Osteoarthritis of the fingers

Hand osteoarthritis is a degenerative disease of the hand joints characterized by the deterioration of cartilage, leading to pain, stiffness, and loss of function.

Introduction to hand osteoarthritis

Hand osteoarthritis, a painful and sometimes disabling manifestation of osteoarthritis, is a condition that affects the joints of the hand, including the proximal interphalangeal (PI) joints, the distal interphalangeal (DI) joints, and the carpo- metacarpals (CMC). This specific form of osteoarthritis can cause progressive deterioration of joint cartilage, leading to decreased mobility, stiffness and pain.

It will then be painful to perform usual tasks which will cause the surrounding muscles to weaken. If there is severe osteoarthritis of the fingers, the spurs will be ground against each other during the movement. This can, over time, change the shape of the joint creating deformation.

Symptoms of hand osteoarthritis

1. Joint pain: Pain is one of the most common symptoms of hand osteoarthritis. It may be felt during or after using the hand, and it tends to get worse over time.
2. Stiffness: Affected joints may become stiff, especially in the morning or after a period of inactivity. Stiffness can limit the ability to perform normal movements.
3. Swelling: Affected joints may experience swelling, usually caused by irritation of the surrounding tissues.
4. Cracking or crackling noises: As joint surfaces wear down, cracking, crackling, or rubbing sounds may occur during movements.
5. Joint deformity: As the disease progresses, joint deformities, such as Bouchard’s nodes (in the proximal interphalangeal joints) and Heberden’s nodes (in the distal interphalangeal joints), may appear.
6. Loss of strength and mobility: Osteoarthritis can lead to decreased strength and mobility in the fingers and hands, affecting the ability to perform daily tasks.
7. Sensitivity to touch: Affected joints may become sensitive to touch, and pressure on these areas may cause pain.

Types of hand osteoarthritis

Hand osteoarthritis can present in different forms, and two distinct types are nodular osteoarthritis and erosive osteoarthritis. These two types of osteoarthritis have different characteristics in terms of symptoms, radiological presentation and disease progression.

Nodular Osteoarthritis

• Characteristics: Nodular osteoarthritis is often associated with the formation of bone nodules or small growths in the affected joints. These nodules, such as Bouchard’s nodules and Heberden’s nodules, are palpable and sometimes visible.
• Location: Nodules generally form at the middle joints (proximal interphalangeal joints – API) and at the tips of the fingers (distal interphalangeal joints – ADI).
• Symptoms: In addition to the presence of nodules, the typical symptoms of osteoarthritis, such as pain, stiffness and loss of joint function, are also present.
• X-ray: X-rays can reveal signs of joint wear, abnormal bone formation, and characteristic nodules.

Erosive Osteoarthritis

• Characteristics: Erosive osteoarthritis is characterized by progressive destruction of articular cartilage and underlying bone. Unlike nodular osteoarthritis, it can cause substantial loss of bone substance.
• Location: Joints affected by erosive osteoarthritis can include the small joints of the fingers, often at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints.
• Symptoms: In addition to the classic symptoms of osteoarthritis, people with erosive osteoarthritis may experience more severe pain and more pronounced joint deformity.
• X-ray: X-rays may show signs of bone erosion, joint space reduction, and sometimes joint deformities more severe than those seen in nodular osteoarthritis.

Nodular osteoarthritis of the hand

Bouchard’s nodule

Bouchard’s nodules are a classic sign of osteoarthritis (OA) of the fingers.

Bouchard’s nodule is a characteristic manifestation of osteoarthritis specifically affecting the intermediate joints of the fingers, called the proximal interphalangeal joints (PIA). These nodules are named after the French physician Charles Bouchard, who contributed to the understanding of osteoarthritis in the 19th century.

Characteristics of Bouchard’s Nodule

1. Location: Bouchard’s nodules form at the intermediate joints of the fingers, which are the joints located between the proximal and middle phalanges. These joints are often affected by osteoarthritis due to continued wear and breakdown of the cartilage.
2. Physical Appearance: Bouchard’s nodules appear as small bony growths or palpable nodules located on the dorsal side (top) of the affected joints. These nodules can vary in size, but they are generally smaller than Heberden’s nodules, which form on the ends of the fingers.
3. Formation: These nodules result from abnormal bone growth, often in response to the breakdown of the cartilage that normally covers joint surfaces. When the cartilage wears away, the bones respond by forming new bony growths in an attempt to stabilize the joint.
4. Symptoms: People with Bouchard’s nodules may experience tenderness and pain around these nodules, especially when using the affected joints. Finger mobility may also be limited due to the presence of these nodules.

