“My hands are deforming just like my grandmothers.”
We don’t think about how much our hands do for us until they start giving us problems. We assume we will be able grip our steering wheel, type on our keyboards and button our shirts. But for many of us, usually in our 40’s (although it can start earlier), we start to notice changes in our hands. A day of work at our computer ends with our hands sore. We can’t quite open jars as easily as before and we may notice seemingly random shooting pains and numbness in our fingers. These symptoms can go unnoticed until we start noticing our hands LOOK different and rings don’t fit. Shoot….time to see a doctor!
When someone ends up in my office worried about their hands, I know their number one concern is Rheumatoid Arthritis (RA). A quick visit to Dr. Google, informs everyone that RA could cause hand pain and lead to “deformities.” For most of us with hand pain (including myself), RA will not be the culprit, but instead, osteoarthritis (OA).
Rheumatoid v. Osteo Arthritis
Both RA and OA can cause hand pain, stiffness and physical changes. But that’s where the similarities end. RA is a systemic, autoimmune, inflammatory condition that affects the entire body and leads to inflammation of the small joints of the hands. This includes the wrists and the big knuckles of the fingers. One hand may be affected slightly more than the other, but usually both hands will have difficulties.
OA, on the other hand, is a degenerative joint condition. It does not have systemic, inflammatory effects on the body, and, although, it can also affect the wrist and large knuckles of the fingers, it mainly affects the small knuckles (the ones at the end of the finger) and, most uniquely, the base of the thumb. An experienced rheumatologist can distinguish between the two in minutes. Often times, just by looking at your hands or hearing your symptoms. But, occasionally, we need tests. Checking the Rheumatoid Factor, Anti-CCP and inflammatory markers such as ESR and CRP can be very helpful, as can X-rays.
Distinguishing between the two is key as treatment and prognosis are very different between the two. “Which type of arthritis is worse?” is a common question. Honestly, there is no better or worse, just different.
Show me your thumb
I am ALWAYS a proponent of getting a full head-to-toe evaluation by a rheumatologist when you have joint pain. Rheumatologists are trained to sniff out autoimmune or complex musculoskeletal issues. Even if someone is concerned about one joint, we can often find issues in others. That being said, when it comes to hand pain, I could probably make a diagnosis of osteoarthritis over the phone by asking one question. “Is your pain in your thumb?”
Where the thumb connects to the hand, known as the carpometacarpal joint, is one of the first places we see osteoarthritis. It can start as soreness after typing or using our phones and progress to more significant weakness and difficulty. The base of the thumb can appear to “stick out” and movement is associated with pain that radiates throughout the wrist. Although, RA can affect this joint, when in isolation, pain in the thumb is usually due to osteoarthritis.
Did you mom have hand arthritis?
When talking about autoimmune conditions, discussing one’s family inevitably comes up. However, we don’t tend to think of it when discussing matters of osteoarthritis. Felt to be due to aging or an injury, whether or not our parents or grandparents had OA just doesn’t occur to us. But in the case of arthritis of the hands, there IS a connection.
Just like RA (and any other autoimmune condition), there are different “flavors” of osteoarthritis. There are those with one bad joint (a bad knee or hip), those with significant back arthritis, and those with hand arthritis. Of course, there is plenty of overlap. But as a rheumatologist who sees arthritis day in and day out, you start to notice the “flavor categories” people fall into. Those with significant hand arthritis are, not only, more likely to have arthritis in other joints but are also likely to have family members with similar problems. This pattern has been noted in the women in families, but can certainly happen among men as well.
What can you do for your hand arthritis?
Our approach to arthritis in our hands is very similar to our approach to arthritis elsewhere. Unfortunately, we do not have interventions (aside from surgery) that can alter the bone or the joint. But we can decrease pain and improve function. Topical treatments, such as topical NSAIDs (diclofenac, for example) can be very effective. Oral treatment such as ibuprofen, naprosyn and acetaminophen can also be useful. Rest and ice are also a low-risk but highly effective strategy. Joint injections can be useful but I would advise caution. Steroid injections into the small joints of the hands can lead to weakened cartilage, tendons and ligaments and if done repeatedly can cause more harm than good. PRP (platelet rich plasma) and stem cell injections have had disappointing study results. I would only recommend pursuing these options after a frank discussion with your doctor about your personal treatment goals.
An often overlooked but very effective strategy at decreasing hand pain and improving strength and function is hand therapy. This can be done with the help of a physical or occupational therapist and has the best long term benefits. Hand therapists are specialists and access to a great hand therapist can be limited. Technology and innovation, however, is rising to the challenge. Innovators, such as those at Reactiv Rehab are using smart phone technology to bring virtual hand therapy to everyone who needs it. Gamifying therapy to make it engaging and fun, tracking your progress and putting you in touch with a real-life therapist, enables everyone to keep up with their exercises at home. This is not sponsored! I just think this a cool sign of what’s to come!