Arthritis of the Hand

What is arthritis of the hand?

Arthritis is a disease that attacks the tissues of your joints. A joint is where two bones meet. Arthritis can attack the lining of your joint or the cartilage, the smooth covering at the ends of bones. Eventually the cartilage breaks down, the ends of your bones become exposed, rub against each other and wear away. You have many joints in your hand, therefore it’s a common site for arthritis to happen.

Arthritis of the hand causes pain and swelling, stiffness and deformity. As arthritis progresses, you can’t use your hands to manage everyday tasks as you once could.

Are there different types of arthritis that affect the hands?

Yes. There are many, but these are some of the more common ones.

• Osteoarthritis, also known as “wear and tear” or degenerative arthritis, is the most common type of arthritis. It causes the cartilage (the smooth, cushion covering at the ends of your bones) to break down and wear away. The ends of bones then rub together without protection, which causes pain, stiffness and loss of movement over time. Osteoarthritis most commonly affects your wrist, joint at the base of your thumb and the middle and top (near fingernails) joints of your fingers. Long-term disease can cause bony lumps to form in the joints of your finger.
• Rheumatoid arthritis is a chronic (long-term, ongoing) inflammatory disease that causes the joint lining to swell, causing pain, stiffness and loss of function. It's an autoimmune disease (your body’s immune system attacks its own healthy tissue). A joint’s lining is called synovium. Your synovium produces the fluid (lubricant) that allows cartilage to easily slide against each other. Eventually the inflammation destroys the cartilage at the end of bones and then erodes the bone itself. The joints lose their shape and alignment as the tendons and ligaments surrounding the bone weaken and stretch. Rheumatoid arthritis commonly affects the small joints of your wrists, hands and fingers. It usually affects the same joints on both sides of your body. For instance, if arthritis affects finger joints one hand, it's likely to affect the finger joints on your other hand too.
• Psoriatic arthritis is a form of arthritis that affects your skin (psoriasis) and joints. Your fingers become swollen. You will also feel joint pain and morning stiffness. In many cases, it is similar to rheumatoid arthritis. However, it may only involve several fingers.

What parts of the hand are most affected by arthritis?

The four areas of your hand attacked by arthritis are:

• The base of your thumb, where your thumb meets your wrist.
• Your knuckles.
• The middle joints of your fingers.
• The top joint of your fingers nearest your nails.

Who gets arthritis in their hands?

You are more likely to get arthritis in your hands if:

• You’re older. Osteoarthritis is commonly seen after age 50. Rheumatoid arthritis typically first appears between the age of 35 and 50.
• You’re a woman.
• You’re white.
• You’re overweight.
• You’ve had previous injuries to your hand. If you’ve dislocated or broken any joints in your hands or fingers, you are more likely to develop arthritis.
• You've inherited genes that cause the development of arthritis.

What are the symptoms of arthritis in the hands?

Early symptoms include:

• Dull or burning joint pain, appearing hours or a day after increased use of your hands.
• Morning pain and stiffness in your hand(s).
• Swollen joints in your hand(s).

If you've had arthritis in your hand(s) for some time:

• Symptoms are present more often.
• Pain may change from dull ache to sharp pain.
• Pain may wake you up at night.
• Pain may cause you to change the way you use your hand(s).
• Tissue surrounding your affected joint may become red and tender to the touch.
• You’ll feel grating, grinding, cracking or clicking (crepitus) when bending your fingers.
• Your fingers can’t fully open and close.
• Small bony nodules form on the middle joint of your fingers (called Bouchard’s nodes) or at the top joints of your fingers (called Heberden’s nodes).
• Your finger joints become large and deformed and abnormally bent, leaving your hands weak and less able to accomplish everyday tasks.

How is arthritis in the hand diagnosed?

Your healthcare provider can make the diagnosis of arthritis of the hand by examining your hand and with X-rays. X-rays show loss of bone cartilage and formation of bone spurs. A blood test for rheumatoid factor and other markers can help determine if the cause is rheumatoid arthritis.

How is arthritis in the hand treated?

