Monday Medical: Treatment for hand and wrist arthritis |

Monday Medical: Treatment for hand and wrist arthritis

Susan Cunningham
For Steamboat Pilot & Today

Editor’s Note: This story is Part 1 of a three-part series on treating arthritis in the hands and wrists. Part 2 focuses on surgical options, and Part 3 focuses on the role of physical therapy.

A look at someone’s hands reveals a lot, especially when it comes to arthritis.

“I think a lot of people are surprised by what you can discover by looking at somebody’s hands,” said Dr. Nicole Cotter, a rheumatologist at UCHealth Rheumatology Clinic in Steamboat Springs. “Even if someone comes in with knee pain, I start by looking at their hands. You can get a tremendous amount of information on what’s going on with all joints.”

Main types of arthritis

While there are dozens of different kinds of arthritis, the two major types that impact the hands and wrists are osteoarthritis and rheumatoid arthritis.

With osteoarthritis, the cartilage at certain joints breaks down over time, resulting in damage to the joints. This damage can cause bony enlargements, often visible at the finger joints.

“Osteoarthritis is very common,” Cotter said. “The four big risk factors are age, weight, genetics and trauma. We typically see it in older people.”

Post-traumatic arthritis is similar to osteoarthritis, but results from specific trauma to the joint.

Rheumatoid arthritis is an autoimmune disease that is often seen in younger adults in their 30s and 40s.

“The immune system gets confused and starts to create inflammation in the joints,” Cotter said. “You didn’t slam your hand in the door, but your hand swells like you did.”

Rheumatoid arthritis has a genetic component, but is triggered by something environmental, such as an infection, emotional trauma or an environmental exposure. Because rheumatoid arthritis is a systemic disease, it impacts all of the joints in the body.

Keep in mind that other types of arthritis impact the immune system. A negative test for rheumatoid arthritis doesn’t mean arthritis isn’t at play.

Symptoms of arthritis

“Both osteoarthritis and rheumatoid arthritis cause pain,” Cotter said. “Some of the fine motor tasks that require you to bend the joints in specific directions become painful, and people can be limited in how they’re able to use their hands.”

This might make it hard to open jars, to do snaps or buttons, or to complete other fine-motor tasks.

With osteoarthritis, joints get more painful with use. With rheumatoid arthritis, pain often lessens with use.

“Rheumatoid arthritis is usually worse with inactivity,” Cotter said. “People have more symptoms first thing in the morning, but symptoms typically improve a bit as they use their joints.”

Medical treatments for arthritis

These two major types of arthritis are treated differently.

“With osteoarthritis, we don’t have medications that slow the progression of the disease, but modifying lifestyle can be very useful,” Cotter said. “We know that being at a healthy body weight and staying physically active can slow the progression of osteoarthritis.”

Medications to treat inflammation, as well as physical therapy to help strengthen muscles, can also help lessen symptoms.

But with rheumatoid arthritis, various medications now exist that help stop the abnormal immune response.

“We have very targeted therapies to treat rheumatoid arthritis and they’ve revolutionized the treatment of the disease,” Cotter said. “People often see dramatic improvements in swelling, and by getting rid of the swelling, people can function like they don’t have arthritis.”

It can take some trial and error to determine which medicine works best, but most people find relief.

“It’s reasonable to get significant control of the disease with the options we have,” Cotter said.

With rheumatoid arthritis, an early diagnosis is especially important so the disease can be treated aggressively to slow the progression. Early intervention is also helpful with osteoarthritis, as it can help reduce pain and allow people to get back to their regular lifestyle.

“It’s important to see a rheumatologist to get the right diagnosis and know what you’re dealing with,” Cotter said. “I would encourage anybody who has joint symptoms that don’t seem right or that are intrusive to their lives to see a rheumatologist and get the right diagnosis. You shouldn’t have debilitating joint pain. There are absolutely things we can do to give people their lives back.”

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at

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