Hand and Wrist Arthritis Advancement: State-of-the-Art Therapeutic Modalities

Introduction

Arthritis of the hand and wrist is a common condition that affects many people and can range in severity from mild to debilitating.  Arthritis is the loss of cartilage – the smooth, lubricating surface between the bones that make up a joint – that creates pain due to bone rubbing against bone.  There are more than 15 joints that make up the hand and wrist and all can be affected by arthritis changes. There are also multiple types of arthritis.  Osteoarthritis is part of normal aging or “normal wear and tear” of the joints.  There is also an autoimmune disease known as rheumatoid arthritis which can affect any of the joints in the body with the hand and wrist being very commonly involved.  Arthritis, regardless of the type, can cause pain, swelling, stiffness, and difficulty with simple daily activities.  Genetics, aging, injuries, and overuse are all potential causes of arthritis.

Importance of Early Diagnosis and Treatment

Early signs of arthritis include swelling of one or multiple joints, pain of one or more joints, and decreased range of motion.  While the above symptoms are not exclusive to arthritis it is important to seek care if you experience any of these symptoms.

There is no cure for arthritis, but early identification and treatment can help reduce pain and allow patients to maintain good range of motion of the fingers and wrist.  Often the symptoms of arthritis will fluctuate in severity.  Management of the symptoms early on in the condition can lead to better long-term outcomes.

Non-Surgical Advancements & Treatment

Initial treatment of arthritis is always done with non-surgical methods. Oral medications including Tylenol (pain reliever) or non-steroid anti-inflammatory medications (NSAIDs like Advil, Motrin, Aleve) are always first line treatments as long as no allergies or contraindications are present.  The NSAIDs tend to be more effective treatment because they treat both pain and inflammation associated with arthritis.  There are special medications used to treat rheumatoid arthritis known as disease modifying medications.  These medications have drastically improved the prognosis in patients with rheumatoid arthritis and are typically prescribed by primary care doctors or rheumatologists.

Joint injections are commonly used to treat hand and wrist arthritis.  Corticosteroids are used for joint injections and can often provide significant relief due to arthritis pain.  There are several types of corticosteroids, and all have been shown to be fairly effective.  Hyaluronic acid injections are also used to treat arthritis, but these injections are only approved for treatment of arthritis in the lower extremity and are not approved for use in the hand or wrist.

Occupational therapy, or dedicated hand therapy, can often be very effective to maintain joint mobility.  Joint stiffness is common with any type of arthritis and can prevent patients from being to simply grasp or grab on a regular basis.  Consultation with a hand therapist can prove to be effective and often simple daily exercises for 10 to 15 minutes can allow patients to maintain critical joint mobility.

Finally, there have been several scientific advances in recent years including platelet rich plasma injections and stem cell therapy which have proven effective for certain diseases.  It is important to understand that as of now, neither of these therapies have enough evidence for the treatment of hand and wrist arthritis.  Both are promising areas of study with the potential for a future role in arthritis treatment.

Surgical Advancements & Treatment

Several different types of surgical treatment, including minimally invasive options, can be used to treat hand and wrist arthritis and are typically recommended if non-surgical treatment has been ineffective. Denervation and arthroscopy have proven to both be effective.  Denervation refers to eliminating the nerve input to a joint to decrease pain signals back to the brain thereby decreasing or possibly eliminating the pain from an arthritic joint.  This procedure can often be done with small incisions to allow faster recovery.  Arthroscopy refers to using a small camera to allow surgeons to visualize an arthritic joint.  Through this method, small tissue tears can be repaired, joint debris can be removed, or inflamed tissue can be eliminated.

More traditional surgical options include joint fusion or joint arthroplasty.  Joint fusion is done by taking the two or more bones that make a joint and fusing them together to make one bone.  This procedure is very reliable for pain relief but does come at the expense of losing the joint motion.  Most patients who undergo this procedure are typically satisfied with the pain relief and are willing to sacrifice the motion of a joint given that pain can be debilitating.  Joint fusion can also be a great option for patients with severely deformed joints as it can often create a more cosmetic appearance in addition to relieving pain.  Arthritic joints of the hand and wrist can also be treated with surgery known as arthroplasty, or joint replacement.  Different types of arthroplasty exist based on the joint involved whether it be the wrist or fingers.  Partial joint replacement is also an option.  It is important to discuss with your surgeon which procedure would suit you best based on symptoms and the joint involved.

Choosing the Right Treatment

Arthritis treatment is individualized to each patient and no two patients or joints are ever the same.  It is important to discuss with your hand and wrist surgeon which treatment is best suited to your goals and lifestyle.  Factors such as age and overall health status need to be considered to determine the appropriate treatment.  It is also important to remember that arthritis is not dangerous or life threatening.  However, ignoring the signs and symptoms can lead to further progression and decline in overall function.

Post-Treatment Care and Rehabilitation

Once a specific treatment is chosen it is important to follow the post treatment protocols outlined by your surgeon.  Occupational hand therapy, physical therapy, and home exercise programs are critical to increase success of treatment.

Conclusion

Hand and wrist arthritis is a common cause of pain, stiffness, and swelling.  There have been great advancements in recent years to treat this condition – all of which have proven to be effective.  While it is important to remember that there is no cure for arthritis, that does not mean that it cannot be treated.  If you are experiencing any of the signs or symptoms then you should seek care by scheduling an appointment with an experienced hand and wrist specialist at Rothman Orthopaedics to discuss your options.