Heberden’s knot

Heberden’s nodule is a distinctive manifestation of osteoarthritis that affects the distal interphalangeal (DIA) joints of the fingers. These nodules were named after the British physician William Heberden, who described them in the 18th century. Here are some characteristics of Heberden’s knot:

Characteristics of Heberden’s Knot

1. Location: Heberden’s nodes form at the ends of the fingers, more precisely at the level of the distal interphalangeal joints (ADI), which are the joints located between the middle and distal phalanges.
2. Physical appearance: These nodules appear in the form of small, palpable and visible bony growths located on the dorsal side (top) of the affected joints. They can vary in size and shape, sometimes giving the fingers a swollen appearance.
3. Formation: Heberden’s nodes result from abnormal bone growth in response to the breakdown of cartilage in the joints. Wear and tear of the cartilage leads to a response from the underlying bone, causing these bony growths to form.
4. Symptoms: People with Heberden’s nodes may experience pain, stiffness, and decreased joint function in the affected fingers. These symptoms are often exacerbated during hand use and can affect daily quality of life.

Bouchard knots are less common than Heberden knots

Erosive osteoarthritis of the hand

Arthritis of the thumb(carpometacarpal joint)

Thumb arthritis, also known as carpometacarpal joint (CMC) osteoarthritis, is a specific form of osteoarthritis that affects the base of the thumb, where the thumb connects to the wrist. This joint is crucial for many hand movements and is subject to significant wear and tear over time. Here are some characteristics of thumb arthritis:

Characteristics of Arthritis of the Thumb (CMC):

1. Location: Thumb arthritis focuses on the carpometacarpal joint, which is the joint between the carpal bones (wrist bone) and the first metacarpal (thumb bone).
2. Cartilage wear: As in other forms of osteoarthritis, arthritis of the thumb is characterized by the progressive breakdown of the cartilage that covers the joint surfaces. This wear and tear on the cartilage can lead to increased friction between bones and inflammation of the joint.
3. Symptoms: Common symptoms include pain at the base of the thumb, stiffness, decreased strength and mobility of the thumb. Activities such as grasping objects, rotating the thumb, and pinching can become painful.
4. Deformity: In some advanced cases, arthritis of the thumb can cause visible deformity of the joint, with a widening of the base of the thumb.

Causes of hand osteoarthritis

1. Aging: Natural aging is one of the most important risk factors for osteoarthritis. Over time, the cartilage that covers the ends of bones can wear away, which can lead to the development of osteoarthritis.
2. Genetics: A family history of osteoarthritis may increase the risk of developing this condition. Certain genes may influence the genetic predisposition to osteoarthritis.
3. Gender: Women are more likely to develop hand osteoarthritis than men, especially after menopause. Hormonal changes may play a role in this predisposition.
4. Joint trauma: Previous injuries, such as severe fractures or sprains, can increase the risk of developing osteoarthritis in the affected joints.
5. Overuse of the hands: Repetitive movements or excessive use of the hands in work or recreational activities can contribute to cartilage wear.
6. Obesity: Being overweight or obese puts additional pressure on the joints, especially those of the hands and fingers, increasing the risk of osteoarthritis.
7. Mechanical factors: Certain mechanical factors, such as joint abnormalities or joint misalignment, can increase stress on joints and promote the development of osteoarthritis.
8. Inflammatory Diseases: Inflammatory conditions such as rheumatoid arthritis can also contribute to the development of hand osteoarthritis.

Diagnosis and associated examinations

1. Medical history and physical exam: Your doctor can discuss your symptoms, medical history, and daily activities. A physical exam of your hands may also be performed to assess mobility, strength, and swelling.
2. X-rays: X-rays are often used to visualize joints and detect signs of osteoarthritis. They may show loss of cartilage, bony growths (osteophytes), and other joint changes.
3. Blood test: Although osteoarthritis is primarily a joint condition, blood tests can sometimes be done to rule out other possible causes of joint pain, such as rheumatoid arthritis.
4. Magnetic resonance imaging (MRI): MRI can provide more detailed images of soft tissues, such as cartilage, ligaments, and tendons. This can be helpful in assessing the extent of joint damage.
5. Ultrasound: Ultrasound can be used to evaluate the soft tissues around the joint and can be particularly helpful in detecting inflammation.
6. Arthroscopy: In some cases, an arthroscopy may be performed. It is a procedure where a small tube equipped with a camera is inserted into the joint to directly visualize the condition of the tissues and possibly perform minor surgical procedures.

