What is arthritis?

In general, arthritis describes joint destruction. Arthritis can be broken down into three broad types:

Osteoarthritis (OA): By far, osteoarthritis is the most common form of arthritis.  It is usually referred to as “wear and tear arthritis.” However, osteoarthritis occurs regardless of activity level; it doesn’t matter if you were a pipe fitter or an expert quilter, osteoarthritis is an age-related phenomenon. The smooth layer of cartilage breaks down and does not heal. Some people can get osteoarthritis at a very young age (20-30) whiles others may live into their 90s with no arthritis.

Inflammatory arthritis:  Much less common than OA, inflammatory arthritis is an autoimmune attack on the cells that line the joints and tendons (synovial cells). Inflammatory arthritis includes Rheumatoid Arthritis, Psoriatic Arthritis, Lupus, among others.  While gout is included in inflammatory arthritis, but it is joint destruction from the deposition of uric acid crystals, not synovial cell breakdown.

Post-Traumatic arthritis:  This should be called “wear and tear arthritis.” Any joint that is injured can have cartilage damage. Persistent joint irregularities and joints that remain unstable or loose can lose their cartilage.

What kind of arthritis is most common in hands?

Osteoarthritis is by far the most common type of arthritis in the hands and fingers. For some reason, it is more common in women than in men.

What are the common symptoms of finger arthritis?

Surprisingly, the most common symptom of arthritis in the fingers is a painless swelling at the distal interphalangeal joint or the end knuckle of the finger. It is very common to get osteoarthritis in this joint. It usually doesn’t hurt, but it can limit motion. Arthritis will first cause swelling and loss of motion, but pain can arise as the joint spaces become narrowed or irregular.  Sometimes arthritis can give rise to mucinous cysts in this joint, a common side effect.

Inflammatory arthritis can cause redness and swelling, which can sometimes be very noticeable and look like an infection.  It can cause a deformity as well

How do we treat finger arthritis?

Activity modification, anti-inflammatory medication, and splinting can help individuals who have minor arthritis. However, there is nothing to prevent or slow the progression of osteoarthritis or post-traumatic arthritis. If an individual has inflammatory arthritis, treatment by a rheumatologist is warranted, as some patients can benefit from disease-modifying medications. Surgical treatment is reserved for those with continued pain. Surgical treatment for finger arthritis will not increase motion or function; it will only decrease pain.

What are the surgical treatments for finger arthritis?

Surgical intervention for finger arthritis is mostly dependent on the location of the arthritic joint.

Distal Interphalangeal Joint (DIP)

Fusion or arthrodesis is the only treatment warranted.  The primary indication for surgery is pain and instability of the joint. In surgery, we remove what is left of the joint and place a screw to hold it in place. A fusion of the DIP joint is well tolerated and results in significant pain relief.

Proximal Interphalangeal Joint (PIP)

The PIP joint is tough to treat. Recommendations currently are to manage the border digits with fusion (index and small) and middle digits with a silicone arthroplasty. Silicone arthroplasty gives excellent pain relief and modest motion but offers reduced side-to-side stability. For this reason, the index finger is treated cautiously with a replacement.

Metacarpophalangeal Joint (MCP)

The MCP joint can do well with silicone replacement or an unconstrained replacement. The most common reason for replacing the MCP is rheumatoid arthritis. By nature, RA causes ligament damage and will require a silicone replacement. Silicone replacement can help to modestly re-align the joints.  Osteoarthritis and Post-traumatic arthritis can also be treated with unconstrained joints, which theoretically will last longer.

How long do silicone arthroplasties last?

Silicone joint arthroplasty has a high failure rate; one study found a 50% failure rate at ten years. Unfortunately, we have not developed any better implants than the silicone version developed in the 1960s by Dr. Swanson. These implants are just spacers and rely on the patient’s body to form scar tissue to stabilize the joint. However, revision surgery for a broken implant is generally well tolerated and offers excellent results.

 

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