Arthritis of the Hand

Joints of the hand affected by arthritis

• DIP joints: the joints nearest the fingertips
• PIP joints: the middle finger joints
• MCP joints: the knuckles where fingers meet the hand
• CMC joint of the thumb: at the base of the thumb, near the wrist
• Wrist joints

The pattern of joints involved is one of the best clues to the type of arthritis.

Types of hand arthritis

Osteoarthritis

Osteoarthritis is the most common type. Cartilage thins and bone thickens, forming bony spurs.

• Affects the DIP joints (bony bumps called Heberden's nodes), PIP joints (Bouchard's nodes) and the thumb base
• More common in women and after age 50, often running in families
• Pain with use, stiffness after rest lasting less than 30 minutes
• Joints may become knobby or angled
• Erosive hand osteoarthritis is a more inflammatory form with sudden painful flares

Thumb base arthritis

Osteoarthritis at the base of the thumb causes aching at the wrist side of the thumb, weak pinch and difficulty opening jars, turning keys and writing. A bump may form, and the thumb can collapse into a "Z" shape. See thumb arthritis.

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease that inflames the joint lining.

• Affects knuckles (MCP), middle joints (PIP) and wrists on both hands, usually sparing the fingertip joints
• Warm, soft, spongy swelling
• Morning stiffness lasting more than 30 minutes, often hours
• Fatigue and sometimes low-grade fever
• Without treatment, can cause deformities such as fingers drifting toward the little finger side

Early treatment within the first few months prevents joint damage.

Other types

• Psoriatic arthritis: often affects fingertip joints, can cause a whole "sausage" finger, with psoriasis or nail pitting.
• Gout: sudden attacks of a hot, red, swollen joint; chalky lumps (tophi) in long-standing gout.
• Lupus: joint pain and swelling, usually without erosion.
• Post-traumatic arthritis after fractures or ligament injuries.

Osteoarthritis vs rheumatoid arthritis in the hands

Diagnosis

A doctor examines the hands for swelling, warmth, bony nodes, deformity, grip strength and range of motion. X-rays show joint narrowing, bone spurs or erosions. Blood tests (CRP, ESR, rheumatoid factor, anti-CCP antibodies, uric acid) help identify inflammatory types. Ultrasound or MRI can detect early inflammation. Fluid from a swollen joint may be tested for crystals or infection.

Treatment

Self-care and therapy

• Hand exercises: gentle range-of-motion and strengthening exercises daily keep joints flexible and improve grip.
• Heat: warm water soaks or paraffin wax for stiffness; cold packs for flares.
• Splints: a thumb splint at night or during activity eases thumb base pain.
• Assistive devices: jar openers, thick-handled utensils, lever taps and key turners.
• Occupational therapy for joint protection techniques.

Medicines

• Topical NSAID gels (such as diclofenac) are recommended first for hand osteoarthritis.
• Oral NSAIDs for flares, following the label dose, if safe for you.
• Steroid injections into the thumb base or an inflamed joint give short-term relief.
• Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, and biologic medicines for rheumatoid and psoriatic arthritis.
• Urate-lowering therapy for recurrent gout.

Surgery

• Thumb base surgery: removing the trapezium bone (trapeziectomy), sometimes with ligament reconstruction, relieves pain for most people.
• Joint fusion of fingertip or middle joints for pain and instability.
• Joint replacement of the knuckles or middle joints, mainly in rheumatoid arthritis.
• Tendon repair or synovectomy in rheumatoid arthritis.

Living with hand arthritis

• Spread loads across larger joints, such as carrying bags on the forearm.
• Avoid tight, sustained gripping; take breaks.
• Keep active and maintain a healthy weight, which is linked with less hand osteoarthritis.
• Stop smoking, which worsens rheumatoid arthritis.

Frequently asked questions

What are the first signs of arthritis in the hands?

Early signs include aching or stiffness in the finger joints or base of the thumb after use, mild swelling, reduced grip strength and difficulty with fine tasks like buttons or jars. In rheumatoid arthritis, prolonged morning stiffness and puffy knuckles on both hands are early clues.

How can I tell if hand pain is osteoarthritis or rheumatoid arthritis?

Osteoarthritis usually affects the fingertip and middle joints and thumb base, with hard bony bumps and short morning stiffness. Rheumatoid arthritis affects the knuckles and wrists on both hands, with soft swelling and stiffness lasting over 30 minutes. Blood tests and X-rays confirm it.

What is the best treatment for arthritis in the hands?

For osteoarthritis, hand exercises, splints, heat and topical anti-inflammatory gel are first-line, with injections or surgery for severe thumb arthritis. For rheumatoid arthritis, early disease-modifying medicines from a rheumatologist are the most important treatment.

Can arthritis in the fingers be reversed?

Joint damage from osteoarthritis cannot be reversed, but pain and function often improve with treatment, and flares settle. In rheumatoid arthritis, starting treatment early can stop inflammation and prevent damage, and many people reach remission.