Arthritis of the Hand
Simply defined, arthritis literally means “inflamed joint” and may include one or more of the joints. The most common types of arthritis are osteoarthritis and rheumatoid arthritis, however, there are more than 100 different forms. Arthritis can also occur in many areas of the hand and wrist and often has more than one cause.
Healthy joints move easily because of a smooth, slippery tissue called articular cartilage. Cartilage covers the ends of bones and provides a smooth gliding surface for the joint. This smooth surface is lubricated by a fluid with a similar consistency of oil and is produced by the joint lining called the synovium.
Arthritis can affect any of the body’s joints, but it is most noticeable when it affects the hands and fingers. Arthritis of the hand can be both painful and disabling and impacts the myriad hand bones (totaling 27) and the two forearm bones that form the wrist.
The hand and wrist have multiple small joints that work together to produce motion, including the fine motion needed to pick up objects or tie a shoelace. When the joints are affected by arthritis, activities of daily living can be difficult.
Over time, if the arthritis is not treated, the bones that make up the joint can lose their normal shape. This causes more pain and further limits motion.
The most common forms of hand arthritis are osteoarthritis, arthritis caused by trauma (post-traumatic arthritis), and rheumatoid arthritis. Other causes of arthritis of the hand include infection, gout and psoriasis.
Osteoarthritis affects a large majority of the population, especially older people. Women are usually affected more than men and often at an earlier age. X-rays reveal joint destruction in approximately 60% of adults over age 60 and 80% to 90% of patients over age 75. Also known as “wear and tear” arthritis, osteoarthritis causes cartilage to wear away.
Rheumatoid arthritis is a chronic disease that can affect many parts of the body. It causes the joint lining (synovium) to swell, which causes pain and stiffness in the joint. Rheumatoid arthritis most often starts in the small joints of the hands and feet, usually affecting the same joints on both sides of the body.
Affecting about 1% of the adult population, women are three times more likely than men to develop this disease. Though it may strike persons of any age, it typically begins between ages 20 and 40 years.
When arthritis occurs due to disease, the onset of symptoms is gradual and the cartilage decreases slowly. The two most common forms of arthritis from disease are osteoarthritis and rheumatoid arthritis.
Trauma is another cause of arthritis. Even when properly treated, an injured joint is more likely to suffer arthritis over time. Fractures, particularly those that damage the joint surface and dislocations are among the most common injuries that lead to arthritis.
Symptoms of arthritis from any cause can include:
- Stiffness, pain and swelling are common to all forms of hand arthritis. Osteoarthritis may result in bony nodules commonly known as Bouchard’s nodes when they are found in the middle joints of fingers or Heberden’s nodes when the nodes are in the joints closest to the fingernail.
- Swelling and a bump at the base of thumb where it joins the wrist.
- Grip and pinch strength diminished.
- Loss of motion in the joint as arthritis progresses. However, sometimes as motion is lost, pain is lessened.
- Joint motion that is accompanied by grinding, clicking, or cracking as the cartilage continues to wear down.
- Joints that swell and often become red and tender to the touch. This is a sign of damage to the tissues surrounding the joint. Deformity occurs as these stabilizing soft tissues are worn away.
- Weakness that results from joint pain, loss of motion and joint deformity.
- Adapting, limiting or stopping the activities that are causing pain
- Splinting the affected joint for short periods of time. Splinting keeps the joint still, which helps reduce pain.
- Applying heat/ice to reduce pain and swelling
- Taking anti-inflammatory medicines to reduce pain and swelling. Prescription drugs are available for osteoarthritis and rheumatoid arthritis.
- Injecting joints with cortisone preparation to relieve symptoms. This works temporarily and can be periodically repeated.
- Movement of the joints through gentle exercise on a daily basis
While arthritis in the hands and wrists is common, it can be a painful, functionally limiting disorder. Many treatments are available to reduce symptoms and help patients. Newer medications available for the treatment of rheumatoid arthritis have led to a significant reduction in the severe hand deformities that these diseases can cause when left untreated.
In the absence of a solution with medications and other non-invasive techniques, surgical treatments for osteoarthritis and rheumatoid arthritis can provide pain relief and allow patients to return to many daily activities.
Deformity, loss of motion and pain that is not adequately controlled are the main reasons for surgery. Surgery is also recommended in some patients with inflammatory arthritis. In these patients, the surgery stabilizes joints and prevents tendon damage. Surgical options include a variety of reconstructive procedures as well as joint fusion.