Arthritis

Arthritis literally means “inflamed joint.” Normally a joint consists of two smooth, cartilage-covered bone surfaces that fit together as a matched set and that move smoothly against one other. Arthritis results when these smooth surfaces become irregular and don’t fit together well anymore and essentially “wear out.” Arthritis can affect any joint in the body, but it is most noticeable when it affects the hands and fingers.

Each hand has 19 bones, plus 8 small bones and the two forearm bones that form the wrist. Arthritis of the hand can be both painful and disabling. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infection, gout, and psoriasis.

Treatment for the osteoarthritis of the hand

Treatment is designed to relieve pain and restore function. Anti-inflammatory or other analgesic medication may be of benefit in relieving pain. Brief periods of rest may help if the arthritis has flared up. You may also be advised to wear finger or wrist splints at night and for selected activities. Often soft sleeves may be of some benefit when the rigid splints are too restrictive, especially when the arthritis is affecting the joint at the base of your thumb. Heat modalities in the form of warm wax or paraffin baths might help, and when severe swelling is present, cold modalities may be of help. It is important to maintain motion in the fingers and use the hand as productively as possible. Hand therapy is often helpful with these exercises, splints, and modalities. A cortisone injection can often provide relief of symptoms, but does not cure the arthritis. Surgery is usually not advised unless these more conservative treatments fail.

Surgery is indicated when the patient either has too much pain or too little function. In most cases, the patient knows best and actually tells the doctor when it is time for surgery. The goal is to restore as much function as possible and to eliminate the pain or reduce it to a tolerable level. One type of surgery is joint fusion, in which the arthritic surface is removed and the bones on each side of the joint are fused together, eliminating motion from the problem joint. Joint fusion may be used to relieve pain and correct deformities that interfere with functioning. Another approach is joint reconstruction, in which the degenerated joint surface is removed in order to eliminate the rough, irregular bone-to-bone contact that causes pain and restricts motion. Once the degenerated portion of the joint surface is removed, it may be replaced with rolled-up soft tissue, such as a tendon, or with a joint replacement implant. Which type of surgery is used depends on the particular joint(s) involved, your activities, and your own needs. Your hand surgeon can help you decide which type of surgery is the most appropriate for you.

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Treatment of rheumatoid arthritis

Treatment is designed to relieve pain and restore function. If you have rheumatoid arthritis in your hands, medications can help decrease inflammation, relieve pain and slow the progression of the disease. Anti-inflammatory medications, oral steroids, and/or cortisone injections may be used. Several disease-modifying treatments are now available, including anti-malarial drugs, methotrexate, cyclosporine, gold, and other new drugs (remicade, enbrel) that help suppress the body’s immune system to reduce the inflammation and pain. A rheumatologist will often prescribe and monitor these types of medications. Your physician may also refer you to a hand therapist for exercises, splints, modalities such as paraffin (warm wax) baths, and instruction on how to use your hands in ways that may help relieve pain and pressure and also protect your joints. Adaptive devices may help you cope with the activities of daily living.

Rheumatoid arthritis often affects the tendons as well as the joints. The tendons that become inflamed may trigger (click) or rupture. If this happens, you may be unable to bend or straighten your fingers or to grip properly. In certain cases, specific preventive surgery may be recommended. Preventive surgery may include removing nodules, releasing pressure on tendons by removing the inflamed tissue and degenerated, rough bone that may scrape the tendons, and reinforcing the tendons. If a tendon rupture has occurred, a hand surgeon may be able to repair it with a tendon transfer or graft, in addition to performing these other procedures.

Surgery to treat the arthritic joints includes removal of inflamed joint linings, joint replacements, joint fusions, and in some cases, removal of damaged bone. The specific procedure(s) depends on a variety of factors, including the particular joint(s) involved, the degree of damage present, the condition of adjacent joints, and your own needs. Your hand surgeon can help you decide on the most appropriate treatment for you.

Unfortunately, there is no cure for rheumatoid arthritis. However, surgical procedures can often help correct deformities, relieve pain, and improve function. Optimal care entails a team approach between the rheumatologist, hand surgeon, hand therapist, and patient. It is particularly important that surgical intervention be appropriately timed to rebalance the hand and preserve the joints for as long as possible, before the development of more severe deformities has occurred.

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