I am new to the world of hand arthritis. I'm trying to find as much information as I can before choosing a treatment plan I can live with. What can you tell me?
In a recently published article, orthopedic surgeon Marco Rizzo, MD from the Mayo Clinic (Rochester, Minnesota) provides an update on what can be done for anyone with joint arthritis of the hands. There are two basic choices: conservative (nonoperative) care and surgery. Conservative care consists of three options: splinting to protect the joint and give it a rest, medications, and steroid injections. Usually splints are worn during activities and removed during rest periods. Daily exercises are performed with the splints off. Some physicians advise their patients to just wear the splints at night as they do seem to help prevent deformities from developing. New medications are available that target the immune system and stop the inflammatory processes linked with arthritis. Patients with inflammatory arthritis and especially rheumatoid arthritis get the most benefit from these drugs. The physician will often prescribe one drug to start. If it is not effective or doesn't work as well as expected, a combination of drugs may be used. It can take a while before finding just the right mix of medications that work best for each patient. Patience and persistence are the keys to success here. Nonsteroidal antiinflammatories (NSAIDs) are still used for all types of arthritis (even osteoarthritis, which doesn't have a strong inflammatory component). NSAIDs help improve pain and function but they do have some potentially serious adverse side effects (GI, kidney, liver damage). There is also a new topical agent (diclofenac) that works well for the hands and is less likely to cause systemic problems. Steroid injections are easy to give and provide immediate relief from pain. Having the freedom from pain can give you a new lease on life. Improved function follows but the effects wear off and aren't long-lasting. If there's more than one finger involved, then splinting and systemic medications are a better choice. When it comes to surgery, there are two main surgical choices: joint replacement and fusion. It's more difficult to replace the thumb joint, so fusion is more common there. But silicone implants have worked well for the fingers and are an acceptable choice for all the other metacarpophalangeal (MCP) joints. If there is too much bone loss and deformity, surgery may not be as effective as patients hoped for. On the other hand, even some pain relief and improved motion can help aid function and hygiene. For joint replacement, there are many types of joint implants available. The surgeon makes his or her decision on which implant to use based on the type of arthritis, amount of bone, and condition of the surrounding soft tissues. Patients with rheumatoid arthritis typically don't get the same excellent outcomes as patients with osteoarthritis but they are still happy with improved results. When selecting joint implants, the patient's goals and lifestyle are also taken into consideration. The silicone implants still remain the top choice but newer carbon and metal-plastic are gaining in popularity. Patients must have good bone stock to benefit from the newer-generation implants. The carbon and metal-plastic implants are less likely to fracture compared with the more fracture-prone silicone implants. Metacarpophalangeal (MCP) joint arthritis is a common problem. One that can be very disabling but when diagnosed early, conservative care can be very helpful in treating symptoms and even preventing progression of disease. Newer drugs on the market have made this possible. Splinting seems to be effective but studies are needed to really prove this point. And for those patients who need surgery, joint implant procedures have improved steadily over the years.