How is arthritis in the hand treated?

Updated on

How is arthritis in the hand treated?

Treatment options depend on the type of arthritis, stage of arthritis, how many joints are affected, your age, activity level, the hand affected (if it's your dominant hand) and other existing medical conditions.

Goals of treatment are to:

  • Decrease joint pain and stiffness.
  • Improve mobility and function.
  • Increase your quality of life.
  • In the case of rheumatoid or psoriatic arthritis, to slow the progression of the disease.

Treatment options include splinting/bracing, medications, injections, non-drug approaches and surgery.

Splinting/braces

Splits or braces support and protect the affected joint, reduce deformity, provide joint stability, lessen strain, and promote proper joint alignment. Your healthcare provider, occupational therapist or hand therapist will discuss splinting/bracing options, how and when to wear them and how long to wear them (wearing splints or braces too long can cause your muscles to weaken).

Medications

Your healthcare provider may prescribe medications to reduce your joint pain and swelling and, in the case of rheumatoid or psoriatic arthritis, to prevent joint damage. Your provider may try different drug classes, depending on the severity and type of your arthritis. For osteoarthritis, only acetaminophen or nonsteroidal anti-inflammatory drugs are recommended for limited use (as needed) for relief of your symptoms. There are currently no medications approved that help slow the progression of osteoarthritis. The drugs listed below are used to treat rheumatoid and psoriatic arthritis. Before taking any over-the-counter medication, make sure you check with your provider, as there are risks and reasons for not using these medications (depending on your other health conditions and/or medications).

  • Acetaminophen. This drug helps relieve pain.
  • Nonsteroidal anti-inflammatory drugs. These drugs reduce pain and swelling in affected joints. Examples include ibuprofen, diclofenac, naproxen, celecoxib. Topical NSAIDs are the first topical treatment of choice for osteoarthritis.
  • Disease-modifying antirheumatic drugs. These slow the progression of rheumatoid arthritis and relieve symptoms. Examples include methotrexate, hydroxychloroquine, sulfasalazine (Azulfidine®), leflumonide (Arava®).
  • Corticosteroids. Taken by mouth, injected into your muscle or given by IV, these medications reduce inflammation and other symptoms of rheumatoid arthritis. Examples include prednisolone, prednisone, triamcinolone and methylprednisolone.
  • Immunosuppressive drugs. These slow the progression of rheumatoid arthritis and reduce damage to bone surrounding joints. Examples include azathioprine and cyclosporine.
  • Biologic agents. These can slow joint damage in rheumatoid arthritis. Examples include adalimumab (Humira®), etanercept (Enbrel®), infliximab (Remicade®), tofacitinib (Xeljanz®), tocilizumab (Actemra®), abatacept (Orencia®), rituximab (Rituxan®).

Steroid injections

Steroids reduce inflammation and relieve pain. Steroids are usually used if medications don’t control inflammation or if the inflammation is limited to a few joints. Injections are administered directly into the affected joint. Because steroids can weaken tendons and ligaments, injections are repeated only a few times.

Other management strategies

A complete treatment plan for arthritis of the hand includes these additional approaches:

  • Exercises — strengthening and stretching — to reduce symptoms and improve function. A hand therapist will work with you to prescribe the exercises best suited for your hand arthritis.
  • Hot and cold packs. Cold can help reduce pain and swelling. Heat can help reduce stiffness. Apply for no longer than 20 minutes at a time.
  • Rest. Regular rest periods can help relieve pain and inflammation in your joints.
  • Healthy eating and managing diabetes and cholesterol.
  • Weight loss if you’re overweight.
  • Smoking cessation. Smoking increases your risk of developing arthritis.
  • Occupational therapy to learn how to use self-help devices including those used to assist with dressing or preparing food in the kitchen.

Surgery

If nonsurgical treatments no longer provide relief and the cartilage at the ends of your bones has worn away, surgery may be an option. There are several approaches:

  • Joint fusion (arthrodesis): This surgery uses a plate and screws to keep the bones of your joint together. You’ll have a more stable, pain-free joint, but will have limited flexibility and movement.
  • Joint replacement (arthroplasty): Similar to other joint replacements, surgeons use an artificial implant made of plastic, ceramics, silicone or metals to replace your damaged joint. Keep in mind that hinged finger implants don’t mimic normal finger movement.
  • Tendon transfer: Tendons connect muscles to bones. The tendons that control your fingers attach to muscles in your palm and forearm. Ongoing inflammation from arthritis can cause tendons to rupture. If this happens, a portion of a healthy tendon can be used to restore your hand function.

You and your surgeon will discuss which surgical approach might be best for your hand considering your age, activity level, the joint(s) affected and the amount of pain and deformity you’re experiencing.

Related posts