Hand Arthritis: A Tale of Two Diseases
Although there are many diseases that cause pain in the hands, the two most common are Osteoarthritis and Rheumatoid Arthritis.
Osteoarthritis (OA) and Rheumatoid Arthritis (RA) both cause pain, stiffness, loss of function, and can be disabling. OA is more likely to affect the base of the thumb (CMC joints) and the set of knuckles closest to your fingertips (DIPs). OA also causes those knuckles to develop bone spurs that we call Heberden’s Nodes. RA is more likely to affect your bigger knuckles (MCPs and PIPs) and not just make them painful: RA causes joints to become swollen, red and hot. That is why a thorough physical exam by a trusted specialist is important. The stiffness you experience in the morning can last 15-30 minutes in OA, but patients that suffer from RA can be stiff for hours. Symptoms improve with rest in OA, but in RA exercising the hands will relieve the pain and swelling.
Classically rheumatologists have thought of Osteoarthritis as a degenerative process, a “wear and tear” on the body that comes with trauma, overuse and age. In fact, hand OA usually begins after the age of 55. Other risk factors for hand OA include female sex, family history of OA, repetitive hand use, obesity and metabolic syndrome. RA is an inflammatory process driven by the immune system “overacting and attacking” the joints. It can occur at any age, and there is even Juvenile Arthritis that can appear in infancy. Risk factors include family history of RA, smoking, female sex, periodontitis (inflammation of the gums and bone) and some lung diseases.
My work up for OA and RA is similar: I listen to the patient’s history, examine the patient, order lab tests and X-rays. In Rheumatoid Arthritis you may see positive antibodies (RF, CCP) and markers of inflammation (ESR, CRP) in the blood. X-rays show distinct patterns of damage: in OA we see increases in bone such as sclerosis (hardening of the edges) and osteophytes (bone spurs). Whereas in RA, bone is lost, causing osteopenia (weak bones) and erosions. “Erosive Osteoarthritis” is more common in women but has a different pattern of erosions. MRI shows damage to cartilage in OA as well as inflammation in RA in the form of “edema.” Rheumatologists are trained to see these differences.
The treatment for OA focuses on decreasing pain, maintaining mobility and function. Medications can help, as does physical therapy. Newer treatment modalities for OA include radiation therapy. In RA we must suppress the immune system with strong medications such as “Biologics” to stop the inflammatory process. These medications must be prescribed by qualified, Board-certified Rheumatologists.
If you have arthritis in your hands and don’t know the cause, come see me! As a USC fellowship-trained, Board Certified Rheumatologist with more than 10 years of experience, I can help. You will get a greater understanding of the disease and might find a better treatment for your pain!
