Small Joint Arthritis

What is it?

The fingers have many small joints that help us perform a variety of fine movements. Movement is possible because of cartilage that lines the joints and provides a gliding surface. When the cartilage becomes worn or damaged, the joint stops functioning normally and can become painful and stiff.  Early symptoms of small joint arthritis include a dull or “toothache” type pain. The pain can occur after periods of increased use and may show up hours later or even the following day. In some cases, the pain and stiffness are worse at the beginning of the day.

What causes it?

Small joint arthritis is a result of thinning of the cartilage in the finger joints. This results in joints that can be stiff, swollen, and/or painful. The onset of painful arthritic inflammation can be related to trauma (fractures or dislocations of the fingers), osteoarthritis, rheumatoid arthritis, gout, or other inflammatory conditions. Over time, the bones can lose their normal shape and cause more pain and further limitation of motion. At times, the joint themselves become enlarged due to the chronic inflammation.

How is it diagnosed?

The diagnosis is determined by the patient’s symptoms, a careful physical exam and x-rays. Finger stiffness and swelling may be present, and pain may be reproduced with manipulation of the fingers. There may be deformity, such as crooked fingers and enlargement of the joints. It is important to rule out other conditions that may cause pain such as carpal tunnel or tendonitis.

What are the treatments?

Treatment options for small joint arthritis of the hand include medications (including alternative medicines like glucosamine), splinting, injections, and surgery. Arthritis without significant pain may not require any treatment as no treatment is able to slow or reverse arthritis. The majority of patients with symptoms are treated without surgery.  A single steroid injection can provide pain relief for months or longer. The injections can be repeated, but should demonstrate long-term effectiveness.  Surgery is reserved for  patients whose non-surgical treatment is unsuccessful.

Patients that require surgery often have severe pain; deformity without pain is not usually an indication for surgery. Surgical options include joint replacements or “freezing” the joint, also known as fusion. Most patients can return to light hand use and even work shortly after surgery. The treatment option chosen should be tailored to the patient’s individual needs.