Can osteoarthritis (OA) manifest as hand pain?

Hand Osteoarthritis as a Cause of Hand Pain

Yes, osteoarthritis commonly manifests as hand pain, particularly affecting the distal interphalangeal joints (DIPJs), proximal interphalangeal joints (PIPJs), and the base of the thumb (first carpometacarpal joint). 1

Clinical Presentation of Hand Osteoarthritis

Hand osteoarthritis (HOA) has distinctive clinical features that help identify it as a cause of hand pain:

Characteristic Symptoms

• Pain pattern: Pain on usage with only mild morning or inactivity stiffness
• Distribution: Typically affects one or a few joints at a time
• Timing: Symptoms are often intermittent
• Target sites: DIPJs, PIPJs, thumb base, and index and middle metacarpophalangeal joints (MCPJs) 1

Physical Examination Findings

• Bony enlargements: Heberden's nodes (at DIPJs) and Bouchard's nodes (at PIPJs)
• Structural changes: Bony enlargement with or without deformity
• Deformities: May include lateral deviation of interphalangeal joints, subluxation, and adduction of thumb base 1

Risk Factors for Hand Osteoarthritis

Several factors increase the risk of developing hand osteoarthritis:

• Demographics: Female sex, increasing age over 40, menopausal status
• Genetics: Family history
• Body composition: Obesity, higher bone density
• Physical factors: Greater forearm muscle strength, joint laxity
• Environmental factors: Prior hand injury, occupation or recreation-related usage 1, 2

Subtypes of Hand Osteoarthritis

Hand osteoarthritis can present in different forms:

1. Interphalangeal joint OA: With or without nodes
2. Thumb base OA: Affecting the first carpometacarpal joint
3. Erosive OA: A more aggressive form with radiographic subchondral erosion, typically with:
   • Abrupt onset
   • Marked pain and functional impairment
   • Inflammatory symptoms and signs
   • Mildly elevated C-reactive protein levels
   • Worse outcome than non-erosive interphalangeal joint OA 1

Diagnostic Approach

A confident clinical diagnosis of hand osteoarthritis can be made in adults over 40 with typical symptoms and physical examination findings 1. However, additional testing may be helpful:

• Plain radiographs: Gold standard for morphological assessment, showing:

  • Joint space narrowing
  • Osteophytes
  • Subchondral bone sclerosis
  • Subchondral cysts
  • Subchondral erosion (in erosive hand OA) 1

• Blood tests: Not required for diagnosis but may be needed to exclude coexistent inflammatory conditions, especially when symptoms are severe or involve atypical sites 1

Functional Impact

Hand osteoarthritis can significantly impact quality of life:

• Functional impairment may be as severe as in rheumatoid arthritis
• Causes decreased grip strength and limited ability to perform daily tasks 1, 2

Common Pitfalls in Diagnosis

1. Misdiagnosis: Hand OA can be confused with other conditions such as:

   • Psoriatic arthritis (which may target DIPJs or affect just one ray)
   • Rheumatoid arthritis (mainly targeting MCPJs, PIPJs, wrists)
   • Gout (which may superimpose on pre-existing HOA)
   • Hemochromatosis (mainly targeting MCPJs, wrists) 1

2. Overlooking erosive OA: This more aggressive form requires different management and has worse outcomes 1

3. Failing to recognize generalized OA: Patients with polyarticular HOA are at increased risk of knee OA, hip OA, and OA at other common target sites 1

Management Considerations

While not the focus of the question, it's worth noting that management options include:

• Non-pharmacological approaches: Education, exercise programs, orthoses/splints 3
• Pharmacological treatments: Topical NSAIDs, oral analgesics, intra-articular injections 1, 3, 4
• Surgical interventions for severe cases 1, 5

In conclusion, hand pain is a common manifestation of osteoarthritis, with distinctive clinical features that allow for confident diagnosis in most cases. The condition significantly impacts function and quality of life, making proper recognition and management essential.