Hand osteoarthritis, like generalized osteoarthritis, is considered a degenerative disease that is caused by the breakdown of cartilage [Cartilage is a covering on the bone in the joint] resulting in pain, stiffness, tenderness, and swelling in the affected joints.
Hand osteoarthritis most often develops in three sites
- The base of the thumb where the metacarpals form a joint with carpal bone (the trapezio-metacarpal, or basilar joint)
- Distal interphalangeal joint [distal most joint of the finger]
- Proximal interphalangeal [first joint beyond the knuckles]
It also often develops in the wrist.
Heberden node is a bony deformity at the distal interphalangeal joint and is one of the early signs of hand osteoarthritis. The deformity is a result of the bone spurs from the osteoarthritis in that joint. A similar deformity at proximal interphalangeal joints is called Bouchard node. Often, these nodes develop gradually, with little or no discomfort.
However, they may present acutely with pain, redness, and swelling, which sometimes triggered by minor trauma.
These nodes may not be painful but can cause limitation of motion of the joint.
Types of Hand Osteoarthritis
Hand osteoarthritis can develop as a separate entity or may occur as part of generalized osteoarthritis. Hand osteoarthritis can be of three types
Generalized Hand Osteoarthritis
Generalized osteoarthritis is characterized by the involvement of three or more joints or groups of joints (distal interphalangeal and proximal interphalangeal joints are counted as one group each). Heberden and Bouchard nodes are prominent.
Symptoms may be episodic, with marked by soft tissue swelling, redness, and warmth. The erythrocyte sedimentation rate may be elevated, but serum rheumatoid factor tests are negative.
Erosive Hand Osteoarthritis
In erosive osteoarthritis, distal and proximal interphalangeal joints of the hands are most prominently affected. Erosive osteoarthritis tends to be more destructive than typical nodal Osteoarthritis.
Radiographic imaging shows collapse of the subchondral plate and bony ankylosis may occur.
In erosive arthritis, joint deformity and functional impairment may become very severe. There is a history of pain and tenderness. The synovium is much more extensively infiltrated with mononuclear cells than in other forms of Osteoarthritis.
Thumb Base Osteoarthritis
Thumb base is the second most frequent area of involvement in osteoarthritis. Swelling, tenderness, and crepitus on the movement of the joint are typical.
In contrast to Heberden nodes, which usually do not interfere significantly with function, thumb base osteoarthritis frequently causes loss of motion and strength.
Pain with pinch leads to adduction of the thumb and contracture of the first web space, often resulting in compensatory hyperextension of the first metacarpophalangeal joint and swan-neck deformity of the thumb.
Presentation of Hand Osteoarthritis
Patients may be symptomless in spite of the disease. Stiffness, swelling, and pain are common symptoms that patients complaints of.
Clinical examination may reveal Heberden’s nodes and/or Bouchard nodes.
Pain at the base of the thumb is a common presentation of the base of thumb osteoarthritis. Pain and decrease in the motion of the joints may cause problems in daily activities like opening jars or turning of keys.
Diagnosis of hand osteoarthritis is based on history, examination, and routine x-rays. Blood investigations are usually normal.
Treatment may not be necessary for hand osteoarthritis with minimal or no symptoms. Treatment is designed to relieve pain and restore function.
Treatment of hand osteoarthritis includes
Pain medications like acetaminophen are helpful in relieving the symptoms of mild hand osteoarthritis. Other commonly prescribed drugs are ibuprofen, ketoprofen, naproxen, and other nonsteroidal anti-inflammatory drugs.
Food supplements like glucosamine and/or chondroitin can be added in therapy. These medicines do not benefit all the patients though.
Local heat/cold applications and topical pain creams are helpful for relieving pain. Steroid injections at the site receive the symptoms.
Finger or wrist splints may be added especially in the night to provide the rest to affected joint(s).
Surgical options include fusion of the affected joint or joint reconstruction.