Osteoarthritis is a degenerative pathology that affects the joints and affects 15% of the world’s population. A joint has optimal movement thanks to the articular cartilage but, when a patient suffers from osteoarthritis, this cartilage progressively degenerates and loses thickness until it disappears, causing evident changes in the bone.
If osteoarthritis is analyzed on a socioeconomic level, it is the first cause of permanent disability and the third cause of temporary incapacity for work. According to the Artrocad study, it represents a total cost of healthcare resources and a socioeconomic impact of 4,738 million euros per year.
Osteoarthritis of the hands: a disease affecting 6% of the population
Osteoarthritis can affect one or several joints. The most common are osteoarthritis of the hip, knee, hands and spine. It is usually polyarticular, affecting several joints, but there are patients who are only affected in the hands. It is estimated that 6% of the population suffers from hand osteoarthritis, with clinical differences in relation to osteoarthritis in other parts of the body.
Some differences are:
- The reduction or disappearance of pain once the nodules have developed in the joints of the long fingers or distal and proximal interphalangeal joints (Heberden’s and Bouchard’s nodules, respectively).
- Less joint stiffness but greater joint deformities.
- Hand osteoarthritis does not respond as well to treatment with common anti-inflammatory drugs as it does in other joints.
Moreover, within osteoarthritis of the hands there are different subtypes, the most notable being erosive osteoarthritis and nodal osteoarthritis. The main difference between them lies in the bone involvement, since in the former there is erosion at the central level of the bones in the proximal and distal joints, with subsequent formation of new bone in the form of osteophytes, which is not present in nodal osteoarthritis. However, the differences between the two osteoarthroses do not seem to be so obvious, as some sensitive imaging techniques have shown that in nodal osteoarthrosis there is also bone erosion. This makes some researchers consider erosive osteoarthritis more virulent, at a more advanced stage or even equate both osteoarthritis but associate it with other comorbidities, which makes the development different.
What are the symptoms of osteoarthritis and how can it be diagnosed?
Osteoarthritis usually manifests itself with pain and stiffness, especially at “onset”, i.e. when starting movement after rest. Once in motion the stiffness usually improves. Other symptoms are joint swelling and deformity, when the disease is already in more advanced stages. In addition, in the case of the hands it is usually bilateral (affecting both hands), polyarticular, additive, symmetrical and progressive.
To diagnose it the specialist in Traumatology will make a physical examination and anamnesis. A posteriori will make an X-ray to certify the diagnosis. In the initial stages, when the bone involvement is not so evident and there is only a risk of cartilage wear, an MRI is also useful.
Why does osteoarthritis occur?
Osteoarthritis usually appears in the 5th and 6th decade of life, being more frequent in women. Although the reasons for this are unknown, it is known that in some joints, such as the base of the thumb (trapeziometacarpal joint), joint laxity influences the onset of osteoarthritis. In addition, laxity is more frequent in women.
As for the actual origins of the disease, several genetic studies have been carried out without promising results. This indicates that osteoarthritis is a very heterogeneous disease where the primary causes of its onset are very diverse, as well as unknown. Although there are patients with a family history, there are also others in whom a certain relationship is observed with the manual activity exercised during life, although this link is not entirely clear.
The treatment of osteoarthritis will be conservative, as far as possible.
As a general rule, treatment is symptomatic. It starts in mild cases with little pain by applying cold and anti-inflammatory ointments. However, when the symptomatology intensifies, oral anti-inflammatory drugs should be added, although it is not advisable to extend this treatment. Joint injections with corticosteroids are also often effective in cases where oral medication does not work, as it will temporarily relieve symptoms.
Physiotherapy exercises may also help in some cases by improving joint flexibility and reducing inflammation. In cases of osteoarthritis of the hands, treatments with Chondroitin Sulfate and Glucosamine seem to improve the symptomatology.
When the previous treatments are not effective, surgery will be chosen, in most cases to replace the joints or to fix them.
Can hand osteoarthritis be prevented?
At present there are no studies that specify the possibility of preventing osteoarthritis of the hands. However, in the case of osteoarthritis of the base of the thumb (which is the most common), if gripper activities are avoided or carried out with a splint, in order to prevent progression.
On the other hand, as mentioned above, Glucosamine and Chondroitin Sulfate can improve the symptomatology and, therefore, also cartilage degeneration.
However, there is no sport or activity that can improve osteoarthritis of the hands. The most advisable is to maintain joint flexibility without forcing the range of motion, in case of pain, and to avoid, of course, sports involving great grip and fist strength, which could trigger an inflammatory flare-up.