Arthritis in the Hand: Understanding Your Treatment Options

How Arthritis Affects the Hand

The hands contain more joints than almost any other part of the body, which makes them a frequent target of arthritis in its various forms. The two most common types are osteoarthritis (OA) and rheumatoid arthritis (RA), and while both cause pain and stiffness, they have different mechanisms and different treatment priorities.

Osteoarthritis of the hand is degenerative — the protective cartilage at the joint surface gradually wears away, leading to bone-on-bone contact, inflammation, and progressive deformity. It most commonly affects the basal joint at the base of the thumb (carpometacarpal or CMC joint), the end joints of the fingers (DIP joints), and the middle finger joints (PIP joints). Thumb basal joint arthritis is particularly disabling because the thumb is involved in nearly every grip and pinch activity.

Rheumatoid arthritis is an autoimmune condition in which the immune system attacks the joint lining (synovium), causing inflammation, pain, swelling, and — if inadequately treated — progressive joint destruction and deformity. RA in the hand tends to affect the knuckles (MCP joints) and wrist symmetrically.

Both conditions can significantly impair hand function and quality of life, but both also respond well to appropriate treatment.

Non-Surgical Treatment

For most patients, non-surgical management is the starting point and often provides sustained relief.

Splinting offloads arthritic joints by providing external support and limiting painful range of motion. Custom-fabricated splints from a hand therapist are more precisely fitted than over-the-counter options. For thumb basal joint arthritis specifically, a thumb spica splint worn during high-demand activities can meaningfully reduce pain.

Hand therapy with an occupational therapist addresses grip strength, range of motion, joint protection strategies, and adaptive equipment. Therapists also teach patients how to modify daily activities — changing how you open jars, grip utensils, or position your hands during tasks — in ways that reduce joint load without sacrificing function.

Corticosteroid injection provides targeted anti-inflammatory relief directly into the affected joint. For the thumb basal joint and small finger joints, injection is a reliable short-term treatment that can be repeated as needed. The duration of relief varies — some patients find relief lasting months, others weeks.

Nonsteroidal anti-inflammatory drugs (NSAIDs) — both topical formulations applied directly over the joint and oral medications — reduce inflammation and pain. Topical diclofenac is often preferred for older patients or those with gastrointestinal sensitivity to oral NSAIDs.

Surgical Treatment

Surgery is considered when non-surgical measures no longer provide adequate pain relief and when hand function is significantly impaired.

For thumb basal joint arthritis, the most established procedure is trapeziectomy with ligament reconstruction and tendon interposition (LRTI) — removal of the trapezium bone at the base of the thumb, with reconstruction of the joint using a portion of tendon. This procedure has a long track record of durable pain relief, though recovery takes several months.

For DIP joint arthritis (the end knuckles), fusion in a functional position is the standard surgical treatment. It reliably eliminates pain and is well-tolerated, with minimal loss of overall hand function.

For RA-related joint destruction at the MCP joints, silicone arthroplasty (joint replacement) can restore alignment and improve function. This is a more complex undertaking and is typically managed in coordination with a rheumatologist.

Coordination with Rheumatology

For patients with rheumatoid arthritis or other inflammatory arthritides, medical management with disease-modifying antirheumatic drugs (DMARDs) and biologics is essential and should be managed by a rheumatologist. Surgical intervention, when needed, is planned in coordination with your medical team to ensure that immunosuppressive medications are appropriately managed around the time of surgery.

If you're experiencing pain or stiffness from hand arthritis, the specialists at Maryland Orthopedic Specialists can help. Call (301) 515-0900 or [schedule an appointment online](https://www.mdorthospecialists.com/contact).