Understanding Osteoarthritis in the Hand
What is Osteoarthritis?
“Osteoarthritis” is a common form of arthritis, a term that broadly refers to joint inflammation. Often called “wear and tear” arthritis, this term can be misleading, as hand osteoarthritis is usually due to natural aging and genetics rather than specific use or overuse of the hands. Osteoarthritis can also develop following a joint injury, known as “secondary osteoarthritis.”
In osteoarthritis, joint swelling is accompanied by bony spurs, loss of the joint’s smooth cartilage surface, and often pain and stiffness.
Why Does Osteoarthritis Develop?
Osteoarthritis in the hands primarily results from genetic factors and aging. On an X-ray, the cartilage covering bone does not appear directly, so the space between bones represents the amount of cartilage left. This space decreases with age, becoming smaller as we grow older.
As cartilage wears down, the joint’s natural stability is compromised, and the bones may compensate by forming extra bone around the edges, leading to bony spurs. Inflammation in the joint can make movement painful.
What is the natural history of Osteoarthritis?
The progression of hand osteoarthritis often follows patterns observed in family history, as it can be hereditary. Most people will experience gradual changes, like stiffness or slight deformities, while still maintaining good hand function. Occasionally, individual joints may flare up, causing pain and inflammation that can last for months or years, but often subsides over time, leaving the joint stiff or altered in shape.
In rare cases, a more aggressive form of osteoarthritis can affect multiple joints at once, causing considerable pain and inflammation. Generally, over time, the hands may stiffen, making it difficult to fully close or extend the fingers.
How is Osteoarthritis Diagnosed?
A diagnosis is typically based on a physical examination of the hands, identifying characteristic lumps, such as Heberden’s nodes at the end finger joints and Bouchard’s nodes on middle finger joints. X-rays confirm the diagnosis, and a blood test may be suggested if another type of arthritis is suspected.
Treatment
Non-Surgical Options
Pain in osteoarthritis serves as a protective signal, which can lead to concerns like:
- 1. Worsening Over Time: While osteoarthritis can slowly worsen, pain typically diminishes as the associated inflammation “burns out.”
- 2. Impact of Hand Use: Normal hand activity does not worsen osteoarthritis; aging and genetics drive its progression.
With these reassurances, many people manage without extensive treatment. However, if pain interferes with daily activities, the following options may help:
- Splints: Immobilising the joint can improve comfort during use.
- Physical Therapy: Exercises help maintain mobility, aiming to delay stiffness.
- Pain Relief: Occasional painkillers may help but should be used sparingly due to potential side effects. NSAIDs, like ibuprofen, can be effective but pose risks with frequent use. Stronger painkillers are generally discouraged due to risk of dependence.
- Steroid Injections: These may reduce inflammation and pain in specific joints, though typically not recommended for fingertip joints. Steroid injections are often temporary and carry some risk.
Surgical Options
Two main surgeries can provide relief from joint pain:
- 1. Joint Replacement: Some knuckle joints can be replaced with a plastic hinge, relieving pain but also changing hand mechanics. Replacements in the hands may wear out in a few years and can reduce grip strength. Risks include infection, loosening, or dislocation.
- 2. Joint Fusion: Fusion involves removing the joint and connecting the adjacent bones to eliminate movement and pain. Fusion is particularly useful for fingertip joints. Risks include infection, incomplete fusion, and discomfort from the stabilising pins.
Both surgical approaches offer potential relief, though each has associated risks, and the choice depends on the specific needs and preferences of the patient.
