Robert J. Snyder, MD
Arthritis can strike anywhere in the body that there is a joint. However, one of the most challenging places for arthritis to settle is in the joints of the hand and fingers. We use our hands constantly while we are awake and rely on them to do such varied activities as type, open jars, put on makeup, play the piano, operate machinery and to gently stroke a pet’s fur. When doing those activities become painful, that is when I am asked to help.
When you come to see me in the office for a consultation, I am going to examine your hands and fingers closely, looking for swelling, redness or warmth in the joints. I will ask you lots of questions about your pain, such as “When did it start? Is it worse in the morning? Does it come and go? What seems to help your pain?” I will also take x-rays of your hands so that we can rule out any other conditions. Depending on your answers, I may order lab tests or take a sample of the fluid in your joints. Our findings will determine how we proceed with treatment.
For simple osteoarthritis, I will recommend conservative treatment, which may include oral anti-inflammatory medications, topical ointments and physical therapy. Warm compresses or a heating pad may also offer relief. You may need to stop or modify activities that cause pain. We will monitor your condition and change the medication if necessary, so that you get pain relief. Physical Therapy may also help you to increase strength and range of motion in your hand and your Therapist can help you learn new ways of completing tasks that you find painful.
If you have uric acid crystals in your joint fluid, indicating gout, you need to be treated differently. Gout usually affects the big toe, but can settle in the ankle, knee or any joint. There is a treatment regimen which addresses acute flare-ups and long-term management of this condition. Anti-inflammatory medications will also be prescribed or injected, along with other drugs. Cochicine is a drug that has been used forever to treat gout, but it often causes nausea and stomach issues. It is important to bring down the levels of uric acid in your body, so I will prescribe a medication to help with that. You must also be careful about your diet and not eat foods that increase uric acid. Reducing stress, getting adequate rest and limiting alcohol can also help.
Another condition which causes pain in the hands is infectious arthritis, which means that you have a bacterium or fungus in your joints causing the pain and inflammation. You could have had a puncture wound, an infection somewhere else in your body that settled in your joint or you could have had a recent surgery that got infected. In that case, we would take a sample from your joint fluid to determine what type of bug you have. Then you would be treated with antibiotics or an anti-fungal drug, administered orally or by an IV, specific to the type of organism infecting your joint. This can take weeks or even months to resolve.
I may be concerned, however, that you have an inflammatory type of arthritis such as rheumatoid or psoriatic, which commonly impacts small joints like those in the hand. To get a diagnosis, I may refer you to a rheumatologist who can test you for these by looking at your blood for a specific marker. If you have an auto-immune type of arthritis, you will need to be treated with drugs that will arrest joint destruction. These are called biologics. If left untreated, your hands and fingers can become deformed because of the joint damage.
If we live long enough, we may all face some form of arthritis in the hands and fingers. Fortunately, there are many ways we can treat the pain and dysfunction, helping those who suffer get back to the activities they enjoy doing.
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