What are the treatment options for arthritis with deformed fingers?

Treatment Options for Arthritis with Deformed Fingers

The treatment of arthritis with deformed fingers requires a comprehensive approach including physical modalities, orthoses, medications, and possibly surgery, with the American College of Rheumatology recommending orthoses as a first-line intervention for hand joint osteoarthritis. 1

Conservative Management Options

Physical Interventions

• Heat and Cold Therapy:
  • Apply local cold (crushed ice or ice cubes with water) for 20 minutes with periodic interruptions to prevent chondrocyte damage 1
  • Use local heat (paraffin wax, hot packs) before exercise to relieve pain and stiffness 1

Orthoses (Splints)

• Strongly recommended for first carpometacarpal joint osteoarthritis 1
• Conditionally recommended for other hand joints 1
• Custom-made neoprene or rigid rest orthoses worn at night can be effective 1
• Consult with an occupational therapist for proper fitting 1

Exercise Therapy

• Perform range of motion exercises to maintain joint mobility 1
• Implement strengthening exercises to stabilize affected joints 1
• Active finger motion exercises help maintain mobility 1

Joint Protection

• Teach techniques to minimize stress on affected joints 1
• Avoid adverse mechanical factors 1
• Evaluate ability to perform activities of daily living 1
• Provide assistive devices as needed 1

Pharmacological Management

Topical Treatments

• Topical NSAIDs are recommended as first-line pharmacological treatment 1
  • Provide localized pain relief with fewer systemic side effects

Oral Medications

1. Paracetamol (Acetaminophen): Second-line option for mild to moderate pain 1
2. Oral NSAIDs: Third-line option when other treatments fail 1, 2
   • Monitor for gastrointestinal, cardiovascular, and renal side effects 2
   • Use with caution in elderly patients 2
   • Should be used at the lowest effective dose for the shortest duration 2
3. Chondroitin sulfate: May be considered as a supplement 1

Intra-articular Injections

• Corticosteroid injections may provide short-term pain relief 3
• Hyaluronic acid injections have questionable long-term efficacy 3

Advanced Treatment Options

Disease-Modifying Antirheumatic Drugs (DMARDs)

• For inflammatory arthritis (rheumatoid arthritis), DMARDs and biologics like etanercept may be considered to retard disease progression 4, 5
• Etanercept (25mg twice weekly or 50mg once weekly) has shown efficacy in rheumatoid arthritis 6

Surgical Interventions

• Consider when conservative treatments fail and pain/deformity significantly impacts function 1, 3
• Options based on joint location:
  • Thumb metacarpophalangeal joint: Arthrodesis (joint fusion) is reliable 3
  • Finger metacarpophalangeal joints: Silicone implant arthroplasty is the gold standard 3
  • Distal interphalangeal joints: Arthrodesis is most effective for advanced arthritis 3
  • First carpometacarpal joint: Trapeziectomy or other procedures may be considered 1

Treatment Algorithm

1. Initial approach:

   • Orthoses/splinting
   • Heat/cold therapy
   • Exercise therapy
   • Joint protection techniques

2. If pain persists:

   • Add topical NSAIDs
   • Consider paracetamol for additional pain relief

3. For moderate to severe pain:

   • Add oral NSAIDs (with appropriate precautions)
   • Consider intra-articular injections

4. For inflammatory arthritis:

   • Consider DMARDs or biologics

5. For severe deformity or persistent pain despite conservative measures:

   • Consider surgical consultation

Important Considerations and Caveats

• Self-management is crucial: Enroll patients in self-efficacy and self-management programs 1
• Monitor medication side effects: Particularly with oral NSAIDs 1, 2
• Regular follow-up: Evaluate response to treatment in 4-6 weeks 1
• Surgical outcomes: While surgical methods have shown benefits in clinical practice, high-quality randomized controlled trials are still needed 3
• Age considerations: Elderly patients are at higher risk for NSAID-related complications 2, 7

Remember that approximately 80% of patients recover within 3-6 months with appropriate treatment 1, but arthritis with finger deformities often requires long-term management strategies.