Arthritis of the Hand
Arthritis is a very common condition, affecting the majority of people over the age of sixty-five. It can range in severity from a minor inconvenience to a disabling disease. Arthritis is an erosion of the joint surfaces and can occur in any joint, including those of the wrists and fingers. Once arthritis develops, patients often notice swelling, aching, pain, stiffness, and sometimes blister-like cysts. X-rays may demonstrate joint space narrowing, bone erosions, or bone spurs. There are many types of arthritis, but they can generally be categorized into two types: 1) Inflammatory, and 2) Non-inflammatory.
Non-inflammatory arthritis, generally known as osteoarthritis, is the most common type of arthritis. This type of arthritis can be a result of mechanical, biochemical, hereditary, and traumatic factors, among others. Its likelihood increases with increasing age and tends to run in families. Women are more likely to be affected than men.
Osteoarthritis most commonly affects the distal interphalangeal joints of the fingers. These are the joints closest to the fingernails. Many people with this type of arthritis develop firm swellings around these joints. Cysts can also form in these areas, and often appear as blister-like, fluid-filled lesions. These cysts contain joint fluid and can progressively enlarge, often pressing on the nearby nailbed. This pressure on the nailbed can result in deformation of the fingernail, including lines, grooves, and ridges.
The other very common location for osteoarthritis is the base of the thumb. Because of the very loose nature of this joint and its use in virtually every task, this joint is subject to very heavy loads over a lifetime. Again, some degree of arthritis is noted in this joint in most people over the age of sixty-five, but it is more common in women than men. Arthritis in this joint often causes pain with such everyday activities as turning a car key, opening jars, or turning doorknobs.
Although the underlying problem of destroyed joint surfaces cannot be corrected, there are a number of ways to treat arthritis, once the diagnosis is made. For most patients, a visit to the primary care physician can confirm that osteoarthritis is the problem. Simple remedies, including rest, ice, heating pads, and splints are helpful for many patients. Many physicians recommend the use of over-the-counter anti-inflammatory medications, including acetaminophen, ibuprofen, or naproxen. These medications should not be taken without discussing their use with a physician. A hand surgeon may recommend steroid (cortisone) injections, which are helpful for varying periods of time in different patients. When these conservative measures fail to provide relief, surgery may be beneficial. Surgical treatment for osteoarthritis of the distal interphalangeal joint ranges from removal of cysts to joint fusions. Surgery for arthritis at the base of the thumb typically involves reconstructing the joint to maintain motion and relieve pain.
The most common form of inflammatory arthritis is Rheumatoid Arthritis. Rheumatoid arthritis (RA) affects up to ten percent of people by the age of sixty-five, although it can also affect children. Again, it most commonly affects women. It is thought that heredity plays a role in the development of RA, although environmental factors are also likely.
Rheumatoid arthritis is generally treated with a combination of medications and surgery. A number of medications have been developed in recent years to help slow the progression of the disease. A primary care physician may enlist the expertise of a rheumatologist when caring for patients with RA. Surgery may be helpful in patients with RA. The joint malalignment and instability generally resulting from RA can result in severely limiting the functionality of the hand and fingers. Progressive disease can also cause tendon ruptures, further limiting the ability of the hand to function. These types of problems cannot be treated with medicines alone, and patients often require artificial joint replacement, tendon re-alignment, tendon repair, removal of inflammatory tissue, and occasionally joint fusion.
In summary, arthritis is very common and its prevalence increases with age. It can be severely disabling, but many medical and surgical treatments are available. Many patients do require evaluation by a hand surgeon, and the physicians of the Hand & UpperEx Center, located at Jefferson Regional Medical Center, look forward to the opportunity to participate in your care.