Treatment options depend on the type of arthritis, stage of arthritis, how many joints are affected, your age, activity level, the hand affected (if it's your dominant hand) and other existing medical conditions.

Goals of treatment are to:

• Decrease joint pain and stiffness.
• Improve mobility and function.
• Increase your quality of life.
• In the case of rheumatoid or psoriatic arthritis, to slow the progression of the disease.

Treatment options include splinting/bracing, medications, injections, non-drug approaches and surgery.

Splinting/braces

Splits or braces support and protect the affected joint, reduce deformity, provide joint stability, lessen strain, and promote proper joint alignment. Your healthcare provider, occupational therapist or hand therapist will discuss splinting/bracing options, how and when to wear them and how long to wear them (wearing splints or braces too long can cause your muscles to weaken).

Medications

Your healthcare provider may prescribe medications to reduce your joint pain and swelling and, in the case of rheumatoid or psoriatic arthritis, to prevent joint damage. Your provider may try different drug classes, depending on the severity and type of your arthritis. For osteoarthritis, only acetaminophen or nonsteroidal anti-inflammatory drugs are recommended for limited use (as needed) for relief of your symptoms. There are currently no medications approved that help slow the progression of osteoarthritis. The drugs listed below are used to treat rheumatoid and psoriatic arthritis. Before taking any over-the-counter medication, make sure you check with your provider, as there are risks and reasons for not using these medications (depending on your other health conditions and/or medications).

• Acetaminophen. This drug helps relieve pain.
• Nonsteroidal anti-inflammatory drugs. These drugs reduce pain and swelling in affected joints. Examples include ibuprofen, diclofenac, naproxen, celecoxib. Topical NSAIDs are the first topical treatment of choice for osteoarthritis.
• Disease-modifying antirheumatic drugs. These slow the progression of rheumatoid arthritis and relieve symptoms. Examples include methotrexate, hydroxychloroquine, sulfasalazine (Azulfidine®), leflumonide (Arava®).
• Corticosteroids. Taken by mouth, injected into your muscle or given by IV, these medications reduce inflammation and other symptoms of rheumatoid arthritis. Examples include prednisolone, prednisone, triamcinolone and methylprednisolone.
• Immunosuppressive drugs. These slow the progression of rheumatoid arthritis and reduce damage to bone surrounding joints. Examples include azathioprine and cyclosporine.
• Biologic agents. These can slow joint damage in rheumatoid arthritis. Examples include adalimumab (Humira®), etanercept (Enbrel®), infliximab (Remicade®), tofacitinib (Xeljanz®), tocilizumab (Actemra®), abatacept (Orencia®), rituximab (Rituxan®).

Steroid injections

Steroids reduce inflammation and relieve pain. Steroids are usually used if medications don’t manage the inflammation or if the inflammation is limited to a few joints. Injections are administered directly into the affected joint. Because steroids can weaken tendons and ligaments, injections are repeated only a few times.

Other management strategies

A complete treatment plan for arthritis of the hand includes these additional approaches:

• Exercises — strengthening and stretching — to reduce symptoms and improve function. A hand therapist will work with you to prescribe the exercises best suited for your hand arthritis.
• Hot and cold packs. Cold can help reduce pain and swelling. Heat can help reduce stiffness. Apply for no longer than 20 minutes at a time.
• Rest. Regular rest periods can help relieve pain and inflammation in your joints.
• Healthy eating and managing diabetes and cholesterol.
• Weight loss if you’re overweight.
• Smoking cessation. Smoking increases your risk of developing arthritis.
• Occupational therapy to learn how to use self-help devices including those used to assist with dressing or preparing food in the kitchen.

Surgery

If nonsurgical treatments no longer provide relief and the cartilage at the ends of your bones has worn away, surgery may be an option. There are several approaches:

• Joint fusion (arthrodesis): This surgery uses a plate and screws to keep the bones of your joint together. You’ll have a more stable, pain-free joint, but will have limited flexibility and movement.
• Joint replacement (arthroplasty): Similar to other joint replacements, surgeons use an artificial implant made of plastic, ceramics, silicone or metals to replace your damaged joint. Keep in mind that hinged finger implants don’t mimic normal finger movement.
• Tendon transfer: Tendons connect muscles to bones. The tendons that control your fingers attach to muscles in your palm and forearm. Ongoing inflammation from arthritis can cause tendons to rupture. If this happens, a portion of a healthy tendon can be used to restore your hand function.

