Hand Arthritis

What is hand arthritis?

Arthritis is a broad term for joint inflammation and damage. It can affect any number of joints in the body. When it occurs in the hand, including the wrist and fingers, then it is commonly referred to as hand arthritis. It is important to remember that hand arthritis is not a specific medical diagnosis. It is just a way of saying that the joints of the hand are inflamed, damaged or eroded. The focus is then to identify the type of arthritis responsible for these hand symptoms. Different types of arthritis may have different consequences and require different treatments. Therefore there is no one specific way to treat hand arthritis.

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Hand Arthritis Joints

It is important to know the different joints in the hand to identify which are the affected joints. These joints can be broadly classified as :

  • Wrist joints
  • Hand joints
  • Finger joints

Wrist

There are 8 wrist bones known as the carpals. These bones are arranged in two rows – one row in contact with the forearm bones (radius and ulna) and the other row in contact with the long bones of the hand (metacarpal bones).

  • Radiocarpal joints between the one row of wrist bones (carpals) and radius and ulna.
  • Carpometacarpal joints (CMC) between the second row of wrist bones (carpals) and the hand bones (metacarpals).
  • Intercarpal joints between the bones that make up the wrist (carpals).

Hand

There are 5 bones in the hand known as the metacarpals. These are the bones within the hand itself, not including the wrist bones and the finger bones. There are joints between these bones and the wrist bones on one end, and the finger bones on the other end. In addition, there are small joints between the hand bones itself.

  • Carpometacarpal joints (CMC) mentioned above.
  • Metacarpophalangeal joints (MCP) between the hand bones (metacarpals) and the finger bones (phalanges).
  • Intermetacarpal joints between the hand bones (metacarpals).

Finger

There are 3 bones in each finger (proximal, middle and distal phalanges) except for the thumb which has only two bones (proximal and distal phalanges). There are joints between these finger bones as well as between the first finger bones (proximal phalanges) and hand bones (metacarpals).

  • Metacarpophalangeal joints (MCP) mentioned above.
  • Interphalangeal joints (IP)  between the finger bones.

Hand Arthritis Types

There are various different types of arthritis. Some arise with injury, known as traumatic arthritis, while others with infection and is referred to as septic arthritis. These types of arthritis are usually intense and short lived. The two most common types of chronic arthritis is rheumatoid arthritis and osteoarthritis. Although there are some similarities between rheumatoid arthritis and osteoarthritis, the nature of the disease in each case is different. Similarly the extent to which the joint is affected is also different.

A joint is a point of articulation between two bones. Basically this means that the two bones meet at this point and are then able to move.  The parts of the bone involved in the joint are lined with cartilage. This soft but strong material acts as a shock absorber and reduces the friction between the bones as it moves against each other. It is constantly replenished and provides a protective surface for the bone. The joint is lined by a membrane known as synovium which produces a lubricant fluid – synovial fluid. As with the cartilage, the synovial fluid acts as a shock absorber and reduces friction between the joint.

Rheumatoid arthritis starts earlier in life and affects the lining of the joint (synovium). Osteoarthritis tends to occur in the elderly and affects the cartilage of the joint and the bone underneath it. However, after long periods of time both types of arthritis have a similar effect on the joint causing swelling, pain and restricting movement.

Hand Arthritis Causes

Although the focus is primarily on rheumatoid arthritis and osteoarthritis of the hand, it is important to understand all the possible causes of the different types of arthritis.

  • Traumatic arthritis – injury
  • Septic arthritis – infection
  • Crystal-induced arthritis – uric acid or calcium pyrophosphate within the joints
  • Juvenile idiopathic arthritis – unknown
  • Ankylosing spondyloarthritis – immune
  • Psoriatic arthritis – immune

Rheumatoid arthritis

The exact cause of rheumatoid arthritis (RA) is unknown. It is believed to be a combination of genetic and environmental factors causing the immune system to attack the joint. Therefore rheumatoid arthritis is known as an autoimmune disease. Sometimes it can occur after an infection, but it is not the infecting microbe that is responsible for the arthritis but rather the way in which it upsets the immune system. Rheumatoid arthritis is more likely to occur in the 40 to 60 year age group and particularly in females with a family history of this joint disease.

