By Louis Neipris, M.D., Staff Writer, myOptumHealth
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Arthritis in the hands can literally tie your fingers into knots. Fluid motions that should come easily - like opening a jar, tying your shoe or using a pencil - are now awkward and painful. Some types of arthritis can even cause the fingers and wrist bones to bend out of shape. Even shaking hands is hard to do. Getting arthritis diagnosed and treated soon after you notice symptoms is critical. Treatment can often stop further damage to your hands and preserve function.
What causes arthritis of the hands and wrists?
Rheumatoid arthritis and osteoarthritis are the two most common arthritic conditions of the hands. Osteoarthritis can cause gradual wearing away of cartilage, including that which lines the joints of the fingers and wrists. Cartilage is the tissue that provides a smooth surface over which a joint can glide. Rheumatoid arthritis causes inflammation of the tissues that line the joints. This can also lead to a wearing away of the cartilage.
- Rheumatoid arthritis is an autoimmune response. The body attacks its own tissues, including the joint tissues.
- In osteoarthritis, the stress of everyday movement wears down the smooth cartilage surface of a joint, leading to pain and other symptoms.
Arthritis in the hands can also develop after an injury. An injured joint is about seven times more likely to develop arthritis, even if the injury is treated. It can also be related to work or hobbies that involve repetitive hand motions.
It is important to find out the type of arthritis you have, because different treatments may be needed.
Symptoms
Symptoms of hand or wrist arthritis can include:
- Dull or burning pain, often after heavy gripping or grasping
- Morning stiffness
- Swollen joints
- A grating or grinding sensation
- Loose or unstable joints
- Enlarged or misshapen joints
Also:
- Cysts or bony nodules may develop close to the fingertips.
- Joints may feel warm to the touch.
Treatment
Treatment usually starts with nonsurgical methods.
- Medications
-
- Pain medication. The most common type of pain medication used for hand pain is acetaminophen (such as Tylenol). For severe pain, your doctor may suggest other prescription pain medicines.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Non-prescription aspirin, ibuprofen (Advil, Motrin) and long-acting naproxen (Aleve) may help relieve pain and also reduce inflammation. There are also prescription NSAIDs. Even though some of these medicines are available without a prescription, it's best to have your doctor monitor your use of them. Use of these medicines can lead to ulcers, stomach bleeding and other serious side effects. They can also interact with other medicines.
- Topical pain relievers. One example is a prescription ointment, capsaicin (Zostrix), which may help relieve pain in osteoarthritis of the hands. It can cause burning or stinging.
- Disease-modifying agents. Several disease-modifying agents are now available that can slow the progression of rheumatoid arthritis. Common ones include methotrexate (Rheumatrex) and hydroxychloroquine (Plaquenil).
- TNF blockers. These medicines inhibit an immune messenger known as TNF, which acts as an inflammatory agent in rheumatoid arthritis.
- Glucosamine/chondroitin. Some doctors advise taking the over-the-counter supplements glucosamine or chondroitin for a limited time for osteoarthritis. But, studies have not shown benefit from these supplements. There is no basis for the claim made by manufacturers that these supplements "rebuild cartilage." Don't take any supplement without first talking with your doctor. These products are not regulated by the FDA and may cause side effects or interact with other medications.
- Injections. Long-acting anesthetic, similar to novacaine, and/or steroids (to reduce inflammation and pain) can be injected directly into the joint. But these only give temporary relief and can only be used a limited number of times. Steroid injection can cause possible side effects, such as weakening of ligaments and tendons.
- Splinting helps to support the affected joint, minimizing motion and pain. A splint may be especially helpful if you have "ulnar drift," shifting of the joints toward the little finger.
Depending on your age and other factors, surgery to correct a deformity may be an option.
- Joint fusion. Fusing the joint may stabilize and straighten the joint, but it also restricts motion. Pain is usually relieved.
- Joint replacement. Just like in larger joints (knee, hip), the joints of the hand and wrist can be replaced with artificial ones made of ceramic, metal and plastic parts. Replacing the joint lets you move the fingers and gives pain relief. Most of the joints of the hand and wrist can be replaced. You will need to find a surgeon who has special training in joint replacement of the hand and wrist.
How can a physical therapist help me with arthritis of the hand and wrist?
A physical therapist can help you to relearn activities so that you can still use your hands even if some joint damage is permanent. You will be shown how to do exercises that you can do on your own and treatments to quell the pain and inflammation:
- Exercises. A physical therapist can teach you hand exercises to do daily. They can help maintain movement and flexibility of your hands. These are simple exercises that involve bending your fingers together and one at a time.
- Hot wax treatment. This involves gentle hand exercises while your hands are soaking in soft warm wax.
- Application of ice. Ice treatments for inflamed joints may help ease pain.
View the original Rheumatoid arthritis and osteoarthritis in the hands article on myOptumHealth.com
SOURCES:
- Ring D, Kay J. Hand rheumatoid arthritis. In: Frontera WR, Silver JK, Rizzo TD. Frontera: Essentials of Physical Medicine and Rehabilitation, 2nd ed. Philadelphia, PA: Saunders Elsevier; 2008.
- Oesch PR, Bachmann S. Physical modalities. Heat and cold. In: Firestein GS, Budd RC, Harris ED, McInnes IB, Ruddy S, eds. Firestein: Kelley's Textbook of Rheumatology, 8th ed. Philadelphia, PA: W.B. Saunders; 2008.
- Lozada CJ. Management of osteoarthritis. In: Firestein GS, Budd RC, Harris ED, McInnes IB, Ruddy S, eds. Firestein: Kelley's Textbook of Rheumatology, 8th ed. Philadelphia, PA: W.B. Saunders; 2008.
- National Institutes of Health. National Center for Complementary and Alternative Medicine. Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). Accessed: 08/25/2009
- Sellam J, Berenbaum F. Hand osteoarthritis. In: Firestein GS, Budd RC, Harris ED, McInnes IB, Ruddy S, eds. Firestein: Kelley's Textbook of Rheumatology, 8th ed. Philadelphia, PA: W.B. Saunders; 2008.
- American Academy of Orthopedic Surgeons. Arthritis of the hand. Accessed: 08/27/2009
An injured joint is about seven times more likely to develop arthritis, even if the injury is treated. © iStockphoto.com/Joanne Green
