Arthrosis of the hands and fingers

Arthrosis of the hands and fingers is a chronic degenerative disease of small joints, accompanied by gradual destruction of cartilage, changes in surrounding tissues and restriction of function. Characteristic symptoms are pain that increases after physical exertion, stiffness after a period of rest, joint deformities. Pathology is diagnosed on the basis of complaints, anamnesis, physical examination data, radiography results. Additionally, ultrasound, MRI, CT, laboratory tests can be prescribed. Treatment – physical therapy, orthoses, drug therapy. In some cases, operations are performed.

General information
Arthrosis of the hands and fingers is a common pathology affecting mainly elderly and senile people. It accounts for 38% of the total number of osteoarthritis of all localizations. Radiological changes characteristic of this disease are detected in 80% of people in the older age group. Clinically significant symptoms of the disease are found in 2-6% of adults and in 5-20% of elderly patients. The most common are lesions of the distal joints of the fingers. Proximal interphalangeal joints, wrist joints are less often involved.

Reasons
Osteoarthritis of small joints of the hand is a polyethological disease. Its occurrence and the rate of progression is influenced by many factors, including:

Age. With aging, involutive changes in cartilage tissue increase, cartilage damage entails pathological changes in the underlying bone and soft tissue structures – capsules and ligaments of the joint.
Heredity. The peculiarities of the structure and aging of cartilage are inherited to a certain extent, therefore arthrotic lesions of small joints are often detected in blood relatives.
Work and lifestyle. A significant role in the development of arthrosis is played by constant high professional and household loads, as well as repeated microtrauma of the joints of the hand.
Diseases and injuries. Arthrosis forms in the long-term period after dislocations, intra-articular fractures. Pathology is more often detected in people who previously suffered from arthritis of various origins.
Female gender. Hormonal background affects the condition of the joints, so osteoarthritis often manifests during menopause.
It is believed that people with obesity are more susceptible to arthrosis of small joints. Some authors point out that hypermobility of the joints is a provoking circumstance, but the statistics are quite contradictory.

Pathogenesis
Articular cartilage is unevenly thinning, cracks appear on its surface. Over time, zones are formed in which there is no cartilage. Cartilage damage provokes changes in the underlying bone. The subchondral parts of the bone are sclerosed, cysts and necrosis sites are detected in the bone tissue. The articular gap narrows, becomes uneven. Osteophytes are formed, causing pain syndrome during movements. With further progression of the process, typical growths are found – Heberden and Bouchard nodules.

Classification
There are two types of arthrosis – symptomatic and idiopathic. The first option occurs after injuries or against the background of other diseases. The second one develops for no apparent reason. There is a special form of pathology characterized by a severe course – erosive osteoarthritis, presumably associated with a hereditary predisposition and causing serious functional disorders. In clinical rheumatology , classification is used taking into account the degree of severity according to Kosinskaya:

Stage 1. Reduced resistance to stress, minor movement restrictions, changes in the composition of synovial fluid, small marginal bone growths on radiographs.
Stage 2. Significant limitations of movements, pain and crunch during movements, moderate osteophytes and a decrease in the lumen of the articular gap on X-rays.
Stage 3. Gross functional disorders, contractures, pathological mobility, finger axis change, muscular atrophy. Radiologically, there are obvious changes in the configuration of the joint, subluxations, pronounced marginal growths.
Symptoms
In 90% of cases, distal interphalangeal joints suffer. The second place in prevalence is occupied by arthrosis of the proximal interphalangeal joints and 1 metacarpophalangeal joint. Even less often, other hand joints formed with the participation of wrist bones (semilunar or navicular) are involved in the process. The lesion is usually symmetrical except in cases of post-traumatic osteoarthritis. Less common is the variant in which pathological changes are found in three joints of one finger.

In the initial stages, patients complain of joint pain, which increases with exertion, disappears at rest. With the further development of the disease, the pain syndrome becomes more prolonged, the pain is disturbed in the afternoon, in the first half of the night. There is a crunch. In the morning and after periods of rest, stiffness is noted, which disappears some time after the start of movements.

