MUSCULOSKELETAL MATTERS
Bulletin 14
Hand osteoarthritis
an important, common but neglected
cause of pain, disability and frustration
The hands are one of the sites most frequently
aff ected by osteoarthritis (OA), which can cause
knobbly swellings (‘nodes’) and pain, aching and
stiff ness in the fi nger joints (Fig 1). There are
diff erent types of hand OA depending on which
of the many joints are aff ected. Fig. 2 shows the
common sites of OA in the hand joints. These are
the interphalangeal joints (highlighted in red), and
the thumb base joints (blue).
One of the rarer but more symptomatic ‘erosive’
type of hand OA involves joint infl ammation
and erosions (eroded areas of bone seen on
X-rays). Erosive hand OA tends to lead to more
severe hand problems, including increased pain,
reduced function and grip strength. We found
that erosive OA aff ects the same hand joints, in
the same order of frequency, and has the same
symmetrical patterning across both hands as
moderate and severe hand OA, suggesting that it
is a more severe form of hand OA, as opposed to
a separate disease.
A fi nger without nodes:
How common is hand OA?
Hand OA is more common in older adults,
aff ecting more women (1 in 4) than men (1 in 7).
In a study of people aged 50 years and over with
hand pain in the past month we found that:
• a combination of both thumb and fi nger OA occurred
most frequently
• thumb base OA occurred in isolation more often than
fi nger OA alone (with or without nodes)
• erosive OA was the least common form
Finger joints
Thumb
base joints
Figure 2. The joints of the hand
A fi nger with nodes:
Figure 1. A fi nger node is a fi rm, knobbly pea-sized
swelling on the back of a fi nger joint (O’Reilly et al, 1999)
Who is most likely to develop
hand OA?
Hand OA is associated with increasing age, and
is commoner in women and those with a family
history of hand OA. Possible risk factors include
occupations or hobbies that involve intense
and prolonged repetitive movements and hand
injuries, being overweight, having high blood
pressure, raised blood fats and diabetes have
also been linked with hand OA.
Diagnosis and Assessment
Hand OA can be diagnosed clinically without the use of x-ray (NICE). Hand OA often co-exists with other
conditions such as carpal tunnel syndrome and trigger fi nger but hand OA has the greatest impact and this
may be as severe as for rheumatoid arthritis.
These bulletins are designed to provide information for general practitioners, the primary care team, teachers, trainers and policy makers about musculoskeletal problems in practice.