FINGER SWELLING PART 1 – COMMON CHRONIC CAUSES

When I sat down to write this blog, I thought it would be short and sweet. But, the more I wrote the longer it got! So it will be appearing in a few segments.

As a Rheumatologist in practice for 33 years I have seen a lot of swollen hands. Some causes are long-term and permanent, others are acute and reversible. Whatever the underlying cause, in addition to pain and stiffness the swelling often causes emotional upset (“my hands look ugly”, “I cant wear my rings”, “it hurts to shake hands” etc).

OSTEOARTHRITIS (OA) is the commonest form of arthritis world-wide. In its familial form it affects the hands, spine, hips, knees and feet. It is associated with bony swelling of the joints of the fingers which can make daily tasks difficult. When the arthritis is developing there is often pain in the joints. Sometimes the joints swell more due to episodes of crystal shedding (called pseudogout) – this is very painful and the joints become hot and red. This form of arthritis develops over years to decades. As yet there is no therapy to prevent progression of OA.

RHEUMATOID ARTHRITIS (RA) is auto-immune (meaning the immune system turns inwards and attacks self) and affects around 2% of people world-wide. It usually starts in the hands and feet and moves centrally to involve more joints. Typically it is a symmetrical arthritis – meaning that the joints affected on either side of the body are identical mirror images. At onset the swelling is soft – in the joint lining and with fluid accumulation in the joint space. This is painful and often causes stiffness in the morning and after rest. If left untreated the swelling progresses to joint destruction and bony change that is irreversible. There are many therapies available to treat RA and to prevent progression. The earlier it is treated the better the outcome.

PSORIATIC ARTHRITIS (PsA) is another auto-immune arthritis that can take a number of forms. It is rarer than RA -affecting around 0.4% of people world-wide- and associated with the skin rash Psoriasis. It is often asymmetrical - affecting different joints on different sides of the body. The symptoms of PsA are very similar to RA and the two may get confused. As with RA there are now very effective therapies to control it and prevent progression and chronicity.

SYSTEMIC LUPUS ERTYHEMATOSUS (SLE) is a rare autoimmune condition that affects up to 0.2% of the population – mostly young women. Common symptoms include arthritis and skin rash. Hand joints are often involved. It may be challenging to diagnose and treat. Apart from arthritis there may be internal organ inflammation that needs to be evaluated and treated. There are many established therapies for the treatment of SLE and many evolving over the last decade.

This is a very short list to highlight potential causes of joint swelling in the hands. As you can see it is never “just arthritis” and every case needs individual attention so a firm diagnosis and proper treatment can be started.