Pain Management: Losing your grip with osteoarthritis
One day, Kathy, a 58-year-old accountant, found herself staring at her hands. The second joint (PIP or proximal interphalangeal joint) on her right index and four first joints (DIP or distal interphalangeal joints) on both hands were enlarged, lumpy and bony, but her knuckles (MCP or metacarpophalangeal joints) were normal. She recalled that several DIP joints often were red and constantly ached and stung when she hit them. Furthermore, it took her about 20 minutes every morning for her fingers to become limber.
Like Kathy, about 75 percent of women and 50 percent of men are affected with nodal osteoarthritis by age 70. A common time for osteoarthritis to emerge is around menopause, suggestive of a possible hormonal correlation. Another factor is heredity, as many women affected have a mother or sister who has osteoarthritis of the hands. Finally, activity seems to play a role, as right-handed people have more right-hand knuckles affected, especially in the fingers that are most used.
Though physically unattractive and lumpy growths will most likely form on affected fingers, they are non-progressive, non-disabling and not serious. Named after their discoverers, Heberden’s nodes are located in the DIP joints and Bouchard’s nodes in the PIP joints. Their “lumpiness” is due to the formation of new bone at the margins of a joint. Occasionally, these growths appear suddenly and are red, painful and swollen, but commonly, they develop gradually and are painless. At times, when Heberden’s nodes form, a clear, jelly-like substance drains out from the skin. Several fingers may be affected, or the nodes may be confined to just one. And even though it is impossible to predict which joint will be affected or spared, eventually the fingers will stabilize. Unfortunately, patients who suffer with osteoarthritis of DIP and PIP joints have a high risk of developing osteoarthritis of the knees.
The base of the thumb, where it pivots on the wrist (CMC or carpometacarpal joint) can also be affected with osteoarthritis. It tends to affect the non-dominant hand; pain may be the main symptom, especially upon gripping. Rarely, MCP joints (knuckles) are involved, which can suggest rheumatoid arthritis.
Acetaminophen (Tylenol); low-dose non-steroidal anti-inflammatory drugs (NSAIDs); local cortisone injections; wearing a thumb splint; paraffin wax baths; and topical pain-relieving creams containing capsaicin, hyaluronic acid, boswellia serrata, arnica montana, lidocaine or other herbs may help relieve joint pain associated with osteoarthritis. However, in more severe cases of osteoarthritis of the CMC joint, hand surgery may improve pain and restore function. Self-assisting devices such as products with long handles, handle attachments, special key holders, electric can openers, doorknob extenders, and easy-grip mechanisms are great tools to help conserve hand strength and decrease pain.
Dr. Yong H. Tsai is board-certified in rheumatology, allergy and clinical immunology and has been practicing in this area since 1993. His website is arthritis-allergy.net.