What is the Best treatment for Arthritis in the hands?

Arthritis can affect any joint of the body, but mostly in the upper and lower limbs. Osteoarthritis and rheumatoid arthritis affect the hands, sometimes as an early sign of disease.

While osteoarthritis is a degenerative disease with changes in the cartilage, RA is an autoimmune condition in which the body’s immune system attack the healthy tissue that protects the joints. Women are more likely to experience the condition than men, and there’s a post-traumatic arthritis when the patient has damaged their hands e.g. sports-related injuries or accidents.

Do I have arthritis in the hands?

Arthritis is not always easy to diagnose. Most patients have the following signs and symptoms:

• Pain: Itis an early symptom of arthritis, in most cases as morning pain and stiffness. Activities that once were easy, such as opening a jar or starting the car engine become difficult due to pain in the hands
• Swelling: This symptom is characterized by a series of signs that include pain, redness of the skin, and warmth. Warmthupon touch is due to the body’s inflammatory response.
• Crepitations: When the articulation crepitates, it can be due to damaged cartilage surfaces rubbing against one another.
• Other signs and symptoms: Other include joint tenderness, instability, effusion, limitation of range of movement and wasting of the muscles.

But even if you have these symptoms in your hands, you don’t necessarily have arthritis. You will need several exams, including blood tests, X-rays, rheumatoid arthritis serology, and you may also need more advanced exams, as in joint aspiration.

The Best treatment for Arthritis

The best treatment of arthritis of the hands depends on your individual condition. However, there are more expensive and less expensive treatments, as well as home treatments you can try without any cost.

Most expensive

The most expensive treatments for arthritis are known as biologics, or biologic Disease Modifying Anti-Rheumatic Drugs (DMARDs) which mainly act through cytokine inhibition, reduce inflammation, and reduce joint swelling. Their beneficial effect is not immediate, and may be partial or transient.

Methotrexate is considered as drug of choice, but it is contraindicated in pregnancy. It has been replaced by more recent biologic DMARDs, such as tocilizumab and certolizumab. These drugs have less side effects but they are extremely expensive (up to $ 30,000 annually). Compared to conventional DMARDs, that’s very expensive. They are not usually over $2,000 annually.

Other examples include Etanercept, which is given by subcutaneous injection, or Infliximab,  a monoclonal antibody against TNF, given intravenously. Adalimumabis a fully monoclonal antibody against TNF a. Anakinra, Anti citrullinated peptide and Rituximabare newer drugs, which is why they are quite pricey.

Least expensive

Medications treat symptoms, but cannot restore joint cartilage or reverse joint damage. Symptoms are often controlled with least expensive medications such as NSAIDs (non-steroidal anti-inflammatory drugs). NSAIDs are more effective than acetaminophen for osteoarthritis, but have greater toxicity. NSAIDs inhibit cyclooxygenase (COX), the enzyme that converts arachidonic acid to prostaglandins. Prostaglandins play important roles in promoting inflammation.

Most patients with RA are unable to cope without an NSAID to relieve night pain and morning stiffness. Proton pump inhibitor can be added if the patient is over 65 with Gastrointestinal side effects. This type of treatment is cost-effective. However, it might not be the fastest way to relief pain. There are other ways to relieve acute and severe pain.

Most effective

NSAIDs are very useful, but there is another way to relieve severe joint pain through corticosteroids.

Low dose corticosteroids (e.g. oral prednisone 5–10 mg daily) produce a prompt anti Inflammatory effect and slow the rate of articular erosion. These are often used as a bridge to reduce disease activity until the slower-acting DMARDs take effect. In other cases, they can be used as an adjunctive therapy for active disease that persists despite treatment with DMARDs.

The best home treatment

Hot and Cold Compression Therapy is effective for moderate to severe pain, and it is something anybody can do at home. Apply heat 2-3 times a day for 20 to 30 minutes using a heating pad, hot shower or hot pack. It works by warming viscous joint fluid contained in each joint capsule and maintaining hand flexibility. Warmth leads to vasodilatation, which favors blood circulation, oxygen and nutrients to be delivered to the injured tissues.

Taking a steamy shower at the start of the day helps to reduce morning stiffness, limber up the body and increase range of motion. Dipping hand in melted paraffin wax also helps in relieving pain. After a heat or cold treatment, try some gentle massage for relaxation and pain relief. Electric heating pad or putting a wet washcloth in a freezer bag and warming it in the microwave for one minute are helpful warm compressions.

Applying cold packs on a painful joint for 10 to 20 minutes is also effective to reduce swelling and inflammation in case of acute injury.

Hand Arthritis | Bill's Story

Topical therapy and other treatments

When first line treatment with anti-inflammatory medications is not appropriate, injections may be used. These contain a long-lasting anesthetic and steroid that can provide pain relief for weeks to months. Topical NSAIDs (e.g. 4 g of diclofenac gel 1% applied to the affected joint four times daily) appear more effective than placebo for arthritis of the hand. Topical NSAIDs should be considered early in the treatment of patients with mild osteoarthritis affecting a few joints, especially of the hand. Among these, topical capsaicin may be of benefit for osteoarthritis of the hand or the knee.

Other therapies include the following:

• Splinting: Ithelps supporting the affected joint to ease the stress placed on it from frequent use and activities.
• Rest and exercise: A combination of rest for active arthritis and exercises to maintain joint range and muscle activity are both essential. Exercise in a hydrotherapy pool is especially popular and effective.
• Surgical treatment: Single joint disease can be treated by surgical synovectomy to reduce the bulk of inflamed tissue and prevent damage. Excision arthroplasty of the ulnar styloid reduces pain and risk of extensor tendon damage.

References:

Emery, P., Sebba, A., & Huizinga, T. W. (2013). Biologic and oral disease-modifying antirheumatic drug monotherapy in rheumatoid arthritis. Annals of the Rheumatic Diseases, 72(12), 1897-1904.

Yazici, Y., Shi, N., & John, A. (2008). Utilization of Biologic Agents in Rheumatoid Arthritis in the United States. Bulletin of the NYU hospital for joint diseases, 66(2).

Schipper, L. G., Kievit, W., den Broeder, A. A., van der Laar, M. A., Adang, E. M., Fransen, J., & van Riel, P. L. (2011). Treatment strategies aiming at remission in early rheumatoid arthritis patients: starting with methotrexate monotherapy is cost-effective. Rheumatology, 50(7), 1320-1330.

Finckh, A., Bansback, N., Marra, C. A., Anis, A. H., Michaud, K., Lubin, S., … & Liang, M. H. (2009). Treatment of very early rheumatoid arthritis with symptomatic therapy, disease-modifying antirheumatic drugs, or biologic agents: a cost-effectiveness analysis. Annals of Internal Medicine, 151(9), 612-621.