You and your surgeon will discuss which surgical approach might be best for your hand considering your age, activity level, the joint(s) affected and the amount of pain and deformity you’re experiencing.

What type of hand surgery is most commonly performed on the specific joints affected by arthritis?

• Base of the thumb: Where your thumb and wrist join. Common surgical options include removing part or all of one of the trapezium bone (the wrist bone immediately below your thumb joint), tendon transfer or joint fusion.
• Knuckles (metacarpophalangeal joints): Joint replacement is almost always considered for this repair. Rheumatoid arthritis can cause serious damage and disability to your knuckles.
• Second joint of your finger (proximal interphalangeal joints): Osteoarthritis commonly causes stiffness and loss of motion. Joint replacement or fusion are considered for these joints. Because you use these joints frequently, there is a chance your implant could wear out. In this case, your provider may recommend further surgery.
• Top of finger joint (distal interphalangeal joints): Joint fusion is commonly used to treat arthritis in this joint.

What should I expect after hand surgery?

You may need a cast or splint after surgery to protect your hand while it’s healing. Your surgeon may refer you to a hand therapist. Your provider will likely prescribe pain medication to take for a limited amount of time to reduce discomfort.

What are the complications of hand surgery?

Complications of hand surgery include:

• Lack of improvement in mobility.
• Need to replace an implant that breaks or wears out.
• Failure of bones to grow together or properly align (for fusion surgery).

How long does it take to recover from hand surgery?

Recovery time depends on many factors, including the severity of your condition, type of surgery you had, the skill of your surgeon and your compliance with therapy. Most people can return to their activities about three months after joint reconstruction surgery. Your team of caregivers can give you the best estimate of your particular recovery time.

Are there any other treatment options being investigated?

For osteoarthritis, some clinical research trials are underway in the U.S. exploring stem cell treatment. Early findings are encouraging.

Over the past decade, researchers developed many new medications for psoriatic arthritis and rheumatoid arthritis, with more studies underway.

Can arthritis in the hand be prevented?

Arthritis can’t be prevented. However, you can watch for symptoms of arthritis as you age and see your healthcare provider if you notice changes in your joints. You can also take steps to manage certain risk factors. Eat nutritious foods to nourish your body and maintain a healthy weight. Having overweight (a body mass index, or BMI, greater than 25) puts more stress on your joints. Don’t smoke. Smoking increases your risk of arthritis.

What outcome can I expect if I have arthritis in my hands?

There is no cure for arthritis. However, you can usually manage mild to moderate symptoms with a combination of medication and non-medication approaches. Surgery may be an option if other treatments fail or the arthritis in your hands is severe. Your healthcare provider will explain what outcome you can expect for your type and severity of arthritis, your age, other existing medical conditions and other factors.

Are glucosamine and chondroitin supplements helpful for treating osteoarthritis of the hand?

Supplements are not reviewed or approved by the Food and Drug Administration (FDA). They are not required to undergo the same rigorous clinical trial methods that medications must undergo in the U.S. Some clinical trials show benefits with pain relief; however, there is no proof that these supplements slow the progression of osteoarthritis. If you plan to try these, always check with your healthcare provider before using supplements. These products may interfere with medications you currently take.

A note from Cleveland Clinic

Dull or burning joint pain, morning stiffness, swollen joints in your hand are all symptoms of arthritis. Many types of arthritis could affect your hands. Many treatment options are available depending on your exact arthritis type. Medications can reduce joint pain and swelling. Researchers are still working on ways to slow the progression of osteoarthritis. See your healthcare provider if you think you have arthritis in your hands. They will perform a complete exam and offer you a complete treatment plan, which includes hand exercises, use of hot and cold packs, other lifestyle tips and traditional treatments including medications, braces/splints, steroid injections and surgery.