Joints increase in volume, deform. In the area of the distal joints, Heberden nodules are found, in the proximal area – Bouchard nodules. With the early manifestation of arthrosis against the background of injuries or overloads, effusion often accumulates in the joint cavities. For senile arthrosis, effusion is uncharacteristic, in such cases, more pronounced muscle atrophy is determined. The functions of the brush are broken.

Complications
The main complication of arthrosis is movement disorders of varying severity. A decrease in the volume of movements already at the 2nd stage of the disease causes disability, sometimes – a forced change of profession. Contractures and pathological mobility at the 3rd stage of the disease lead to disability, difficulties in self-care. With an erosive form of arthrosis, ankylosis can form.

Diagnostics
The examination is carried out by rheumatologists or orthopedists. The diagnosis is made on the basis of anamnesis, clinical data and the results of additional studies. The following diagnostic procedures are performed:

Survey. The specialist finds out when and under what circumstances the symptoms of arthrosis appeared, how the disease developed, specifies the time of the appearance of the pain syndrome, the relationship between pain and physical activity.
Physical examination. The doctor evaluates the appearance of the hands, identifies deformities, nodules of Bouchard and Geberden, evaluates the volume of movements, the presence or absence of inflammation (the latter sign is of high importance when conducting differential diagnosis).
Radiography of the hands. It is the main instrumental study for arthrosis. The images show a decrease in the height of the articular gap, osteosclerosis of the subcortical bone, cystic clearances, areas of necrosis, bone growths.
Other visualization techniques. Ultrasound, CT and MRI of the hands play an auxiliary role, are prescribed if necessary to differentiate arthrosis from other diseases with similar symptoms, allow you to detail changes in bones, cartilage, soft tissues.
Laboratory tests. Performed to exclude arthritis. In arthrosis, specific markers of rheumatic diseases (C-reactive protein, rheumatoid factor, ADC, etc.) are absent.
Mandatory clinical criteria for arthrosis are pain at the end of the day, as well as pain that occurs after exercise and decreases at rest. The list of mandatory radiological criteria includes osteosclerosis and narrowing of the articular gap. As an additional feature, bone growths are considered, determined visually and with the help of X-ray examination. The number of swollen (inflamed) joints should be less than 3.

Treatment
Treatment of arthrosis of the hands and fingers is long-term, in the vast majority of cases conservative, carried out on an outpatient basis. Patients are informed about the peculiarities of the course of the disease, drug and non-drug therapies, ways to reduce the influence of factors that aggravate the course and accelerate the progression of pathology. The following therapeutic measures are carried out:

Protective mode. Patients are recommended to limit the load on the hands, take regular breaks during activity. With specialties related to the constant overload of small joints, it may be necessary to change the place of work.
Orthoses. There are a large number of orthopedic devices that allow you to relieve the affected joints. Depending on the modification, orthoses can be used throughout the day, only during work or at night.
Physical therapy. Patients are taught a set of exercises that allows them to increase the strength of the forearm muscles, increase the volume of movements in the joints of the fingers, including improving compression and the function of the tweezer grip when contrasting 1 finger with the rest.
Drug therapy. The recommended remedy for moderate pain syndrome is paracetamol. The drug is taken in strict accordance with the doctor’s instructions to avoid negative effects on the liver and stomach. With severe pain, NSAIDs are prescribed.
Indications for surgical intervention are intense pain syndrome, the presence of contracture, ankylosis, pathological mobility. With arthrosis of the fingers and metacarpophalangeal joints, arthrodesis or endoprosthetics are performed. When the wrist is affected, the affected bone is removed, replaced with an auto- or allograft.

Forecast
Arthrosis of the hands and fingers is a chronic progressive disease. A complete cure is impossible. With non–erosive forms, the prognosis is relatively favorable – in most cases, patients manage to remain able to work for a long time, compliance with the doctor’s recommendations allows to reduce or eliminate the pain syndrome, slow down the aggravation of violations of the functions of the hand. With erosive osteoarthritis, functional disorders quickly arise, ankylosis forms, requiring surgical interventions.

Prevention
It is impossible to completely exclude the development of arthrosis, since it is largely due to involutive processes in the body. It is possible to reduce the likelihood of its occurrence by preventing injuries and eliminating overloads of the hand and fingers.

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