Nutrition and osteoarthritis management

Although diet alone cannot cure osteoarthritis, healthy food choices can help manage symptoms and reduce inflammation. Here are some general tips on food choices that can influence the condition of osteoarthritis:

1. Anti-inflammatory foods:
   • Oily fish: Fish rich in omega-3 fatty acids, such as salmon, mackerel and sardines, may have anti-inflammatory properties.
   • Green leafy vegetables: They are rich in antioxidants and vitamins that can help reduce inflammation.
   • Fruits and Berries: Fruits rich in vitamin C and berries containing antioxidants may contribute to joint health.
2. Foods rich in antioxidants:
   • Colorful Vegetables: Carrots, peppers, sweet potatoes and other colorful vegetables are rich in antioxidants, which can help fight free radicals and reduce inflammation.
   • Fruits: Citrus fruits, berries, and fruits rich in vitamin C are also beneficial.
3. Foods rich in vitamin D and calcium:
   • Dairy products, fatty fish and eggs: These foods can contribute to bone health.
4. Foods rich in collagen:
   • Bone broths, gelatin, and foods containing collagen: These foods can help support joint and cartilage health.
5. Foods to avoid or limit:
   • Processed Foods and High in Saturated Fat: Processed foods and high in saturated fat can contribute to inflammation.
   • Excess sugar: Some researchers suggest that diets high in sugar may promote inflammation.
6. Maintain a healthy weight: Maintaining a healthy weight is crucial to reducing pressure on joints and minimizing symptoms of osteoarthritis.
7. Hydration: Drinking enough water is important to maintain joint and cartilage function.

Radiographic signs of hand osteoarthritis

Radiographic signs of hand osteoarthritis can be identified by specific abnormalities seen on medical x-rays. These signs usually include:

1. Erosion of joint cartilage: X-rays may reveal a loss of joint space, indicating wear and tear of the cartilage between the bones of the joints. This can result in more direct contact between bones, causing friction and irritation.
2. Osteophyte Formation: Osteophytes, also called “parrot beaks,” are bony growths that form in response to cartilage degeneration. They are often visible on the edges of bones and can be seen on x-rays.
3. Subchondral sclerosis: Subchondral sclerosis is a thickening or hardening of the bone beneath the cartilage. This may be a response to cartilage degeneration and is often visible on x-rays.
4. Cysts: Cysts, or pockets of fluid, may form in the bones adjacent to affected joints. These cysts can be detected on x-rays.
5. Joint deformities: X-rays may show signs of joint deformities, including changes in the normal shape of joints, particularly in the proximal interphalangeal (PI) and distal interphalangeal (ID) joints.
6. Narrowing of the joint space: Osteoarthritis can cause a narrowing of the space between the joint bones, indicating a loss of cartilage and a decrease in the distance between the joint surfaces.

