Wrist Arthritis (Inflamed Wrist Joints)

What is wrist arthritis?

Wrist arthritis is a condition where multiple joints that are collectively known as the wrist becomes inflamed. This leads to pain, stiffness and swelling of the wrist. It is one of the most commonly affected sites with regards to arthritis. The term arthritis literally means joint inflammation while arthralgia refers to joint pain. Sometimes there is pain in the wrist (arthralgia) but this does not mean that the joint is inflamed (arthritis). The more common type of arthritis that affects the wrist is osteoarthritis (OA) but the wrist is also a likely site for rheumatoid arthritis.

Location of wrist arthritis

The wrist is the junction between the forearm and hand. It is made up of several bones known as carpal bones or carpus. There are 8 carpal bones arranged in two rows. These bones have joints between each other known as the intercarpal joints and between each row known as the midcarpal joints. However, these joints alone do not make up the entire wrist.

The carpal bones also articulate with the bones of the forearm and hand. The joint between the radius (one of the long bones of the forearm) and carpal bones of the wrist is known as the radiocarpal joint. At the other end, the joint between the hand bones (metacarpals) and wrist bones (carpal bones) is known as the carpometacarpal joints. All of these joints are strengthened by different ligaments which ensures that it does not dislocate.

Therefore inflammation in any of these joints can be considered as wrist arthritis. Since the portion of the individual hand bones near the wrist bones also has joints (intermetacarpal joints) and so does the portion of the radius and ulnar near the wrist (radioulnar joint), these joints may also be considered as part of wrist arthritis when inflamed.

Picture from Wikimedia Commons

Types of wrist arthritis

There are many types of arthritis, irrespective of the joint that is affected. Osteoarthritis (OA) followed by rheumatoid arthritis (RA) are the most common.

Osteoarthritis of the wrist

Osteoarthritis (OA) is a condition where the cartilage that lines the end of the bone in a joint breaks down. It is mainly due to wear and tear in a situation where the body cannot replenish the cartilage to match the erosion. Eventually both the cartilage and the underlying bone is damaged. Therefore it is also known as degenerative arthritis.

Osteoarthritis is a condition mainly seen in the elderly. It tends to affect the weight bearing joints. The wrist joint is not a weight bearing joint but can also be afflicted with osteoarthritis.

Rheumatoid arthritis of the wrist

Rheumatoid arthritis (RA) is an autoimmune condition where the body’s immune system attacks the joint lining. Inflammation is therefore a result of disordered immune activity against the body’s otherwise healthy and normal tissue. It can cause significant damage and destruction of the joint over time if it is severe and left untreated.

Rheumatoid arthritis can affect any person but tends to occur in early adulthood. Many small joints are affected simultaneously with rheumatoid arthritis, with the finger joints being one of the most commonly affected sites.

Other types of arthritis

Although osteoarthritis and rheumatoid arthritis are the main types, wrist arthritis may also be a result of :

  • gouty arthritis – urate crystals in the joint
  • traumatic arthritis – sudden and severe joint injury
  • infectious (septic) arthritis – microbes, especially bacteria, in the joint

Signs and Symptoms

Pain is often the main symptom and often the only symptom in the early stages. However, pain in the wrist joint is not definitive of arthritis. Other symptoms are usually present or diagnostic investigations need to be undertaken in order to conclusively identify wrist arthritis.

  • Pain in the wrist that can worsen with activity (OA) or ease with activity (RA).
  • Stiffness of the joint (both OA and RA) which may be worse in the mornings or with inactivity (RA)
  • Swelling of the joint (more prominent in RA)
  • Redness of the joint (mainly in RA)
  • Grating or rubbing sound during movement of the joint (mainly in OA)
  • Protrusions and anatomical abnormalities – bone spurs (OA) and nodules (RA)

If left untreated, wrist arthritis may progress to a point where the joint becomes deformed and the flexibility at the wrist is severely impaired or lost almost entirely.

Causes of Wrist Arthritis

The causes of wrist arthritis are not significantly different from arthritis in other joints of the body. This includes :

  • Overuse of the joint
  • Degeneration of articular cartilage
  • Autoimmune diseases
  • Injury to the joint or bones
  • Fracture of carpal bones
  • Crystals in the joint – urate (gout) or calcium pyrophosphate (pseudogout)
  • Dislocated joints of the wrist
  • Medication
  • Environmental toxins
  • Genetics
  • Family history

Diagnosis and Tests

The signs and symptoms alone may be sufficient to diagnose wrist arthritis. However, further investigation should be undertaken at the outset to confirm the diagnosis of wrist arthritis and establish the extent of the inflammation or tissue degeneration. These tests may include :

  • Plain x-ray
  • Arthroscopy
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)

In rare instances, removal of joint fluid for further testing may be conducted. This is known as arthrocentesis.

Treatment of Wrist Arthritis

The treatment of wrist arthritis depends on the type of arthritis and severity of the condition. In milder cases, conservative measures are implemented. Moderate cases of wrist arthritis may require the use of medication. Surgery is often the only option for treatment in severe or long standing cases where there is a major loss of flexibility or joint deformity.

Conservative Management

This involves lifestyle measures and even dietary modification in the case of gouty arthritis of the wrist.

  • Minimize or discontinue repetitive or forceful actions that strains the wrist.
  • Rest the wrist and hand for short periods during prolonged activity.
  • Immobilize the hand and wrist as far as possible.
  • Heat and ice therapy may be helpful for short periods of time.
  • Regular exercises as prescribed by a physical therapist.

Medication

Drugs should be used in conjunction with conservative measures. Medication that may be used in the treatment of wrist arthritis includes :

  • Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
  • Antirheumatic drugs for rheumatoid arthritis includes immunosuppressants and immune modulators.
  • Cortisone injections into the joint.
  • Anesthetics may be combined with cortisone injections.

Surgery

There are several surgical procedures that may be considered for the treatment of wrist arthritis. Surgery is reserved for severe cases which are not responding to medication and conservative measures.

  • Removal of damaged and eroded bone, especially the carpal bones (procedure known as carpectomy) or portion of the joint lining (synovectomy).
  • Fusion of bones (joint fusion) thereby eliminating the points of articulation which for the wrist joint can be partial or complete.
  • Prosthetic joint replacement.

References :

http://orthoinfo.aaos.org/topic.cfm?topic=a00218

http://my.clevelandclinic.org/disorders/arthritis/hic_Arthritis_of_the_Hand_and_Wrist.aspx

http://emedicine.medscape.com/article/1933090-treatment