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Recognizing Arthritis in Fingers and Thumbs

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Recognizing Arthritis

Swollen, red, bumpy, or lumpy? These symptoms may seem alike, but they signify distinct types of arthritis conditions. What has happened to your once nimble fingers and thumb? The dexterity that allowed you to effortlessly button a shirt, open a jar, or type your thoughts on a keyboard has now been replaced with stiffness, pain, and deformation.

Arthritis is likely the culprit, and its impact can jeopardize your autonomy. As Dr. Jeffrey Sparks, Assistant Professor of Medicine at Harvard Medical School and a Rheumatologist at Harvard-affiliated Brigham and Women's Hospital, points out:

The American College of Rheumatology has a campaign illustrating how arthritis and other rheumatic conditions affect lives. Their symbol is a fork with twisted tines, representing the difficulty in performing simple tasks such as using a fork, operating a cellphone, typing, grooming, cooking, or eating.

Joints of Fingers and Thumbs

Fingers possess three joints: the metacarpophalangeal (MCP) joint where the finger attaches to the hand, the middle proximal interphalangeal (PIP) joint, and the distal interphalangeal (DIP) joint near the fingertip. The carpometacarpal (CMC) joint is located at the base of the thumb.

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Symptoms and Types of Arthritis in Fingers and Thumbs

There are two primary forms of arthritis that can impact your fingers and thumb, each with distinct symptoms:

Osteoarthritis

The most prevalent type, osteoarthritis, is a degenerative condition that wears away the cartilage cushioning within the joints. As bones rub against each other, new bone forms as bumps or nodes on the joints. Dr. Aaron Bernstein explains:

These bony growths lead to the expansion of surrounding soft tissue. Nodes can appear on one or both knuckles and on different fingers of either hand. The specific location remains somewhat enigmatic.

Osteoarthritis commonly affects the DIP and CMC joints and occasionally the PIP joints. These joints can become painful, stiff, and slightly enlarged, with a bumpy texture due to the small bony growths. Consequently, finger and thumb mobility may be restricted.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) differs from osteoarthritis. It results from an overactive immune system attacking the joint lining for unknown reasons. The hands are often the first site of RA, with the MCP and PIP joints being the most frequently affected. Similar to osteoarthritis, the joints become painful and stiff. However, RA also causes joints to become significantly swollen, red, and warm, indicating internal inflammation.

RA often impacts wrists, feet, ankles, elbows, shoulders, hips, knees, and neck joints. Dr. Aaron Bernstein, Harvard MD notes:

Typically, multiple joints are affected, and it is usually the same joints on both sides of the body simultaneously. Over time, joint damage leads to cartilage loss and joint deformity.

Besides joint pain, RA can result in fatigue, low-grade fever, sweating, poor appetite, difficulty sleeping, and inflammation of the heart, lungs, or eyes.

Other Forms of Finger and Thumb Arthritis

In addition to osteoarthritis and rheumatoid arthritis, several other types of arthritis can affect the fingers and thumbs. Autoimmune diseases, such as lupus and psoriatic arthritis, are particularly notable. Dr. Sparks mentions, "In psoriatic arthritis, the DIP joints may be involved, and there can be small pits in the fingernails."

Gout, another form of arthritis that impacts the fingers, is caused by an accumulation of uric acid in the blood. This buildup leads to the formation of sharp crystals in the joints, resulting in inflammation. Dr. Sparks highlights, "People are aware of gout in the toes, but it can also affect the thumbs and fingers."

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Taking Action Against Arthritis in Hands

If you suspect that you have arthritis in your hands, it is crucial to consult your doctor without delay. Dr. Sparks emphasizes,

We have medications that effectively treat these diseases. The earlier arthritis is addressed, the more likely it follows a milder course. In the case of RA, we can prevent deformities, slow down the disease progression, and avoid additional complications.

Unfortunately, there are no medications to halt or slow osteoarthritis. Treatment focuses on managing symptoms and improving functionality. Dr. Sparks suggests:

We often recommend taking oral pain relievers such as acetaminophen (Tylenol), using topical analgesics like diclofenac (Voltaren Arthritis Pain), applying heat or cold therapy, and strengthening your hands.

For any form of arthritis, you may benefit from wearing a splint or brace, utilizing assistive devices (e.g., a shirt buttoner) to aid with daily activities, and collaborating with a certified hand therapist. A hand therapist can customize therapy to your specific condition and develop alternative strategies for tasks that have become difficult for you.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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