osteoarthritis of the hand
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Epidemiology
- 1st carpometacarpal joint osteoarthritis
- more common in women
- occurs 10 years earlier in women
- peak incidence 70-74 years (women)
- overall incidence = 4.3% of women, 1.7% of men
- radiographic prevalence of hand osteoarthritis in adults 45-79 years is 41%; symptomatic prevalence is 12%[8]
- prevalence of hand osteoarthritis
- increases with age
- more commmon in women
- more common in patients with knee osteoarthritis[8]
Clinical manifestations
- usually involves the distal interphalangeal joints (Heberden nodes) & proximal interphalangeal joints (Bouchard nodes)
- flares of synovitis may occur
- pain usually resolves in 1 to 2 years
- first carpometacarpal joint
- often remains chronically painful with exacerbations
- decreased function over time[2]
- pain with palpation of involved joints
- clinical exam more sensitive than radiology[1]
Laboratory
- no specific laboratory findings
- erythrocyte sedimentation rate: normal to minimally elevated
- serology for autoantibodies not necessary to confirm clinical diagnosis[1]
Radiology
- radiograph of hands
- joint space narrowing
- osteophytes in distal interphalangeal joints & proximal interphalangeal joints
- subchondral cysts in distal interphalangeal joints
- not necessary to confirm clinical diagnosis[1]
- clinical symptoms do not necessarily correlate with radiographic changes
- see osteoarthritis
Differential diagnosis
- pseudogout: wrist or knee more likely involved
- polyarticular gout: joints other than distal interphalangeal joints (DIP) & proximal interphalangeal joints (PIP) more likely involved
- psoriatic arthritis: prolonged morning stiffness, nail pitting
- rheumatoid arthritis:
- prolonged morning stiffness, metacarpophalangeal joint involvement
Management
- see osteoarthritis
- topical diclofenac safe & effective
- hand exercise therapy associated with less pain, better function & greater grip strength in women[1][3]
- multimodal occupational therapy of benefit for patients with osteoarthritis involving the carpometacarpal joint[8]
- hydroxychloroquine of no benefit for hand osteoarthritis[5]
- prednisolone 10 mg QD for 6 weeks, followed by a 2-week taper dimninishes pain before taper but at follow-up 6 weeks after tapering, pain reverts to baseline for most[7]
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2022
- ↑ 2.0 2.1 Wolf JM, Turkiewicz A, Atroshi I, Englund M. Prevalence of doctor-diagnosed thumb carpometacarpal joint osteoarthritis: An analysis of Swedish health care. Arthritis Care Res (Hoboken) 2014 Jun; 66:961 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24339432 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/acr.22250/abstract
- ↑ 3.0 3.1 Hennig T, Haehre L, Hornburg VT et al. Effect of home-based hand exercises in women with hand osteoarthritis: A randomised controlled trial. Ann Rheum Dis 2015 Aug; 74:1501 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24667900
- ↑ Valdes K, Marik T. A systematic review of conservative interventions for osteoarthritis of the hand. J Hand Ther. 2010;23:334-350 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20615662
- ↑ 5.0 5.1 Kingsbury SR, Tharmanathan P, Keding A et al Hydroxychloroquine Effectiveness in Reducing Symptoms of Hand Osteoarthritis: A Randomized Trial. Ann Intern Med. 2018. Feb 20. http://annals.org/aim/article-abstract/2672940/hydroxychloroquine-effectiveness-reducing-symptoms-hand-osteoarthritis-randomized-trial
- ↑ Kloppenburg M, Kwok WY. Hand osteoarthritis--a heterogeneous disorder. Nat Rev Rheumatol. 2011 Nov 22;8(1):22-31. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22105244
- ↑ 7.0 7.1 Kroon FPB, Kortekaas MC, Boonen A et al. Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE): A double-blind, randomised, placebo-controlled trial. Lancet 2019 Nov 30; 394:1993-2001. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31727410 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32489-4/fulltext
- ↑ 8.0 8.1 8.2 8.3 Eaton CB et al. Prevalence, incidence, and progression of radiographic and symptomatic hand osteoarthritis: The Osteoarthritis Initiative. Arthritis Rheumatol 2022 Jun; 74:992. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35077023 https://onlinelibrary.wiley.com/doi/10.1002/art.42076
Tveter AT et al. Short-term effects of occupational therapy on hand function and pain in patients with carpometacarpal osteoarthritis: Secondary analyses from a randomized controlled trial. Arthritis Care Res (Hoboken) 2022 Jun; 74:955 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33338325 https://onlinelibrary.wiley.com/doi/10.1002/acr.24543 - ↑ Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72:220-233. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31908163