Arthritis in the hand or wrists is common, but can be very debilitating. We use our hands for the vast majority of our daily living activities, from washing and dressing to more intricate tasks such as typing or threading a needle. When the joints in the hand and the digits are affected by arthritis, day to day living can be very difficult.

What causes hand arthritis?
Osteoarthritis is one of the main causes of hand arthritis. The hands and wrists are made up of many small bones and joints, which interact with each other to provide the range of motion needed. The joints are protected by a layer of cartilage, which acts as a shock absorber and provides a smooth surface for the bones of the joints to glide over easily. However, over time cartilage can become worn or damaged due to disease or injury. As we age, our cartilage is less able to repair itself, and eventually the smooth, pain free motion of the joint is lost. As the bones begin to rub against the rough surfaces of the worn cartilage and eventually against each other, they can lose their normal shape and become disfigured.

Synoval fluid is naturally produced by the body as lubrication for the joints, but when cartilage becomes damaged, the body will often produce more synoval fluid in an attempt to cushion the joint. However, this can cause swelling within the joint, and reduce motion.

An injury to the hand or wrist, such as a fracture or dislocation, can make the joints more susceptible to arthritis, especially if the surface or the joint has been damaged.

Hand arthritis can also occur as the result of disease such as rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease which affects the whole body, so it is likely that other joints will also be affected, and other symptoms, such as fever, fatigue and general stiffness, may also be experienced.

Symptoms
The first symptoms of hand arthritis are general joint pain or a burning sensation in the affected area. This is likely to occur after repeated use, such as heavy lifting or prolonged typing. Stiffness of the affected area, particularly first thing in the morning, is also a common symptom.

These symptoms will increase in severity as the disease progresses. Sensations of pain may be present constantly, not just when the hands are in use. Swelling of the affected joints is likely to occur, which can make them appear larger, and the area may be red and appear warm to the touch. The motion and use of the joints is likely to be affected, and daily living tasks will become increasingly more difficult.

Crepitus may be experienced; crepitus is the grating or clicking sensation experienced by the damaged cartilage surfaces rubbing against each other. If the end finger joints are affected, small cysts can develop.

If rheumatoid arthritis is the cause, subcutaneous nodules can develop under the skin and can be accompanied by joint damage and deformity.

Hand arthritis caused by osteoarthritis can be diagnosed by X-ray or bone scans if the disease is in the early stages. Rheumatoid arthritis can generally be detected by blood tests.

Treatment
There are a range of treatments available for hand arthritis, consisting of non surgical or surgical options.
Non surgical treatments work by relieving pain and inflammation, and preventing further deterioration of the joints. Anti-inflammatory medications are likely to be prescribed.
Cortisone Injections may also be used, which contain a long lasting anesthetic to reduce pain. Although these injections can provide pain relief for several weeks, their use should be limited as they can cause side effects such as infection and tendon and ligament weakness.

Some patients experience relief by using heat and ice packs on the affected areas, and gently exercising or massaging the joints and fingers can help to maintain joint mobility.

A splint can also be applied to affected joints to support the area during times of use. A splint should only be worn when stress is likely to be placed on the affected area or when pain is experienced, as prolonged use can cause muscle wasting.

If non surgical treatment does not relieve symptoms, or if the condition is advanced, then surgical treatment may be considered. There are several different options for surgery, including joint fusions, joint reconstruction or joint replacement. Your doctor should be able to advise on which option would be best for you based on the progression of the arthritis, your age and your lifestyle.

Although hand arthritis cannot be cured, the range of treatments now available can minimize your symptoms and help you to continue to live a full and active life.