Musculoskeletal Matters 14: Hand Osteoarthritis

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.