended, especially if it can stabilize the joints and deliver pain relief. This surgery should always be done by an experienced hand surgeon, who can discuss specific procedural options with you. Many surgical procedures are now performed on an outpatient basis, requiring only local anesthesia.
- Living with any form of arthritis requires pain management and lifestyle adjustments. Very often occupational and recreational changes are required. Gentle physiotherapy can be helpful, as can whirlpool treatments and the application of heat. Many people benefit from hot wax treatments, in which the hands are exercised gently within a bowl of soft warm wax. Heat increases the flow of blood and nutrients to the hands. The application of ice to the joints can also be beneficial.
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