Hands and arthritis: Protecting important tools of our trade

Our hands are capable of many functions, providing precision for delicate tasks as well as enabling us to complete heavier, physically demanding jobs.

The 29 joints which make up our hands are also common sites for arthritis. When these joints become arthritic they can make everyday activities very difficult.

SYMPTOMS OF HAND ARTHRITIS
Not everyone with arthritis in the hands will experience all these symptoms and some people may not even have any symptoms at all:

• Joint pain, initially experienced as a dull, burning sensation after a particularly busy day. As arthritis advances, the pain becomes sharper and more constant, even occurring at rest.
• Joint stiffness that is common in the morning but also occurs after a long day of work or activity involving the hands
• Crepitus, a grinding, grating feeling or a crunchy sound in the hands or wrists on movement.
• Weakness, difficulty grasping an object or maintaining a strong grip or pinch.
• Warmth or redness where the joint, ligaments or tissues have become inflamed.
• Swelling, fingers and hands appear more puffy than usual.
• Loss of movement in affected joints, particularly as arthritis progresses.
• Changes in joint shape or slight turn in the direction of a finger or thumb, caused by uneven wearing of cartilage or weakness surrounding tissues or ligaments.
• Bone spurs giving the fingers a knobbly or crooked appearance and, in some cases, reducing function of a finger or thumb.
  

Osteoarthritis and hands
In osteoarthritis, the joint at the base of the thumb is often affected and can result in difficulty gripping or pinching objects. Other finger joints can also be affected. Bumps called Herbeden’s nodes and Bouchard’s nodes may appear in the joint at the end of the finger, closest to the nail or the middle joints.

Gout and hands
Gout is associated with high levels of uric acid in the blood, causing crystals to form in the joints. The affected joint becomes red, swollen and is intensely painful to touch. It usually comes on very quickly, often overnight, normally affecting one joint at a time.

Psoriatic arthritis and hands
Psoriatic arthritis (PsA) causes a unique type of swelling with fingers taking on a characteristic ‘sausage like’ appearance. The bones themselves can also become inflamed and painful. Pitting of the nails may also be present.

Rheumatoid arthritis and hands
Rheumatoid arthritis (RA) often starts in smaller joints such as in the hand or wrist. One of the early signs of RA in the hands is an inability to form a complete fist.

It usually occurs in a symmetrical pattern, affecting both hands including the knuckle joints, middle finger joints and wrists. People with longstanding RA or those diagnosed later in life may notice a deviation of their fingers to the side, away from the thumb.

Surrounding tendons can also become inflamed, affecting the ability to straighten fingers. People with RA are also more susceptible to developing carpal tunnel syndrome, a condition caused by pressure on nerves that run through the wrist, with symptoms of numbness, pins and needles, and pain.
 

MANAGEMENT OF HAND ARTHRITIS

• Oral medications (taken by mouth) to reduce pain and swelling.
• Steroid injections into a single joint to relieve symptoms
• Disease-modifying medications for treatment of inflammatory forms of arthritis
• Hand exercises to increase flexibility and strength
• Creams or gels (ask your doctor or pharmacist for advice)
• Hot or cold therapies e.g running hands under warm water or applying a heat pack to relieve pain and stiffness, or applying ice or a cold pack to reduce swelling
• Splinting to rest a painful joint or ease stress on joints during certain activities
• Surgery, in some instances where conservative approaches to treatment are no longer effective, when hand-function is compromised, or to prevent tendon damage.
  

Joint protection strategies such as resting painful joints, pacing activities, simplifying tasks and using assistive tools and equipment, are especially important in the management of hand and wrist arthritis.


Talk to your doctor, specialist or treating allied health professional about the various medications, exercises and other treatment options for hand arthritis.
 

References:
Arthritis & Osteoporosis WA Arthritis & Osteoporosis NSW, Arthritis Matters Winter 2016
Arthritis Australia. At home with arthritis: Simple steps for managing in the home. Sydney: Arthritis Australia, 2010.
Arthritis Australia. Hands and arthritis [fact sheet]. Sydney: Arthritis Australia, 2007, reviewed 2013.