Arthritis of the Hand
Arthritis can affect any joint in the body, but it is most visible when it
strikes the hands and fingers. Each hand has 27 bones plus the two bones of
the forearm that help define the wrist. Joints are created whenever two or more
bones come together, so there is plenty of potential for arthritic problems
in the hand.
Arthritis of the hand can be both painful and disabling. The most common forms
of arthritis in the hand are osteoarthritis and rheumatoid arthritis.
Osteoarthritis of the hand
Osteoarthritis is a degenerative joint disease in which the cushioning cartilage
that covers the bone surfaces at joints begins to wear out. It may be caused
by simple "wear and tear" on joints, or it may develop after an injury to a
joint. In the hand, osteoarthritis most often develops in three sites:
- at the base of the thumb, where the thumb and wrist come together (the trapezio-metacarpal
joint)
- at the middle joint of a finger (the proximal interphalangeal or PIP joint)
- at the finger tip (the distal interphalangeal or DIP joint)
Rheumatoid arthritis of the hand
Rheumatoid arthritis affects the cells that line and normally lubricate the
joints (synovial tissue). It is a systemic condition, which means that it affects
multiple joints, usually on both sides of the body. The joint lining (synovium)
becomes inflamed and swollen. The swollen tissue may stretch the surrounding
ligaments, which are connective tissues that hold bones together, resulting
in deformity and instability. The inflammation may also spread to the tendons,
which are the connective tissues that link muscles and bones. This can result
in tears (ruptures) in the tendons. Rheumatoid arthritis of the hand is most
common in the wrist and finger knuckles (the metacarpophalangeal or MP joints).
Signs and symptoms of arthritis of the hand
Stiffness, swelling, loss of motion, and pain are symptoms common to both osteoarthritis
and rheumatoid arthritis in the hand. With osteoarthritis, bony nodules may
develop at the middle joints of one or more fingers (Bouchard’s nodes)
and at the finger tip (Heberden’s nodes). The joints become enlarged and
the fingers crooked. In rheumatoid arthritis, some joints may be more swollen
than others. There is often a sausage-shaped (fusiform) swelling of the finger.
Other symptoms of rheumatoid arthritis of the hand include:
- a soft, lumpy mass over the back of the hand
- a creaking sound (crepitus) during movement
- a shift in the position of the fingers as they drift away from the direction
of the thumb
- inflammation of the finger tendons, resulting in a permanent bending (Boutonnière)
deformity
- a "swan’s neck" deformity caused by hyperextension (sway-back) at
the middle joint of the finger associated with a bent fingertip
How arthritis of the hand is diagnosed
Your doctor will examine you and ask whether you have similar symptoms in other
joints. X-rays will show certain characteristics of arthritis, such as a narrowing
of the joint space, the formation of cysts or bony outgrowths (osteophytes or
"nodes") and the development of hard (sclerotic) areas of bone. If your doctor
suspects rheumatoid arthritis, he or she may request blood or other lab tests
to confirm the diagnosis.
Treatment options for arthritis of the hand
Treatment is designed to relieve pain and restore function. Treatment decisions
are based on the type of arthritis you have, its progression and its impact
on your life. Anti-inflammatory medications such as aspirin or ibuprofen may
help reduce swelling and relieve pain; prescription medications or steroid (cortisone)
injections may be recommended. Your physician may refer you to a physical or
occupational therapist because changing the way you do things with your hands
may help relieve pain and pressure.
Osteoarthritis treatments
If you have osteoarthritis, your physician may recommend a period of rest.
You may also be advised to wear finger or wrist splints at night and for selected
activities. Surgery is usually not advised unless these treatments fail. Several
surgical options are available:
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Surgery may be used to drain or remove the cysts associated with the
nodes and to remove excess bone growth.
-
Joint fusion (stiffening the problem joint) may be used to correct deformities
that interfere with functioning or that are cosmetically unacceptable.
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A joint replacement may be advised.
Rheumatoid arthritis treatments
If you have rheumatoid arthritis in your hands, medications can help decrease
inflammation, relieve pain and retard the progress of the disease. Rest, controlled
exercise, and wearing finger or wrist splints may also be part of your treatment
program. Several disease-modifying treatments are now available. These include
cortisone injections, antimalarial drugs, methotrexate, cyclosporine, gold and
some other drugs that help suppress the body’s immune system to reduce
the inflammation. Adaptive devices may help you cope with the activities of
daily living.
Rheumatoid arthritis often affects the connective tissues (tendons) as well
as the joints. The tendons that become inflamed may rupture. If this happens,
you may be unable to bend or straighten your fingers or to grip properly. In
certain cases, specific preventive surgery may be recommended. Preventive surgery
options include removing nodules, releasing pressure on tendons by removing
the inflamed tissue, and strengthening the tendons. If a tendon rupture occurs,
an orthopaedic hand surgeon may be able to repair it with a tendon "transfer"
or graft. Unfortunately, there is no cure for rheumatoid arthritis. However,
surgical procedures can often help correct deformities, relieve pain, and improve
function. These options include joint replacements, joint fusion and, in some
cases, removing damaged bone.
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