How to Deal With Arthritis in the Hands

From usnews.com

Arthritis in the hands has many potential causes and levels of severity. But the outcome is often the same, no matter what the trigger or stage of your life. “People of all ages with hand arthritis have difficulty with daily activities like opening doors, shaking hands, typing or writing. It limits what they can do day to day,” says Dr. Jonathan Samuels, a rheumatologist with NYU Langone Health and associate professor at the New York University School of Medicine.

Osteoarthritis

Osteoarthritis typically strikes with age and is by far the most common type of hand arthritis. Research suggests that about 40 percent of adults in the U.S. will have osteoarthritis in at least one hand by age 85. Samuels says it’s also common for signs of arthritis in the hands to appear as early as your 40s.

Osteoarthritis involves a gradual wearing away of cartilage in the joints. With cartilage damaged, the bones in the joints may rub against each other, causing various symptoms of arthritis in the hands such as:

• Pain.
• Swelling.
• Stiffness.
• Deformities and angling of some joints.
• Trouble gripping objects.
• Clicking, popping or grinding sounds when you move the joint.

We don’t know exactly what causes osteoarthritis. “Repetitive use like knitting puts stress across the joint more than you’d expect. So overuse may be one cause. Other risk factors include genetic predisposition, a family history of osteoarthritis and trauma. If you’ve had any prior injury affecting a joint, you’re predisposed to osteoarthritis,” says Dr. Richard Silver, a rheumatologist and distinguished university professor at the Medical University of South Carolina.

Inflammatory Arthritis

Inflammatory arthritis refers to joint inflammation caused by a glitch in the immune system. Immune cells mistakenly attack a particular part of the body, causing damage and other problems beyond the joints.

For example, in rheumatoid arthritis, which affects about 1 percent of the population worldwide (mostly women), the body attacks the lining of the joints, or synovium, and can damage the underlying cartilage and bones.

Other types of inflammatory conditions that can affect the hands include:

• Psoriatic arthritis: an attack on the joints and skin.
• Lupus: an attack on the joints, internal organs and skin.

Like osteoarthritis, inflammatory conditions produce symptoms of arthritis in the hands that include pain, swelling, stiffness and trouble gripping objects.

However, signs of arthritis in the hands from inflammatory conditions are often accompanied by other symptoms, such as:

• Symmetric involvement. Inflammatory diseases such as rheumatoid arthritis typically strike both sides of the body symmetrically – as opposed to osteoarthritis, which may affect just one side – so both hands (and other joints) are affected by arthritis at the same time.
• Extreme fatigue. You may experience a debilitating fatigue that keeps you from your daily activities or work.
• Inflammation in other joints. Rheumatoid arthritis, for example, can also strike the feet, wrists, elbows, knees and ankles.

Because inflammatory conditions can arrive at most any age, people with these diseases may wind up with arthritis in the hands early in life.

Distinguishing the Difference

Doctors can often tell the difference between osteoarthritis and inflammatory arthritis by the pattern of joint involvement. “For example, if you have bony enlargement of the joints, particularly the distal joints (at the end of the fingers) and proximal joints (in the middle of the fingers) but the large knuckles are spared, that would be suggestive of osteoarthritis,” Silver explains. “In rheumatoid arthritis, the big knuckles and the proximal joints are targets. And it’s spongy swelling, not necessarily a bony swelling.”

Other ways doctors discern a difference: the time of day you experience signs of arthritis in the hands. “Pain and stiffness in the hand that lasts in the morning and gets better with use implies an inflammatory process, such as rheumatoid arthritis,” Silver notes. “If there is not a lot of stiffness in the morning but pain gets worse during the day with use, that would imply a mechanical or degenerative process like osteoarthritis.”

Diagnosing Hand Arthritis

Both Samuels and Silver suggest seeking a medical evaluation when symptoms of arthritis in the hands start to interfere with your day-to-day life.

At the doctor’s office, expect a physical exam and lots of questions about your family history, overall health and any signs of arthritis in the hands that you’ve noticed, as well as questions about the effects that your hand symptoms may be having on your activities of daily living. It is also important to rule out non-articular causes of hand pain, like carpal tunnel syndrome.

Your doctor may also order certain medical tests. “We have helpful blood tests that can often help confirm a diagnosis, and we also rely on different types of imaging,” Samuels says. “Sometimes we have to use ultrasound or an MRI to see inflammation that might not show up on an X-ray.”

Treatment for Arthritis in Hands

Treating an underlying inflammatory condition will go a long way toward reducing symptoms of inflammatory arthritis.

For example, the first line of defence for rheumatoid arthritis is a group of medications called disease-modifying antirheumatic drugs (DMARDs) like methotrexate (Trexall) and leflunomide (Arava). They are used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen) and low-dose steroids to reduce inflammation and swelling.

For people whose arthritis does not respond to DMARDs, there are biologic medications such as adalimumab (Humira), etanercept (Enbrel) or abatacept (Orencia). These powerful drugs suppress the immune system. “They are life-changing,” Samuels says. “We see their hands go from claws where they can’t make a fist or open their fingers to playing piano, playing sports and shaking hands without pain. When patients start the medications early, we can prevent damage, and they’re often able to lead fully functional lives.”

Treating Osteoarthritis

There’s little doctors can do for non-inflammatory arthritis in the hands. “Unfortunately, we don’t have a drug that will stop the condition or put it into remission,” Silver says. “Treatment is over-the-counter acetaminophen (Tylenol) or an NSAID, and sometimes a short course of steroid medication.”

However, NSAIDs (both over the counter and prescription strength) are associated with ulcers, stomach bleeding, heart attacks, stroke and kidney failure. Some risks, such as heart attacks, are associated with NSAID use even in the short term. For this reason, doctors recommend infrequent use of the medications. “If they’re going to play golf and know it will exacerbate hand pain, they may be able to take an NSAID in addition to acetaminophen. But you shouldn’t take it every day,” Silver warns.

There has been increasing use of prescription topical NSAIDs in treatment of hand osteoarthritis. But your doctor should supervise use of the medication.

Home Remedies for Arthritis in Hands

The best pill-free treatment for arthritis in hands depends on your symptoms. If you have pain or stiffness, you may benefit from heat therapy (to relax muscles and tendons) such as:

• A paraffin wax bath for the hands.
• Heating pads.
• Therapeutic gloves that promote warmth.

For inflammation, cold therapy (using ice packs) is more appropriate.

Hand exercises for arthritis may help to strengthen the muscles (and your grip) and improve your range of motion. An occupational therapist can help with that and also give you shortcuts to modify activities (such as opening a jar) so you can get through your day.

There’s no conclusive evidence that taking dietary supplements such as chondroitin and glucosamine will help treat osteoarthritis. But doctors say it won’t hurt to give them a try.

And one of the best approaches is getting medical advice as soon as you realize that symptoms are becoming a problem. “Don’t wait,” Samuels advises. “Get help earlier, before damage is done."

https://health.usnews.com/conditions/arthritis/managing-arthritis-in-hands