Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of cartilage cushioning the ends of bones, which leads to pain, stiffness, and reduced function. Hand osteoarthritis commonly affects the joints closest to the fingertip (distal interphalangeal joints), the middle joints (proximal interphalangeal joints), and the carpometacarpal joint at the base of the thumb. This damage causes bones to rub together, often resulting in bony nodules and a deep, aching pain that interferes with daily activities. While there is no cure, adopting practical strategies can help mitigate damage, manage symptoms, and significantly slow the progression of hand OA.
Protecting Joints Through Ergonomics and Assistive Devices
Reducing mechanical stress on affected joints is fundamental to slowing the progression of hand OA. Repetitive motions and tight gripping increase the wear and tear on compromised cartilage and surrounding tissues. Joint protection principles involve minimizing the force exerted by the small finger joints and shifting the load to larger, stronger joints.
A key strategy is modifying how you grip and carry items, such as using two hands instead of one for pouring, or carrying bags on your forearm or shoulder instead of gripping the handles. Using adaptive tools can significantly reduce strain by increasing the surface area of a grip, thereby distributing pressure more evenly. Examples include using built-up handles on kitchen utensils, toothbrushes, and pens, which require less forceful pinching.
Assistive devices like automatic jar openers, key turners, and loop-handled scissors eliminate the need for twisting, tight gripping, and repetitive strain that exacerbates thumb base and finger joint pain. For the thumb, a common site of OA, a custom or commercially available splint for the carpometacarpal (CMC) joint can provide rest and stability during periods of increased activity or inflammation. These ergonomic changes preserve joint integrity and maintain independence by allowing tasks to be completed with less pain and effort.
Maintaining Function with Targeted Hand Exercises
Specific, low-impact hand exercises maintain flexibility, improve range of motion, and strengthen supporting muscles around the joints. Strengthening the muscles in the hand and wrist stabilizes the joints, reducing strain on the damaged cartilage. Exercises should be performed gently and only when pain is minimal, following the guidance of a physical or occupational therapist.
Range-of-motion exercises focus on moving the joints through their available arc without forcing them, which prevents tendons from shortening and joints from stiffening. Simple movements like making a gentle fist, performing finger bends one digit at a time, and touching the thumb to each fingertip help keep the joints pliable. Prior to exercise, applying heat therapy, such as a warm water soak or a heating pad, can temporarily increase blood flow and flexibility, making the movements easier to perform.
For strengthening, gentle resistance exercises can be introduced using therapy putty or a soft stress ball. Squeezing the ball and holding the contraction for a few seconds helps build grip strength, which is often diminished in hand OA. Another strengthening technique involves using a rubber band around the fingers to practice extending and separating them against resistance. These targeted movements support functional capacity for daily tasks like opening jars or turning keys.
Managing Pain and Inflammation with Medications
Controlling pain and inflammation is a primary strategy for slowing disease progression, as chronic inflammation contributes to joint degradation. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are often recommended as a first-line pharmacological treatment for hand OA due to their targeted action. These gels or solutions, such as diclofenac, are applied directly to the painful joint, penetrating the skin to deliver the drug locally.
Topical NSAIDs provide effective pain relief and improved physical function with significantly lower systemic absorption compared to oral versions. This reduced absorption minimizes the risk of systemic side effects, such as gastrointestinal distress or cardiovascular concerns, associated with oral NSAID use.
For short-term relief of acute, severe pain flares, a physician may recommend a corticosteroid injection directly into a specific joint, such as the base of the thumb. This therapy delivers a powerful anti-inflammatory agent to the localized site of inflammation, though the number of injections is typically limited due to the potential for long-term joint damage. Oral NSAIDs, like ibuprofen or naproxen, can be used for more widespread pain or when topical treatments are insufficient, but they carry a higher risk profile, especially in older patients. The goal of these medical interventions is to reduce the inflammatory environment within the joint, easing discomfort and potentially slowing the rate of cartilage loss.
Nutritional Strategies and Supplements for Joint Health
Dietary adjustments complement local treatments by addressing systemic inflammation that influences OA activity. Adopting an anti-inflammatory eating pattern, such as the Mediterranean diet, emphasizes whole foods, lean proteins, and healthy fats. This approach focuses on increasing fruits, vegetables, and whole grains while reducing processed foods and refined sugars.
Omega-3 fatty acids, found in fatty fish like salmon and sardines, possess anti-inflammatory properties that modulate the body’s inflammatory response. While research on omega-3 supplements for OA symptoms is mixed, increasing intake often helps with overall joint comfort and function. Consultations with a healthcare provider or registered dietitian can tailor these nutritional strategies to individual needs.
Certain supplements are utilized for joint health support, though evidence for their disease-modifying effects is varied. Glucosamine and chondroitin, components of normal cartilage, have been studied for their potential to reduce pain and possibly slow cartilage breakdown. Other compounds like curcumin, derived from turmeric, have shown promise in reducing pain intensity due to their potent anti-inflammatory effects.