Ask the Pharmacist

Q) My hands hurt every day. My doctor looked at them, ordered an x-ray and told me I have osteoarthritis (OA) of the hand. Is there anything I can do to improve them?

A) Osteoarthritis is by far the most common type of arthritis and is often referred to as the wear and tear form of the disease. It causes the smooth protective cartilage on the ends of our bones to break down and wear away and the fluid that acts as a lubricant in our joints to slowly leak out. Over the years, this causes the two bones that make up a joint to literally move closer together to the point that the bones virtually rub together causing pain and an assortment of other symptoms.

As well, OA can cause bone spurs (these are bony growths formed on top of normal bone around our joints and appear as hard bumps) to form. While it can strike any joint in the body, the hands are one of the most common sites and also the most troubling given how dependent all of us are on them to perform almost every one of our activities of daily living.

By the age of 55, most of us have some degree of hand OA even if we do not necessarily notice it. 67% of females and 54.8% of males over this age have radiographic OA (i.e. x-rays indicate the presence of arthritis) although those who actually feel like they have it (referred to as symptomatic arthritis) is fortunately a much smaller percentage (15.9% of females and 8.2% of males).

The most severe form of hand OA is called erosive and the numbers affected by this come in at 5.0% & 2.8% respectively. Erosive OA is fairly easy to distinguish from the other forms of hand OA in that it is an inflammatory form of the disease that is characterized by pain (sometimes severe), swelling, redness, warmth and limited mobility. Treatment of the erosive form of this disease differs so we will focus on the more common symptomatic form. The biggest difference between the two is that the application of heat, which can be very beneficial in regular hand OA, should not be used in the erosive form as it might exacerbate the inflammatory process.

OA most commonly affects three parts of the hand:

  • at the base of the thumb (where the thumb and the wrist meet),
  • the joint closest to our fingertips
  • the middle joint of our fingers

There are a number of factors that can make you more or less likely to suffer from this disorder. The first of course is age. The older you are, the more likely you are to have it. As mentioned above, females are more likely to be affected than males are. Whites seem to be often affected as well. Weight also seems to play a role as obese people have it more often than thinner people.

A history of a previous injury to the hand such as a fracture or a dislocation also is a risk factor and genetics are also involved as this condition is more common in some families than others. Symptoms can include:

  • Pain- at first it comes and goes with it being lighter with rest and worse after use. Morning pain and stiffness are common although eventually the pain can become more constant and may change from a dull ache to a sharper sensation.
  • Swelling
  • Stiffness and decreased range of motion
  • Crepitus – grinding, clicking or cracking sensations when you move your fingers
  • Nodules- bony lumps that form
  • Weakness

While all types of arthritis are both incurable and progressive, there are a number of treatments that can relieve the symptoms to some degree and hopefully slow its advancement as well.

Traditional drug treatment involves the use of Tylenol (acetaminophen) or an NSAID such as Advil (ibuprofen) or Aleve (naproxen), a topical anti-inflammatory cream such as Voltaren or even stronger, a specially compounded diclofenac cream on an as-needed basis when the pain gets to be too much. Acetaminophen or the anti-inflammatory creams are the preferred options to try first as they have less potential for drug interactions or side effects.

Other non-drug treatments involve the application of heat or cold. Icing your fingers can reduce swelling, inflammation and pain while the application of heat can really reduce hand stiffness. Paraffin wax treatments can provide very effective relief but should be taught first by a physiotherapist before you try them at home.

There are also a number of simple exercises that can be done to keep the supportive ligaments and tendons in the hand flexible and thereby improve your symptoms. Once again a physiotherapist can teach you a number of them but they are all relatively non-strenuous such as placing your hand flat on a table and slowly lifting one finger at a time and holding it at its highest point for 3 to 5 seconds. Splinting can also provide relief, particularly if worn at night to reduce stress on ligaments thereby decreasing pain and inflammation.

There are many other non-drug measures that can be tried so if you’re struggling with the pain from your hands, reach out to one of your health professionals for some sound advice. For more information on this or any other topic, contact your pharmacist.