Osteoarthritis

Osteoarthritis (OA) is a condition where the cartilage lining the bone in the joint wears down with age and overuse. Eventually even the bone erodes. Although this cartilage is constantly replenishing itself, as a person gets older the ability to form new cartilage does not occur fast enough. Similarly if the joint is overused, then the rate at which the joint replenishes itself may be insufficient to withstand the erosion caused by overuse and strain. Osteoarthritis tends to occur in older people usually after the age of 60 years.

Hand Arthritis Symptoms

The main symptoms of any type of arthritis is :

  • Joint pain (arthralgia)
  • Joint swelling
  • Joint stiffness

There are a host of other joint symptoms as well as symptoms that may occur elsewhere in the body depending on the type of arthritis.

Picture of rheumatoid arthritis nodules and joint deformity of the hand (above) from Wikimedia Commons

Picture of osteoarthritis nodes of the hand (above) from Wikimedia Commons

Hand Arthritis Pain

The pain is usually isolated to the affected joint. In rheumatoid arthritis, activity tends to at times ease the pain whereas in osteoarthritis, prolonged activity worsens the pains. The pain is also accompanied by heat, swelling and stiffness of the affected joint in rheumatoid arthritis.

Hand Arthritis Swelling

Swelling is more prominent in rheumatoid arthritis than in osteoarthritis. In fact there may be no swelling in the early stages of osteoarthritis as opposed to rheumatoid arthritis. Nodules may form around the affected joint in rheumatoid arthritis. Bony projections known as spurs may be seen with osteoarthritis. Both nodules and bony spurs are a late finding in both types of arthritis.

Hand Arthritis Stiffness

Stiffness is a major symptom in both rheumatoid arthritis and osteoarthritis. Typically in rheumatoid arthritis, the stiffness is worse upon waking in the morning and with prolonged periods of rest. It tends to ease once a person starts moving the affected part.  Although the same characteristics of joint stiffness may be seen in osteoarthritis, prolonged or strenuous activity can also trigger stiffness.

Other Hand Arthritis Symptoms

  • Nodules (RA)
  • Joint deformity (RA)
  • Bony spurs (OA)
  • Grating joint sounds (OA)
  • Fever (RA)
  • Fatigue (RA)

Hand Arthritis Diagnosis

The findings of a clinical examination and the patient’s medical history are sufficient to make a preliminary diagnosis. Further tests are then conducted to confirm the type of arthritis and establish the severity of the condition. These tests are also useful to monitor the progression of the disease over time and the effectiveness of any treatment that is initiated.

Tests include :

  • X-rays
  • CT (computed tomography) scan
  • Bone scans
  • Arthroscopy
  • Blood tests for substances such as rheumatoid factor (RF)

Hand Arthritis Treatment

The treatment for rheumatoid arthritis and osteoarthritis differs to a large extent and it is therefore important that the type of arthritis is diagnosed as soon as possible. Treatment includes a combination of medication, sometimes surgery, physical therapy and occupational therapy.

Medication

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroids
  • Opioid painkillers (analgesics)
  • Immunosuppressants
  • Disease modifying antirheumatic drugs
  • TNF-alpha inhibitors

Surgery

  • Steroid injections in the joint
  • Lubricant injections
  • Joint replacement
  • Tendon repair
  • Joint fusion
  • Bone realignment

References :

  1. http://orthoinfo.aaos.org/topic.cfm?topic=A00224
  2. http://my.clevelandclinic.org/disorders/arthritis/hic_Arthritis_of_the_Hand_and_Wrist.aspx
  3. http://www.webmd.com/osteoarthritis/hand-osteoarthritis-degenerative-arthritis-of-the-hand

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