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Guide to Arthritis
Arthritis, which literally means inflamed joint, can occur in any of the joints in the body. However, it tends to be most noticeable when it affects the hands and fingers (image). Although there are hundreds of types of arthritis, the most common form which affects the hands is osteoarthritis, rheumatoid arthritis (RA) and post-traumatic arthritis. Less common types include gout, psoriasis and infectious arthritis. Nearly 85 percent of adults age 75-80 suffer from arthritis and it tends to affect more women than men. This difference is often attributed to declining levels of estrogen in postmenopausal women.
Osteoarthritis Of The Hands
A degenerative joint disease, osteoarthritis occurs when the protective layer around the bone surface (cartilage) starts to wear away. It can be caused by simple wear and tear or as a result of an injury to the joint. When the cartilage thins, the bones become exposed and inflamed. This weakens the bones and tiny fractures develop in them. Synovial fluid (which surrounds the joints) then leaks into the cracks and forms cysts. This can irritate the bone and surrounding structure. In response, the bone is prompted into making new bone in the form a protrusion called a 'spur' (osteophyte). These bone deformities can create a 'nobly' appearance in the finger joints. Those that occur in the smallest joints at the end of the fingers are known as Heberden's nodes. If they appear in the middle joint of the fingers they are called Bouchard's nodes. They may or may not be painful but over a period of time lead to restricted movement of the fingers. Osteoarthritis of the hands can occur in one or both hands.
Osteoarthritis of the hand usually develops in 3 areas:
• Base of the thumb, where the wrist and thumb join (trapezio-metacarpal, or basilar joint).
• Joint nearest the fingertip (distal interphalangeal or DIP joint).
• Second joint up from the fingertip (proximal interphalangeal or PIP joint).
• It can also develop at the wrist.
Rheumatoid Arthritis of the Hands
75 percent of people with RA have hand and wrist problems. RA typically affects the synovium tissue which lines the joints. It becomes swollen and red causing the tissue to stretch. This has the knock on effect of causing the joints to become unstable and deformed as the joint cartilage and bone start to erode. It usually occurs in both hands.
Repetitive mechanical stress of the hand can result in arthritis (see causes of arthritis). This typically affects workers who operate machinery on a daily basis. In other cases, injury (such as a break or fracture) which has not healed properly can result in arthritis (usually osteoarthritis).
What Are The Symptoms?
• Pain is not severe and is usually alleviated by resting the hand.
• Pain occurring in the morning which usually lasts no more than 30 minutes.
• Bony appearance on fingers joints (Heberden's and Bouchard's nodes). See also, an overview of arthritis symptoms.
• Pain in the hand which occurs at rest or throughout the night is a signal that the disease has advanced.
• Stiffness in the joints and loss of strength in the hand.
• Inflammation and swelling of the hand.
• Limited range of motion of the hand.
• Deformity in the middle joint which bends the finger at an angle (Boutonniere deformity)
• Deformity at the end of the finger which bends at an angle (Swan neck deformity).
• Small cysts can develop on the end joints of the fingers (the DIP joints).
• Crepitus, a cracking or squeaky sound when the fingers are moved.
• Numbness and tingling feeling in the hand (carpal tunnel syndrome) caused by pressure from tendons on nearby nerves. This is more associated with RA.
• Sometimes when the disease has finished it's progression the hands may look deformed by pain decreases.
How Is It Diagnosed?
An arthritis diagnosis is usually based on a physical examination and diagnostic tests. The appearance of hands, specifically the presence of nodes on the finger joints is normally enough to suggest the presence of arthritis. The doctor will examine both hands for signs of inflammation, swelling and pain. Some doctors will diagnose based solely on the results of a physical examination. Others may decide further testing can be helpful in determining the degree and type of disease present. Tests can also be helpful for ruling out other potential causes as well as act as a basis for future monitoring. An X-ray will help to determine the extent of the disease. Specialized imaging techniques such as MRI scans are not normally needed. Blood tests are more likely to be taken if RA is suspected. A family physician should be able to carry out a complete diagnosis, but if the diagnosis or treatment plan is unclear, the patient may be referred to a rheumatologist.
