Osteoarthritis

Osteoarthritis (OA) is the most common type of joint disease, affecting more than 30 million individuals in the United States alone. It is the leading cause of chronic disability in older adults. It is primarily a degenerative disorder with inflammatory components from the biochemical breakdown of joint cartilage, synovial tissue and bone.

Signs and symptoms

Symptoms of osteoarthritis include the following:

• Deep, achy joint pain that worsens with use
• Reduced range of motion and cracking noises
• Stiffness during rest and in the morning that improves in less than 30 minutes

Osteoarthritis of the hand

• Distal (farthest away from the hand / wrist) and middle finger joints are most often affected
• Joints at the base of the thumb are also typically involved
• Hard bumps on the distal joints are more characteristic in women than in men

Other symptoms

• Reduced range of motion
• Altered gait if hips affected

The progression of osteoarthritis has been divided into three stages, as follows:

• Stage 1 – Breakdown of protein in the cartilage matrix occurs
• Stage 2 – Breakage and erosion of the cartilage surface develop that deposit in the synovial fluid (fluid around the joint)
• Stage 3 – These breakdown products of cartilage cause a chronic inflammatory response in the synovium, which in turn contributes to more cartilage breakdown

Hand osteoarthritis has been classified as follows:

• Erosive
• Thumb base
• Interphalangeal—finger joints (with or without bumps)
• Widespread hand

Treatment for OA

• Analgesics such as acetaminophen, aspirin, NSAIDS like ibuprofen, naproxyn
• Warm and cool packs
• Physical therapy
• Weight loss especially if hips and knees are affected
• Exercise such as strength and resistance training, pulsed electromagnetic field therapy, and transcutaneous electrical nerve stimulation show mostly short-term benefits, whereas agility training shows both short- and long-term benefits.

• Intra-articular platelet-rich plasma, balneotherapy ( thermal baths or spas with minerals), and whole-body vibration show medium-term benefits.
• Glucosamine-chondroitin and glucosamine or chondroitin sulfate supplements alone show medium-term benefits with no long-term benefits for pain or function

• In June 2018, the US Food and Drug Administration (FDA) approved the combination of the calcium channel blocker amlodipine with celecoxib (Consensi), for patients for whom treatment with amlodipine for hypertension and celecoxib for osteoarthritis are appropriate.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease whose main feature is a persistent joint inflammation of multiple joints of the hands and feet. Other organs may be involved, such as the skin, heart, lungs, and eyes. RA is thought to develop when a genetically susceptible individual experiences an external trigger (e.g., cigarette smoking, infection, or trauma) that triggers an autoimmune reaction.

Signs and symptoms of RA may include the following:

• Persistent symmetric (bilateral) polyarthritis (synovitis) of hands and feet
• Progressive joint deterioration
• Non joint involvement
• Difficulty performing activities of daily living (ADLs)
• Constitutional symptoms like fever
• It can affect other joints like hips, knees, ankles, and spine
• Stiffness
• Tenderness
• Pain on motion
• Swelling
• Deformity
• Limitation of motion
• Rheumatoid nodules

There is no one diagnostic test, but the diagnosis is made by using a combination of clinical, laboratory, and imaging features

Potentially useful x-ray or imaging modalities include the following:

• Radiography (first choice): Hands, wrists, knees, feet, elbows, shoulders, hips, cervical spine, and other joints as indicated
• Magnetic resonance imaging: Primarily cervical spine
• Ultrasonography of joints
• Joint fluid aspiration and analysis of synovial fluid may be considered, including the following

Therapy for RA

Nonsurgical and non-drug therapies include the following:

• Heat and cold therapies
• Splints and support materials, braces
• Therapeutic exercise
• Occupational therapy
• Joint-protection education

Disease-modifying anti-rheumatic drugs (DMARDS) include the following:

• Hydroxychloroquine
• Azathioprine
• Sulfasalazine
• Methotrexate
• Leflunomide
• Cyclosporine
• Gold salts
• D-penicillamine
• Minocycline

Biologic tumor necrosis factor (TNF)–inhibiting DMARDs include the following:

• Etanercept
• Infliximab
• Adalimumab
• Certolizumab
• Golimumab

Biologic non-TNF DMARDs include the following:

• Rituximab
• Anakinra
• Abatacept
• Tocilizumab
• Sarilumab
• Tofacitinib
• Baricitinib
• Upadacitinib