Osteoarthritis of the joints of the hands

Unfortunately, osteoarthrosis of the hand joints has not been studied in as much detail as gonarthrosis and coxarthrosis. This is probably due to the relative benignity of osteoarthrosis in this localization.

Osteoarthrosis predominantly affects the distal (-70% of patients with hand osteoarthrosis), less often the proximal (-35% of patients with hand joint osteoarthrosis) interphalangeal joints and the carpometacarpal joint of the thumb (-60% of women and -40% of men with hand osteoarthrosis). The metacarpophalangeal joints and the wrist are rarely affected (in women -10 and 5%, in men -20 and 20%, respectively). Hand osteoarthrosis affects women 4 times (according to other data, 10 times) more often than men. According to EL Radin et al. (1971), the above-described distribution of the frequency of hand joint damage can be explained by the distribution of the load on them - the maximum load falls on the distal interphalangeal joints. The incidence of hand joint involvement in patients with osteoarthritis is a mirror image of that seen in rheumatoid arthritis.

Osteoarthritis of the hands usually begins in middle age, more often in women during menopause. Osteoarthritis of the hands is often associated with gonarthrosis and obesity (especially isolated osteoarthritis of the carpometacarpal joint of the thumb and interphalangeal joints). Isolated arthrosis of individual small joints of the hands (except for the carpometacarpal joint of the first finger), as well as isolated arthrosis of the wrist joint are usually secondary (for example, osteoarthritis of the wrist joint after Kienbock's disease (aseptic necrosis of the lunate bone) or posttraumatic osteoarthritis I).

The distinctive feature of osteoarthritis of the interphalangeal joints of the hands are Heberden's nodes (distal interphalangeal joints) and Bouchard's nodes (proximal interphalangeal joints). They are dense nodular thickenings mainly on the superolateral surface of the joints. The nodes are painful, often complicated by secondary synovitis, which may cause slight swelling of the soft tissues, local increase in skin temperature, and sometimes hyperemia of the skin over the joint. Patients with osteoarthritis of the interphalangeal joints more often than patients with other localizations complain of stiffness lasting up to 30 minutes in the affected joints in the morning and after a period of rest. In the early stages of osteoarthritis of the interphalangeal joints of the hands, cysts may form over the joints, which sometimes spontaneously open with the release of a viscous, colorless, jelly-like content rich in hyaluronic acid. In the later stages of osteoarthritis of the interphalangeal joints, instability, decreased flexion range, and decreased functional ability of the joints may occur, which manifests itself in difficulties in performing fine work and delicate movements.

Patients with isolated osteoarthrosis of the carpometacarpal joint of the first finger are bothered by pain in the area of the base of the first metacarpal bone. Rarely, the patient may complain of vague pain "somewhere in the wrist joint". A common complaint of patients with osteoarthrosis of the carpometacarpal joint of the first finger is difficulty in folding the fingers into a pinch. Palpation of the joint is painful, sometimes crepitations can be heard and palpated when moving the joint. In severe cases, degenerative changes in the carpometacarpal joint of the first finger are accompanied by adduction of the metacarpal bone and atrophy of nearby muscles, which leads to the formation of a "square hand". Osteoarthrosis of the carpometacarpal joint of the first finger can also be complicated by secondary synovitis, accompanied by increased pain, swelling of the soft tissues, hyperemia and an increase in the local temperature of the skin over the joint.

In severe cases of osteoarthrosis of the hand joints, X-rays reveal not only the signs characteristic of osteoarthrosis (narrowing of the joint space, sclerosis of the subchondral bone, osteophytosis, subchondral cysts), but also the intermittent nature of the white cortical line. Such osteoarthrosis is called erosive. The erosive (non-nodular) form of osteoarthrosis of the hands is characterized by recurrent synovitis. Histologically, inflammation without pannus is detected in the synovial membrane, and blood tests show signs of an acute phase response (hypergammaglobulinemia, increased ESR, increased CRP content, etc.).

The nature of erosive osteoarthritis is unclear. It is sometimes interpreted as a cross-over condition between osteoarthritis and rheumatoid arthritis, although more often it is considered a severe form of osteoarthritis of the joints of the hands.

The evolution of osteoarthrosis of the joints of the hands usually ends within a few years. The disease begins with a feeling of discomfort, pain, sometimes itching in the area of the interphalangeal joints and the base of the first metacarpal bone. Over the course of several years (sometimes months), the symptoms periodically worsen and subside, signs of local inflammation often appear. Cysts may form above the joints. After some time, the process stabilizes, pain and inflammation subside, the swelling above the joints becomes hard and fixed, acquires a nodular character; the range of motion in the joints decreases, sometimes joint instability develops.

Osteoarthritis of the hand joints is characterized by non-simultaneous damage to the joints. Therefore, at any given moment in time, changes in some joints are stable, while in others there are signs of active inflammation and progression of morphological changes. The emerging "erosions" subsequently undergo reverse development, leaving a typical "gull wing" symptom. According to PA Dieppe (1995), osteoarthritis of the hand joints is a staged process in which each joint goes through a period of "active" changes, followed by stabilization of the condition.

Osteoarthritis of the hand joints is rarely accompanied by complications. Damage to the wrist joint may be complicated by tunnel syndrome. Instability may develop in each joint. The erosive (non-nodular) form of osteoarthritis of the interphalangeal joints of the hands may result in fusion of the articular surfaces; this process is accelerated by intra-articular administration of prolonged-release corticosteroids.

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