Osteoarthritis is a deterioration of the moving parts of the joints. In the hand, osteoarthritis most often affects the small joints of the fingers and the joint at the base of the thumb – the basal joint. This is sometimes referred to a degenerative arthritis or degenerative joint disease. Osteoarthritis is primarily treated by medical doctors, and may require treatment by an arthritis specialist. Medical resources on arthritic conditions are available through the American College of Rheumatology.

Cause

The exact reason for developing osteoarthritis is not known.

It is thought to be due to deterioration of the smooth layer of cartilage which covers the ends of the bones. The small joints of the fingers are prone to breakdown of this layer, which seems to self-destruct in some people early in life.

It tends to run in families, and is probably a genetic condition in many people.

Degenerative joint disease can also occur after injury, but the typical pattern of osteoarthritis is that the small joints of the fingers are affected, but the other joints of the hand are not.

Osteoarthritis is different from other forms of arthritis, such as rheumatoid arthritis, gouty arthritis, psoriatic arthritis and others.

What Can You Do?

• A heating pad or warm water soaks for five minutes in the morning to limber up.
• Ice for five to fifteen minutes at a time on the area which is most swollen and tender.
• “Over the counter” non-steroidal anti inflammatory medication (NSAID), such as aspirin, ibuprofen, naprosyn, or ketoprofen. Check with your pharmacist regarding possible side effects and drug interactions.
• There is some scientific evidence to suggest that chondroitin / glucosamine preparations may be helpful in osteoarthritis. These preparations are available without a prescription, but may affect your glucose and cholesterol tests, so it’s not a bad idea to check with your doctor. Other supplements and treatments are of unknown value and unknown risk.
• Wait and watch.

What Can a Doctor Do?

• Confirm that this actually is the problem.
• Prescribe stronger NSAID medication or cortisone type medication.
• Prescribe hand therapy and/or a custom splint.
• Give cortisone shot into sore joints. This can be very helpful in controlling pain and swelling.

Perform surgery to reconstruct or fuse the involved joints. There are two types of surgery commonly performed for joints affected by arthritis, fusion and arthroplasty. Surgery is a consideration when all else has failed.

Fusion (arthrodesis) is an operation to make bones on each side of the joint grow together. Fusion can be very helpful for joints which are stiff and painful, awkwardly crooked, or unstable. Fusion also can reduce the size of an enlarged joint, although this alone is not usually reason enough for surgery.

Arthroplasty, or joint reconstruction, in osteoarthritis is most often performed for thumb basal joint arthritis. Artificial joints have also been developed for the small joints of the fingers. Finger joint replacements made of pyrolytic carbon (the same material used in most artificial heart valves) were FDA approved for use in 2002. These new implants are a reasonable alternative to fusion, and in some cases can be used to restore motion to a joint which has been fused. Click to see mini-movies of arthritis surgery options for small finger joints

How Successful is Treatment?

Many people with mild symptoms will improve with a limited period of anti-inflammatory medication and avoiding painful activities.

A cortisone shot into the sore area helps most people – at least temporarily. When temporary, relief usually lasts about two months.

What Happens if You Do Not Have Treatment?

It depends on how much it is bothering you – it really is a quality of life issue. This is not a problem which can spread to other parts of your body. Many people have pain which subsides after a few years, when the arthritis and irritation in this joint “burns out”.

The main reason to do surgery is to relieve pain and, when possible, prevent the progressive weakness and deformity which may occur. Some people will have a mild problem which flares up from time to time, and treat it themselves or ignore it, others will have a severe problem which prevents them from doing many things with their hand, and feel that they have no choice but to have surgery.