If you are looking for some self-help guides, check books on arthritis for a list of published works.
How Is It Treated?
People with osteoarthritis of the hands in the early stages may show no or few symptoms. In such instances treatment may not be necessary. When symptoms start to become troublesome the first line of treatment is usually pain relief and anti-inflammatory medications. Food supplements such as glucosamine and chondroitin may also be recommended along with hot/cold treatments and topical pain relief creams. Prescription drugs may be required if pain worsens and many patients find cortisone injections helpful. Hand exercises and the use of splints at night may be advised. If all conservative treatments fail, surgery is a last resort. It is only considered where the patient is in constant pain or can no longer use their hand.
Glucosamine And Chondroitin Supplements
Most patients will be advised to take glucosamine and chondroitin supplements which are available in most pharmacies without prescription. Studies presented to the American College of Rheumatology in 1999 reported that these supplements relieve pain and stiffness in some - but not all - patients with arthritis. Some doctors recommend taking the supplements for 2 months and advise the patient to continue only if benefits are noted after this period. Omega 3 capsules may also have some anti-inflammatory benefits.
Many patients find hot wax therapy as a natural treatment for arthritis works very well for relieving pain. This involves dipping their hands in hot paraffin wax. The initial warmth is very therapeutic and as the wax hardens it has a cooling effect. If you want to trap the heat, cover your hands with a towel after the application. The wax can then be peeled off and re-used again. This is also a wonderful option for fibromyalgia patients. Wax can be obtained in most pharmacies and warmed in a crock pot.
The most common type of medication for arthritis treatment is anti-inflammatories which help to reduce pain and joint swelling. Although they may do this effectively, it is worth noting they cannot reverse joint or cartilage damage. Over the counter options include Advil and Tylenol, and prescription drugs include Celebrex and Mobic (which are known as COX-2 inhibitors). COX-2 can increase the risk of stroke in women so they should not be taken by someone with a heart condition.
Creams which provide pain-relief can be applied directly to the hands. Examples include Aspercreme, Zostrix, Arthricare, Flexall, Icy Hot and Bengay. If mild pain occurs at the end of the day, try applying ice to the affected joints.
If pain relief medications do not work, steroid injections are the next option. Corticosteroid injections containing steroids such as prednisolone are injected directly into the affected joints and can give immediate pain relief. They are usually only given up to 4 times a year and can offer pain relief for several months. As they are steroids, they do have potentially harmful side effects including weight gain and high blood pressure. Be sure to talk to your doctor about ensuring you are injected with the lowest possible dosage.
Patients may be recommended to wear finger or wrist splints at night or during the day for specific activities. If the rigid splints are too restrictive consider wearing a neoprene splint/sleeve as an alternative, particularly if the arthritis affects the thumb. Some rheumatologists recommend using sleeves during the day as they keep the finger joint warm and allow patients more function. Splints can be purchased online. See also arthritis aids for other useful ideas.
Which surgery the patient needs will be discussed with their hand surgeon. To a great extent is will depend on the patient's age, needs and what part of the hand is affected.
Joint Fusion Surgery
This involves removing the diseased joint and surgically fusing the two ends of the bones together, so they effectively become one solid bone. Although this means the bone no longer has any motion or flexibility it does eliminate pain. It is normally only offered to younger patients who are not candidates for joint replacement surgery. As they are younger, their activity levels will be higher which means an artificial joint may wear out too quickly. It is also offered to those with DIP joint problems (the joint closest to the fingertip).
Joint Replacement Surgery
Also known as arthroplasty, this surgery involves replacing a diseased joint with an artificial one. It is typically only used in severe cases of hand arthritis and normally to replace the small joints of the hand. Typically offered to older patients it can relieve pain and restore movement to the hand. It is usually performed on those with problems of the PIP joint (second joint after the fingertip) because hand function is especially impaired when this joint does not function correctly.
Raynauds Phenomenon: Why do my hands turn blue?