Hand arthritis: symptoms, what treatments to relieve it?

Arthritis is joint inflammation, which can affect several joints. “On talks about polyarthritis if at least 4 joints are affected“, explains Dr. Jean Darloy, rheumatologist. All joints can be affected, although there are certain particularities depending on the cause. There chondrocalcinosis is for example frequent at wrist. Arthritis can be acute (i.e. present for a short time) or chronic (evolving for several weeks). L’hand arthritis represents a clinical manifestation that can be the expression of various pathologies. “The diagnosis is not always obvious at first glance and may require advice from a specialist rheumatologist. Rapid treatment of these pathologies is essential in order to avoid as much as possible the appearance of deformities which can sometimes lead to severe disability.“, specifies Dr Pflimlin, rheumatologist at Lille University Hospital.

Definitions of arthritis

→ Septic arthritis (microbial): the attack is mono-articular (i.e. affecting only one joint).

→ Microcrystalline arthritis (gout or chondrocalcinosis): gout results from an increase in uric acid in the blood which causes deposits of sodium urate crystals in the joints. “As for chondrocalcinosis, it is linked to the deposition in the cartilage and fibrocartilage of other types of crystals, calcium pyrophosphate crystals”, continues Dr. Jean Darloy.

→ Arthritis of chronic inflammatory rheumatism (like rheumatoid arthritis).

Arthritis is often confused with osteoarthritis, whose clinical expression is often different, which corresponds to cartilage degradation. Other inflammatory rheumatisms can affect the hands like psoriatic arthritis, which belongs to the spondyloarthritis family. “Unlike rheumatoid arthritis, it will likely be asymmetric, with potential involvement of the distal interphalangeal joints. It is associated with skin psoriasis in approximately 90% of cases.“, he continues.

What are the symptoms ?

Arthritis manifests clinically as:

• a pain in a joint, “The pain is called “inflammatory”, that is to say predominant at rest and at nightattenuated during movement, often with morning rust removal lasting more than 30 minutes”, adds Dr Arnaud Pflimlin, rheumatologist.
• swelling,
• redness (inconstant)
• an increase in local temperature.

Septic arthritis can be characterized by the existence of an inconstant fever and significant local inflammatory signs.

Gouty arthritis is often responsible for a “noisy”, very inflammatory clinical picture, potentially accompanied by a low fever. The damage can be mono- or polyarticular.

In case of chondrocalcinosis, the joint damage is also very inflammatory. “For the location of the hand, this pathology regularly concerns the triangular carpal ligament (which is a fibrocartilage and not a ligament), located on the medial side of the wrist, above the little finger.recalls the specialist.

Rheumatoid arthritis classically begins with a picture of bilateral polyarthritis (i.e. affecting both hands) and symmetrical hands, with respect to the distal interphalangeal joints (joints between the 2nd and 3rd phalanges of the fingers). “Allowing rheumatoid arthritis to progress exposes the patient to joint deformities, particularly in the hands, potentially responsible for significant disability and aesthetic discomfort. alerts our interlocutor.

What are the causes ?

For septic arthritis (microbial), it is appropriate to look for an entry point for the bacteria such asa cut For example.

For gouty arthritis : “Gout results from an increase in uric acid in the blood, itself caused by different causes: excess production of uric acid linked to the consumption of foods rich in purines (red meat, offal, cold meats, etc.). ) or sugary drinks (sodas) or alcoholic drinks, lack of renal elimination of uric acid (kidney failure, taking diuretics, genetic mutations, etc.)“, recalls Dr. Darloy.

For chondrocalcinosisthere is often no identified cause but certain pathologies can induce chondrocalcinosis such as hemochromatosis (iron overload of the organism of genetic origin) and primary hyperparathyroidism (which is characterized in particular by an elevation calcium level in the blood).

For rheumatoid arthritis, “The agents causing rheumatoid arthritis are still unknown. A biological assessment should be carried out looking for specific antibodies (rheumatoid factor, anti-CCP antibodies), and x-rays, often normal at first, tracking bone erosions ( which sign the destructive attack of this rheumatism), making all the seriousness of this pathology”underlines the specialist.

Who are the people at risk?

It depends on the cause. Septic arthritis will likely be more common in “fragile” patients with comorbidities such as diabetes or during taking immunosuppressive treatments. Gout will concern patients with a diet rich in purines and/or high consumption of sugary or alcoholic drinks, but also patients with kidney failure or taking diuretics for heart failure, for example. Chondrocalcinosis is more likely to occur in elderly patients. “This multifactorial disease involves genetic but also environmental factors such as smoking,” adds Dr. Darloy.

The diagnosis of arthritis is usually made usinga joint fluid puncture, which will find an inflammatory liquid with bacteria in the case of septic arthritis, an inflammatory liquid with microcrystals in the case of microcrystalline arthritis (gout, chondrocalcinosis), an inflammatory liquid without bacteria and without microcrystals in the case of inflammatory rheumatism. “The location of the hand is particular in that it involves small joints for which joint punctures are often painful for the patient, insists Dr. Darloy. They are therefore only carried out rarely in daily practice, mainly in cases of strong suspicion of septic arthritis. The diagnosis of hand arthritis is then based onother clinical and paraclinical elementsin order to try to bring together a set of arguments to point towards this or that cause“.

What treatments to relieve hand arthritis?

The treatment is chosen according to the origin of the pathology.

• For septic arthritis: the treatment will be based on joint rest, taking antibiotics and surgical washing most often.
• For gouty arthritis, the treatment of gout attacks is based on joint rest, local icing and taking anti-inflammatories such as colchicine. Basic treatment, to reduce the level of uric acid, will be based on the avoidance of risk factors, and specific medications such as allopurinol or febuxostat.
• For rheumatoid arthritis : in addition to the treatment of flare-ups, based on the use of anti-inflammatories, it is therefore essential to consult a rheumatologist quickly in order to initiate specific treatment aimed at preventing flare-ups and deformations. Different molecules are now available, such as methotrexate and biotherapies.

Thanks to Dr Darloy and Pflimlin, rheumatologists at Lille University Hospital