Osteoarthritis is a type of arthritis that is caused by breakdown of cartilage, with eventual loss of the cartilage of the joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. When the cartilage deteriorates (degenerates), the bone next to it becomes inflamed and can be stimulated to produce new bone in the form of a local bony protrusion, called a "spur."
A very common early sign of osteoarthritis is a knobby bony deformity at the smallest joint of the end of the fingers. This is referred to as a Heberden's node, named after a very famous British doctor. The bony deformity is a result of the bone spurs from the osteoarthritis in that joint. Another common bony knob (node) occurs at the middle joint of the fingers in many patients with osteoarthritis and is called a Bouchard's node. Dr. Bouchard was a famous French doctor who also studied arthritis patients at the turn of the last century. The Heberden's and Bouchard's nodes may not be painful, but they are often associated with limitation of motion of the joint. The characteristic appearances of these finger nodes can be helpful in diagnosing osteoarthritis.
Osteoarthritis is also known as degenerative arthritis because of the degeneration of the cartilage that causes it. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common and affects over 20 million people in the United States alone. Osteoarthritis occurs more frequently as we age. Before age 45, osteoarthritis occurs more frequently in men. After age 55 years, it affects women more frequently. Osteoarthritis causes no symptoms in many patients. Symptoms of osteoarthritis include local pain, stiffness, tenderness, and occasionally swelling in the affected joints.
"If I have minimal or no symptoms with early signs of osteoarthritis, what should I do?"
The ideal steps to take should lead to a proper diagnosis and an optimal long-term treatment plan. While many steps are discussed here, the plan must be customized for each person affected by osteoarthritis, depending on the joints affected and the severity of symptoms.
An opinion regarding the cause or the type of the arthritis can usually be adequately obtained by consulting a general family doctor. It is often unnecessary to see an arthritis specialist (rheumatologist), like myself, for this purpose. However, if the diagnosis or treatment plan is unclear, a rheumatologist might be consulted.
When I determine that a patient has a classic node formation from osteoarthritis (Heberden's node), I may make the diagnosis solely based upon the examination, without the need for any additional tests, such as blood or X-ray testing. Sometimes, testing can be helpful to better understand the degree and character of the osteoarthritis affecting a certain joint. It can also be helpful for monitoring and to exclude other conditions.
Treatment may not be necessary for osteoarthritis of the hands with minimal or no symptoms. When symptoms are troubling and persist, however, treatment might include pain and anti-inflammatory medications, with or without food supplements, such as glucosamine and/or chondroitin. Furthermore, heat/cold applications and topical pain creams can be helpful.
As a first step, I recommend that patients go ahead and try the over-the-counter food supplements glucosamine and chondroitin. Each of these supplements has been independently shown to relieve the pain and stiffness of some (but not all) patients with osteoarthritis. These supplements are available in pharmacies and health-food stores without a prescription. If patients do not benefit after a two-month trial, I tell them that they may discontinue these supplements. The manufacturers sometimes make claims that these supplements "rebuild" cartilage. This claim has not been adequately verified by scientific studies to date.
Interestingly, past research found glucosamine (in a radioactive form that could be identified in tissues) fed to beagles was noted to be incorporated into their cartilage. I spoke with the author of this study who interpreted the results to imply that glucosamine supplements taken by mouth actually can reach the cartilage of the joints.
For another type of dietary supplementation, it should be noted that fish oils have been shown to have some anti-inflammation properties. Moreover, increasing the dietary fish intake and/or fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis.
Obesity has long been known to be a risk factor for osteoarthritis of the knee. I recommend weight reduction for patients with early signs of osteoarthritis of the hands who are overweight, because they are at a risk for also developing osteoarthritis of their knees.
Pain medications that are available over the counter for the treatment of osteoarthritis pain, such as acetaminophen (Tylenol), can be very helpful in relieving the pain symptoms of mild osteoarthritis and I recommend these as the first medication treatment. Studies have shown that acetaminophen, given in adequate doses, can often be equally as effective as prescription anti-inflammatory medications in relieving pain in osteoarthritis of the knees. Since acetaminophen has fewer gastrointestinal side effects than nonsteroidal anti-inflammatory drugs (NSAIDS), especially in elderly patients, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis. If symptoms persist, then I recommend trials of over-the-counter anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, Nuprin), ketoprofen (Orudis), and naproxen (Aleve). Many patients do best when they take these medications along with their glucosamine and chondroitin.
Some patients get significant relief of pain symptoms by dipping their hands in hot wax dips in the morning. The wax can often be obtained at local pharmacies or medical supplies stores. It can be prepared (melted) and kept in a crock pot (electric cooker). The hot wax hardens on the hands and thereby provides a warm covering over the hands. The hardened wax then can be reused by peeling it off the hands and placing it back into the melted wax. Warm water soaks and nighttime cotton gloves (to keep the hands warm during sleep) can also help ease hand symptoms. Gentle range of motion exercising regularly can help to preserve function of the joints. These exercises are easiest to perform after early morning hand warming.
Pain-relieving creams that are applied to the skin over the affected joints can provide relief of daytime minor arthritis pain. Examples include capsaicin (Arthricare, Zostrix), salycin (Aspercreme), methyl salicylate (Bengay, Icy Hot), and menthol (Flexall). For additional relief of mild symptoms, local ice application can sometimes be helpful, especially toward the end of the day. Occupational therapists can assess daily activities and determine which additional techniques may help patients at work or home.
"What about surgery for my early osteoarthritis?"
There is no role for surgery in the treatment of early osteoarthritis.
Like many people with chronic ailments, sufferers of chronic arthritis are potentially vulnerable to proponents of heavily marketed "cure-all" treatments. These "quick fix" treatments are promoted as having great benefits, but in reality they have no right to such claims.
Finally, when arthritis symptoms persist, it is best to seek the advice of a doctor who can properly guide the optimal management for each individual patient. Many other prescription medications are available for the treatment of osteoarthritis for patients with chronic, annoying symptoms. And if you are concerned that osteoarthritis could be associated with injury to internal organs, don't be. This disease does not cause internal organ damage or blood test abnormalities.
In addition to the steps described above, you should pay attention to joint problems elsewhere in your body if you develop signs and symptoms of osteoarthritis of the hands. Be on the lookout in the future for persistent, unexplained joint symptoms and see your doctor if you notice them.
Klippel, John H., et al., eds. Primer on the Rheumatic Diseases. 13th ed. New York: Springer and Arthritis Foundation, 2008.