How to Deal With Arthritis of the Hand – Harvard

They pour our coffee, brush our teeth and perform hundreds of other daily tasks too numerous to mention. “But aching hands transform even a simple task into a painful ordeal. Beneath the skin, your hands are an intricate architecture of tendons, joints, ligaments, nerves, and bones. Each of these structures is vulnerable to damage from illness or injury. Arthritis can make it difficult to carry a shopping bag,” according to Dr. Barry P Simmons, Medical Editor of Harvard Health Publications.

Harvard has issued a 44 page report entitled Hands. This Special Health Report from Harvard Medical School, includes super-informed coverage of The Healthy Hand, Arthritis of the hand, Tendon trouble, Exercise for the hand, Carpal tunnel syndrome and other tunnel syndromes, traumatic hand and wrist injuries as well as handy gadgets. This pretty much qualifies as everything you ever wanted to know about the hand, but were afraid to ask. Harvard Medical School offers special reports on over 50 health topics. Visit their website for further reports of interest to you and your family. You can order the Hands report here.



The following is directly from the report:

Osteoarthritis
The most common of all joint diseases, osteoarthritis affects cartilage, the resilient tissue that cushions the ends of your bones. Normally, cartilage provides a smooth, gliding surface so the joints can move easily. In osteoarthritis, the cartilage thins and loses its elasticity. As the cartilage breaks down, the underlying bone may form a bony growth called a spur, or osteophyte. Fluid-filled cysts may form in the bone near the joint. The synovial membrane lining the joints becomes inflamed, triggering the release of proteins that may damage the cartilage further.

Approximately 27 million Americans have osteoarthritis. In addition to the hands, osteoarthritis typically strikes the knees, hips, feet, and back. The incidence rises with age, with most cases occurring in people older than 50. Heredity seems to play a role, particularly for osteoarthritis in the hands. Muscle weakness and a history of joint injuries caused by sports or accidents may also make a person more prone to a type of osteoarthritis known as traumatic arthritis. Ordinary, repetitive activities such as typing or playing a musical instrument may worsen arthritis symptoms, but they do not cause osteoarthritis of the hands.

Treating arthritic hands
Managing pain and improving function are the key goals in treating osteoarthritis. The best approach is usually a combination of different therapies, which can include joint protection, heat or cold therapy, medication, exercise, alternative remedies, and, in some cases, surgery.

■ Joint protection. If you have osteoarthritis, it’s important to learn to recognize your body’s signals to stop or slow down. To prevent pain caused by overexertion, take time to rest and pace yourself by taking frequent breaks. Using specialized products and assistive devices can also make a big difference. Modifying tasks to make them less stressful allows you to continue to do the things you need or want to do while alleviating the symptoms of arthritis. You can also use braces or splints to support painful joints.

■ Heat or cold therapy. You can often soothe painful joints without medications. A warm bath or shower can ease pain and stiffness. Drug and department stores carry paraffin (wax) heating units, another type of heat treatment for the hands, which may be soothing. Other times, usually after exercise or exertion, cold therapy may work better. You can place a bag of ice or frozen vegetables wrapped in a towel on the joint or use a freezer gel pack, available at drugstores. Check with a doctor or therapist to find out whether heat or cold is the best treatment for you.

■ Exercise. Therapeutic exercise helps people with osteoarthritis in many ways: by improving mood, decreasing pain, and increasing flexibility and fitness over all. Therapeutic exercises, especially range-of- motion exercises for the thumb and wrist, help keep hand joints working as well as possible. Gentle, pain-free strengthening may be appropriate once the inflammation and pain have subsided. Consult a hand therapist for specific exercises for your hand problem.

■ Medication. Doctors prescribe a number of medications for arthritis, including topical and oral pain- killers (see Tables 1 and 2). One prescription gel, diclofenac (Voltaren), offers modest relief for hand arthritis, according to a 2009 study in The Journal of Rheumatology. Other over-the-counter gels and creams can be effective for mild to moderate pain, and their effects last as long as oral medications. For more severe pain, oral medications are typically more effective, but they are more likely to cause side effects. Those that are in the class known as nonsteroidal anti- inflammatory drugs (NSAIDs), such as the over-the- counter pain relievers ibuprofen (Advil, Motrin) and naproxen (Aleve), also curb inflammation. For short- term relief, corticosteroids, known informally as steroids, can be injected directly into a joint to relieve pain, but this is rarely done for hand joints. More important, excessive injections actually increase the destruction of bone and cartilage.

■ Surgery. This option usually is recommended only after other treatments don’t work. Several surgical procedures are used for osteoarthritis, the most common being the removal of cysts and osteophytes at the DIP joint. People with severe osteoarthritis may be candidates for joint fusion or joint replacement.