THERE are two types of arthritis that commonly affect the hand: osteoarthritis (degenerative) and rheumatoid arthritis. Today we will address osteoarthritis.

This painful condition typically affects individuals in the 40+ age group. Women are more often affected than men and there may be a hereditary factor involved.

In the hand, the finger joints and the joints at the base of the thumb are frequently affected. The wrist joint may also be involved. Cartilage (gristle) acts as a cushion at the joint and in osteoarthritis the cartilage gradually wears down, resulting in painful bone on bone contact.

Later, bone spurs and inflammation may develop.

Deformity of the joints may also develop, interfering with normal hand function.

In the early stages, patients may experience pain and stiffness in the hands on awakening (“morning stiffness”). Later bumps may develop at the finger joints (Heberden’s nodes).

Arthritis of the base of the thumb can be very disabling, secondary to pain and deformity, since functionally the thumb is 50 per cent of the hand. Simple daily tasks like writing and buttoning buttons can become a major challenge.

Treatment

Treatment varies depending on the stage of the disease. In the early stages, patients may benefit from splinting and anti-inflammatory medication like Advil or Aleve.

In the later stages where there is disabling pain and deformity, surgery may be necessary to relieve pain and restore normal hand function. Surgery may consist of arthroplasty or fusion of the joint. Arthroplasty eliminates pain and preserves movement at the joint. Sometimes an artificial joint may be required.

In some cases, the joint may have to be fused or stiffened to restore useful function. Usually surgery is followed by a course of therapy.

Dr Cecil Aird MBBS, FRCS(C), FACS is a hand and microsurgeon at the Carnegie Hand Institute and Surgery Center in Ironshore, St James. His office may be contacted at 631-7871.