ARTHRITIS IN THE HAND


Osteoarthritis, often simply referred to as arthritis, is the global term for the degenerative joint process where the common denominator is the loss of articular cartilage. The ‘itis’ in arthritis refers to an inflammatory condition, and is a misnomer in medical terminology, since the cause is not inflammatory in nature. Osteoarthritis is therefore seen as part of the aging process where degeneration of joint cartilage creates stiff, painful and swollen joints. Our understanding of this condition is still limited. What we do know, is that the degeneration of the soft cartilage (that creates a smooth gliding surface for the joint), will, with time, expose the subchondral bone. When there is no cartilage left in the joint, the bones on both sides of the joint start grinding against each other. This can be painful, because the bone underneath the cartilage surface (that is exposed in osteoarthritis) has many nerve endings, whereas the cartilage has no nerve supply. Worn down or damaged cartilage cannot grow back or regenerate. Therefore, osteoarthritis is irreversible. The degeneration of cartilage is not an inflammatory process. We take anti-inflammatories to relieve the pain or inject steroids to reduce the inflammation, but this in our current understanding, is not the driving force of this condition.

X-ray findings show narrowing of the joint space (as a result of the loss of cartilage that we cannot see on x-rays), osteophytes (bony spurs), joint effusions (increased synovial or joint fluid) as well as abnormal contact between the two bones of the joint. As yet, there is no cure for this debilitating condition. In principal, we try to delay surgical intervention as long as possible. We do this by maintaining movement with correct exercises, analgesics like paracetamol and anti-inflammatories, and sometimes walking sticks in lower limb arthritic conditions. Splinting and modification of daily activities forms part of conservative management.

Surgical intervention is focused on restoring movement and relieving pain. Total joint arthroplasty or total joint replacement is the surgical procedure where both surfaces of the joint are replaced, like in a knee or a hip replacement. Excision arthroplasty refers to the procedure where we excise both the bone-cartilage surfaces (to relieve pain) and fill the joint with other tissue to prevent bone on bone contact again. A good example of this would be the procedure that is performed in arthritis at the base of the thumb where the trapezium bone which has circumferential arthritis, is excised, and the void is filled with a tendon graft. Finally, we can fuse the joints: we remove the cartilage and make the joint stiff. This is commonly done in the last joint of the finger. We achieve a pain free joint, but trade it in for a stiff one.

In the hand, osteoarthritis is associated with a quintet that is frequently seen together: carpal tunnel syndrome, arthritis of the base of thumb, arthritis with mucoid cysts at the end of the fingers, De Quervain’s tenosynovitis and trigger finger. When a patient presents with one of these conditions in the background of osteoarthritis, it is wise to check for the other conditions of the quintet.

ARTHRITIS IN THE HAND


Osteoarthritis, often simply referred to as arthritis, is the global term for the degenerative joint process where the common denominator is the loss of articular cartilage. The ‘itis’ in arthritis refers to an inflammatory condition, and is a misnomer in medical terminology, since the cause is not inflammatory in nature. Osteoarthritis is therefore seen as part of the aging process where degeneration of joint cartilage creates stiff, painful and swollen joints. Our understanding of this condition is still limited. What we do know, is that the degeneration of the soft cartilage (that creates a smooth gliding surface for the joint), will, with time, expose the subchondral bone. When there is no cartilage left in the joint, the bones on both sides of the joint start grinding against each other. This can be painful, because the bone underneath the cartilage surface (that is exposed in osteoarthritis) has many nerve endings, whereas the cartilage has no nerve supply. Worn down or damaged cartilage cannot grow back or regenerate. Therefore, osteoarthritis is irreversible. The degeneration of cartilage is not an inflammatory process. We take anti-inflammatories to relieve the pain or inject steroids to reduce the inflammation, but this in our current understanding, is not the driving force of this condition.

X-ray findings show narrowing of the joint space (as a result of the loss of cartilage that we cannot see on x-rays), osteophytes (bony spurs), joint effusions (increased synovial or joint fluid) as well as abnormal contact between the two bones of the joint. As yet, there is no cure for this debilitating condition. In principal, we try to delay surgical intervention as long as possible. We do this by maintaining movement with correct exercises, analgesics like paracetamol and anti-inflammatories, and sometimes walking sticks in lower limb arthritic conditions. Splinting and modification of daily activities forms part of conservative management.

Surgical intervention is focused on restoring movement and relieving pain. Total joint arthroplasty or total joint replacement is the surgical procedure where both surfaces of the joint are replaced, like in a knee or a hip replacement. Excision arthroplasty refers to the procedure where we excise both the bone-cartilage surfaces (to relieve pain) and fill the joint with other tissue to prevent bone on bone contact again. A good example of this would be the procedure that is performed in arthritis at the base of the thumb where the trapezium bone which has circumferential arthritis, is excised, and the void is filled with a tendon graft. Finally, we can fuse the joints: we remove the cartilage and make the joint stiff. This is commonly done in the last joint of the finger. We achieve a pain free joint, but trade it in for a stiff one.

In the hand, osteoarthritis is associated with a quintet that is frequently seen together: carpal tunnel syndrome, arthritis of the base of thumb, arthritis with mucoid cysts at the end of the fingers, De Quervain’s tenosynovitis and trigger finger. When a patient presents with one of these conditions in the background of osteoarthritis, it is wise to check for the other conditions of the quintet.

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