What are the non-surgical treatments for arthritis?
Osteoarthritis: First-line treatments for osteoarthritis include:
- Cutting back, stopping, or adapting the activities that are causing pain
- Splinting the affected joint for short periods of time. Splinting keeps the joint still, which helps reduce pain.
- Applying heat/ice to reduce pain and swelling
- Taking acetaminophen (Tylenol®) and anti-inflammatory medicines (such as ibuprofen (Advil®/Motrin®) to reduce pain and swelling.
- Injecting joints with a cortisone preparation to relieve symptoms for a period of time. In some cases, these injections may be repeated.
- Exercising the joints – gently – through the full range of motion on a daily basis. You may need to see a hand therapist.
Unfortunately, there are no known medications or other treatments that can slow the loss of cartilage or make new cartilage.
Rheumatoid arthritis: Treatment for rheumatoid arthritis includes many of the same treatments used for osteoarthritis; however, these measures alone are not enough. It is now understood that the treatment must also include medications that can not only help symptoms, but also slow the progression (advance) of disease. These drugs include disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate and the newer biologic agents. Oral glucocorticoids, such as prednisone, can be used to help reduce symptoms, but they do not appear to be disease modifying. Also, the risks of glucocorticoids tend to outweigh the benefits.
What are the surgical treatment options for arthritis of the wrist and hand?
Surgery is considered when treatments, such as those mentioned above, no longer relieve the pain, or when deformity keeps the patient from being able to use his or her hand. Deformity, loss of motion, and pain that is not adequately controlled are the main reasons for surgery.
Surgical options include a variety of reconstructive procedures, as well as joint fusion:
- Reconstructive surgery for osteoarthritis in the base of the thumb is commonly performed and highly effective. The procedure involves removing one of the arthritic bones and replacing it with a piece of rolled-up tendon from the forearm (the part of the arm between the wrist and elbow) of the same arm. This procedure provides excellent pain relief, allows good range of motion, and restores function to the thumb.
- Joint fusion (also called arthrodesis) is used to treat arthritis in many hand and wrist joints. For example, the joint at the tip of the finger is frequently affected by osteoarthritis. Fusing this joint with the joint below it stabilizes and straightens the joint, which eliminates pain. However, the joint is no longer able to be bent.
- Joint replacement in the hand is recommended for “low-demand” patients, especially those with rheumatoid arthritis involving the joints at the base of the fingers. In these patients, joint replacements may improve the range of motion, making the fingers more useful. Pain is improved, as is use of the hand. However, these artificial hand joints do not provide the same stability as joint fusion and will, in time, wear down.
While arthritis in the hands and wrists is common and can be a painful and a functionally limiting disorder, many treatments are available to reduce symptoms and help patients. Newer medications for the treatment of the rheumatoid arthritis have led to a major reduction in the severe hand deformities that these diseases, when untreated, can cause. Surgical treatments for osteoarthritis and rheumatoid arthritis can provide pain relief and allow patients to return to many of the activities they enjoy.