Hand arthritis, marked by joint pain, stiffness, and a progressive loss of function, significantly impacts daily life. Simple actions like gripping or writing can become challenging, signaling the need for specialized medical attention. Navigating the healthcare system to find the correct professional is the necessary first step toward effective symptom management and functional preservation. A collaborative approach involving several specialists is often required to address the complexity of joint inflammation and structural damage. This guide outlines the roles of the medical professionals involved in diagnosing and treating hand arthritis.
Starting with Primary Care
The Primary Care Physician (PCP) or general practitioner is the appropriate first point of contact for new hand symptoms. Your PCP will conduct an initial assessment, taking a thorough medical history and performing a physical examination to evaluate the affected joints. They will look for signs of swelling, tenderness, and limitations in the hand’s range of motion.
The initial workup may include basic diagnostic tests, such as general bloodwork and conventional X-rays of the hands. This initial testing helps to rule out other causes of joint pain, such as acute injury or infection, and provides a baseline assessment of any joint space narrowing or bone erosions. The PCP then determines whether the condition is likely due to common wear-and-tear (osteoarthritis) or a systemic inflammatory process.
In many managed care systems, the PCP functions as a gatekeeper, and a formal referral is necessary to see a specialist. If the initial assessment suggests a more complex inflammatory condition, the PCP will refer the patient to the appropriate specialist for definitive diagnosis. This early referral is important for conditions where delayed treatment can lead to rapid joint destruction.
The Rheumatologist: Diagnosis and Medical Management
The rheumatologist specializes in inflammatory and autoimmune conditions that affect the joints, muscles, and bones, and determines the specific type of arthritis present. Conditions like rheumatoid arthritis, psoriatic arthritis, and gout are systemic diseases that require specialized diagnostic tools and medical management. The rheumatologist uses advanced blood tests to look for specific biomarkers, such as Rheumatoid Factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, which indicate autoimmune activity.
Diagnostic imaging, including ultrasound or Magnetic Resonance Imaging (MRI), may also be used to visualize soft tissue inflammation and identify joint erosions. Once a diagnosis is established, the rheumatologist focuses on non-surgical, medical management of the disease. Treatment protocols for inflammatory arthritis often include Disease-Modifying Anti-Rheumatic Drugs (DMARDs) like methotrexate, which work to slow the progression of the disease.
For more aggressive conditions, newer biologic therapies may be prescribed; these target specific components of the immune system to reduce inflammation. The rheumatologist will closely monitor the patient’s disease activity and adjust the medication regimen over time to achieve disease remission or low disease activity.
The Orthopedic Hand Surgeon: Structural Solutions
When medical management fails to control pain or when joint destruction severely limits hand function, the patient is often referred to an orthopedic surgeon who specializes in the hand and upper extremity. This specialist focuses on the mechanical and structural damage caused by advanced arthritis, particularly severe osteoarthritis or late-stage inflammatory arthritis. The surgeon evaluates the stability and alignment of the joints to determine the potential benefit of surgical intervention.
Surgical options aim to reconstruct or replace the damaged joints to relieve pain and restore function. Arthrodesis, or joint fusion, involves joining the bones of a severely damaged joint to create a stable, pain-free structure, often performed near the fingertips. Arthroplasty, or joint replacement, removes damaged joint surfaces and replaces them with an artificial implant, typically used in larger knuckles where maintaining mobility is important.
Other structural interventions may include synovectomy, which removes the inflamed joint lining in early inflammatory arthritis, or osteotomy, which involves repositioning bone to correct alignment. The decision to proceed with surgery is made when non-surgical treatments have been exhausted, and the patient’s quality of life is significantly impaired by pain or inability to perform daily tasks.
Supportive Care: Physical and Occupational Therapy
Physical and Occupational Therapists are integral members of the arthritis management team, supporting both medical and surgical treatment. These allied health professionals focus on rehabilitation, pain reduction, and maintaining long-term functional independence. Physical therapy concentrates on exercises designed to improve joint range of motion and strengthen the muscles surrounding the hand and wrist.
Occupational therapy (OT) focuses on adapting activities to protect the joints and preserve function in daily life. OT specialists teach joint protection techniques, modifying how tasks are performed to minimize stress on affected joints. This involves recommending specialized splints or braces to support and stabilize painful joints during activities or at night.
Therapists also train patients on the use of adaptive tools, such as specialized jar openers or writing aids, to make everyday tasks easier. This supportive care is customized to the patient’s specific type of arthritis and the joints involved, continuing as a long-term strategy for living with hand arthritis.