References

1. Fife R S. Osteoarthritis ‐ epidemiology, pathology, and pathogenesis. Primer on the Rheumatic Diseases,  11th ed. Atlanta, Georgia: Arthritis Foundation, 1997216–217.
2. Hochberg M C. Osteoarthritis ‐ clinical features and treatment. Primer on the Rheumatic Diseases , 11th edn. Atlanta, Georgia: Arthritis Foundation, 1997218–221.
3. Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K. et al  The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum  1990331601–1610. [ PubMed ] [ Google Scholar ]
4. Bijkerk C. Assessment of radiological osteoarthritis in peripheral joints and of disk degeneration of the spine. Thesis  199917–32.
5. Cushnagan J, Dieppe P. Study of 500 patients with limb joint osteoarthritis. I. Analysis by age, sex, and distribution of symptomatic joint sites. Ann Rheum Dis  1991508–13. [ PMC free article ] [ PubMed ] [ Google Scholar ]
6. Egger P, Cooper C, Hart DJ, Doyle DV, Coggon D, Spector T D. Patterns of joint involvement in osteoarthritis of the hands: the Chingford study. J Rheumatol  1995221509–1513. [ PubMed ] [ Google Scholar ]
7. Niu J, Zhang Y, LaValley M, Chaisson CE, Aliabadi P, Felson D T. Symmetry and clustering of symptomatic hand osteoarthritis in elderly men and women: the Framingham Study. Rheumatology  200342343–348. [ PubMed ] [ Google Scholar ]
8. Poole J, Sayer AA, Hardy R, Wadsdorth M, Kuh D, Cooper C. Patterns of interphalangeal hand joint involvement of osteoarthritis among men and women. A British cohort study. Arthritis Rheum  2003483371–3376. [ PubMed ] [ Google Scholar ]
9. Cooper C, Egger P, Coggon D, Hart DJ, Masud T, Cicuttini F. et al  Generalized osteoarthritis in women: pattern of joint involvement and approaches to definition for epidemiological studies. J Rheumatol  1996231938–1942. [ PubMed ] [ Google Scholar ]
10. Hunter DJ, Demissie S, Cupples LA, Aliabadi P, Felson D T. A genome scan for joint‐specific hand osteoarthritis susceptibility. The Framingham study. Arthritis Rheum  2004502489–2496. [ PubMed ] [ Google Scholar ]
11. Dougados M, Nakache JP, Gueguen A. Criteria for generalized and focal osteoarthritis. Rev Rum  199663569–575. [ PubMed ] [ Google Scholar ]
12. Kellgren JH, Moore R. Generalized osteoarthritis and Heberden’s nodes. BMJ  19521181–187. [ PMC free article ] [ PubMed ] [ Google Scholar ]
13. Lawrence J S. Generalized osteoarthrosis in a sample population. Amer J Epid  196390381–389. [ PubMed ] [ Google Scholar ]
14. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K. et al  Development of criteria for the classification and reporting of osteoarthritis of the knee. Arthritis Rheum  1986291039–1049. [ PubMed ] [ Google Scholar ]
15. Slatkowsky‐Christensen B, Kvien TK, Bellamy N. Performance of the Norwegian version of AUSCAN – disease‐specific measure of hand osteoarthritis. Osteoarthritis Cartilage  200513561–567. [ PubMed ] [ Google Scholar ]
16. Petersson IF, Jacobsson LT H. Osteoarthritis of the peripheral joints. Best Pract Res Clin Rheumatol  200216741–760. [ PubMed ] [ Google Scholar ]
17. Bagge E, Bjelle A, Eden S, Svanborg A. A longitudinal study of the occurrence of joint complaints in elderly people. Age Aging  199221160–167. [ PubMed ] [ Google Scholar ]
18. Van Saase JL, van Romunde LKJ, Cats A, Vandenbroucke JP, Valkenburg H A. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis  198948271–280. [ PMC free article ] [ PubMed ] [ Google Scholar ]
19. Bagge E, Bjelle A, Svanborg A. Radiographic osteoarthritis in the elderly. A cohort comparison and a longitudinal study of the “70‐year old people in Gothenburg”. Clin Rheumatol  199211486–491. [ PubMed ] [ Google Scholar ]
20. Bagge E, Bjelle A, Eden S, Svanborg A. Factors associated with radiographic osteoarthritis: results from the population study 70‐year‐old people in Gothenburg. J Rheumatol  1991181218–1222. [ PubMed ] [ Google Scholar ]
21. Carman WJ, Sowers M, Hawthorne VM, Weissfeld L A. Obesity as a risk factor for osteoarthritis of the hand and wrist: a prospective study. Am J Epidemiol  1994139119–129. [ PubMed ] [ Google Scholar ]
22. Lawrence J S. Rheumatism in populations . London: Heineman, 1977
23. Chaisson CE, Zhang Y, Sharma L, Kannel W, Felson D T. Grip strength and the risk of developing radiographic hand osteoarthritis: results from the Framingham Study. Arthritis Rheum  19994233–38. [ PubMed ] [ Google Scholar ]
24. Stecher R M. Heberden’s nodes: inheritance in hypertrophic arthritis of finger joints. Am J Med Sci  1941201801–809. [ Google Scholar ]
25. Riyazi N, Meulenbelt I, Kroon HM, Ronday HK, le Graverand Hellio, Rosendaal F R. et al  Evidence for familial aggregation of hand, hip, and spine but not knee osteoarthritis in siblings with multiple joint involvement: the GARP study. Ann Rheum Dis  200564438–443. [ PMC free article ] [ PubMed ] [ Google Scholar ]
26. Knowlton RG, Katzenstein PL, Moskowitz RW, Weaver EJ, Malemud CJ, Pathria M N. et al  Genetic linkage of a polymorphism in the type II procollagen gene (COL2A1) to primary osteoarthritis associated with mild chondrodysplasia. N Engl J Med  1990322526–530. [ PubMed ] [ Google Scholar ]
27. Stefansson SE, Jonsson H, Ingvarsson T, Manolescu I, Jonsson HH, Olafsdottir G. et al  Genomewide scan for hand osteoarthritis: a novel mutation in matrilin‐3. Am J Hum Genet  2003721448–1459. [ PMC free article ] [ PubMed ] [ Google Scholar ]