Arthritis hands

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

When it comes to arthritis, the hand is often called the mirror because so many forms of arthritis affect the hand and the pattern of disease in the hand often provides clues to diagnosis.

A hand has 27 bones plus the two bones of the forearm that help form the wrist. Joints are created whenever two or more bones meet, so there is potential for multiple arthritic problems in the hand.

Arthritis of the hand can be both painful and disabling.

Osteoarthritis is a degenerative joint disease in which the cushioning cartilage that covers the bone surfaces in the joints begins to wear out. It may be caused by simple "wear and tear" on joints, or it may develop after an injury to a joint. In the hand, osteoarthritis most often develops in three sites:

• At the base of the thumb, where the thumb and wrist come together (the trapezio-metacarpal joint)
The shape of these bones gives the thumb a wide range of movement – up and down, across the palm, and the ability to pinch with each finger.

Arthritis in the basilar joint of the thumb is more common in women than in men. It usually starts after age 40. Past injuries to this joint such as fractures, sprains, etc., may increase the chances of developing this type of arthritis.

The first symptom of basilar joint arthritis is pain with activities that involve gripping an object with the thumb and fingers (pinching). These activities could include opening jars, turning door knobs, opening car doors, and turning keys. Heavy use of the thumb may also cause pain in the basilar joint. Changes in weather, such as a change in humidity or temperature also may cause problems. As the disease worsens, less activity is needed to produce pain. Pinching strength decreases and swelling may develop when using the thumb. As the arthritis continues to worsen, the basilar joint begins to look bigger and have a squared-off appearance. Movement of the thumb becomes limited.

Inspection will show a lump at the base of the thumb that can be swelling in the joint or displacement of the thumb’s first bone. Also, forcing the thumb firmly against the wrist bone while moving the joint will usually produce pain and may produce a sandy feeling. The pain and gritty feeling means that the bones are rubbing against each other. Early on, movement of the thumb is normal. Later, movement becomes more difficult, especially when sticking the thumb out to the side. In worse cases, as the joint wears away, the thumb’s first bone collapses into the palm when gripping smaller objects.

The pain of early basal joint arthritis will usually respond to non-surgical treatment: limiting movement of the thumb (placing a splint on the thumb) and using medicine (oral or local injection) to decrease swelling and pain. Patients with more severe cases may require surgery. Your doctor can advise you on the best treatment for your situation.

• at the middle joint of a finger (the proximal interphalangeal or PIP joint)

• at the finger tip (the distal interphalangeal or DIP joint)

Rheumatoid arthritis affects the cells that line and normally lubricate the joints (synovial tissue). It is a systemic condition, which means that it affects multiple joints, usually on both sides of the body. The joint lining (synovium) becomes inflamed and swollen. The swollen tissue may stretch the surrounding ligaments, which are connective tissues that hold bones together, resulting in deformity and instability. The inflammation may also spread to the tendons, which are the connective tissues that link muscles and bones. This can result in tears (ruptures) in the tendons. Rheumatoid arthritis of the hand is most common in the wrist and finger knuckles (the metacarpophalangeal and proximal interphalangeal joints).

Stiffness, swelling, loss of motion, and pain are symptoms common to both osteoarthritis and rheumatoid arthritis in the hand. With osteoarthritis, bony nodules may develop at the middle joints of one or more fingers (Bouchard’s nodes) and at the finger tip (Heberden’s nodes). The joints become enlarged and the fingers crooked. In rheumatoid arthritis, some joints may be more swollen than others. There is often a sausage-shaped (fusiform) swelling of the finger. Other symptoms of rheumatoid arthritis of the hand include:

• a soft, lumpy mass over the back of the hand
• a creaking sound (crepitus) during movement
• a shift in the position of the fingers as they drift away from the direction of the thumb
• inflammation of the finger tendons, resulting in a permanent bending (Boutonnière) deformity
a "swan’s neck" deformity caused by hyperextension (sway-back) at the middle joint of the finger associated with a bent fingertip

Psoriasis, a skin condition may be associated with a severe form of inflammatory arthritis. Typically, a “sausage” finger will develop. The finger will have this appearance because the joint inflammation is accompanied by severe inflammation involving the tendons.

Occasionally, the fingernails will have tiny pits or the nail will appear to separate from the nailbed.

Some forms of inflammatory arthritis are caused by crystals. These crystals deposit out in the synovium and induce an inflammatory response. Typically, there is swelling, warmth, and pain. If left untreated, gout can lead to large soft tissue deposits of uric acid in the fingers. These are called tophi.

Systemic lupus erythematosus is an autoimmune disease that causes a symmetric inflammatory arthritis that leads to fusifrom swelling of the fingers. Patients with lupus joint disease will often have symptoms involving other organ systems.

Your doctor will examine you and ask whether you have similar symptoms in other joints. X-rays will show certain characteristics of arthritis, such as a narrowing of the joint space, the formation of cysts or bony outgrowths (osteophytes or "nodes") and the development of hard (sclerotic) areas of bone. Magnetic resonance imaging (MRI) is a more sensitive procedure used for diagnosing arthritis earlier.

If your doctor suspects inflammatory arthritis, he or she may request blood or other lab tests to confirm the diagnosis.

Treatment is designed to relieve pain and restore function. Treatment decisions are based on the type of arthritis you have, its progression and its impact on your life. Anti-inflammatory medications such as aspirin or ibuprofen may help reduce swelling and relieve pain; prescription medications or steroid (cortisone) injections may be recommended. Topical rubs may also help with symptoms. Your physician may refer you to a physical or occupational therapist because changing the way you do things with your hands may help relieve pain and pressure.

If you have osteoarthritis, your physician may recommend a period of rest. You may also be advised to wear finger or wrist splints at night and for selected activities. Surgery is usually not advised unless these treatments fail. Several surgical options are available:

• Surgery may be used to drain or remove the cysts associated with the nodes and to remove excess bone growth.
• Joint fusion (stiffening the problem joint) may be used to correct deformities that interfere with functioning or that are cosmetically unacceptable.
• A joint replacement may be advised.


If you have rheumatoid arthritis in your hands, medications can help decrease inflammation, relieve pain and retard the progress of the disease. Rest, controlled exercise, and wearing finger or wrist splints may also be part of your treatment program. Several disease-modifying treatments are now available. Assistive devices may help you cope with the activities of daily living.

Rheumatoid arthritis often affects the connective tissues (tendons) as well as the joints. The tendons that become inflamed may 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 options include removing nodules, releasing pressure on tendons by removing the inflamed tissue, and strengthening the tendons. If a tendon rupture occurs, an orthopedic hand surgeon may be able to repair it with a tendon "transfer" or graft. However, surgical procedures can often help correct deformities, relieve pain, and improve function. These options include joint replacements, joint fusion and, in some cases, removing damaged bone.

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