Arthritis of the fingers
The content of the article:
- Causes and risk factors
- Forms
- Stages
- Symptoms of finger arthritis
- Features of the course of arthritis of fingers in children
- Diagnostics
- Finger Arthritis Treatment
- Possible complications and consequences
- Forecast
- Prevention
Finger arthritis is one of the most common forms of peripheral arthritis, in which the metacarpophalangeal and interphalangeal joints are inflamed. The inner synovial membrane of the joint becomes inflamed first, then the pathological process spreads to the joint capsule, cartilage, tendons, ligaments, muscles and bones.
Arthritis of the fingers is an inflammatory process localized in the metacarpophalangeal and interphalangeal joints
Causes and risk factors
The primary inflammatory process usually develops against the background of infection, rheumatic or metabolic pathology, less often on the basis of trauma or surgery. In the case of rheumatoid arthritis, hereditary predisposition plays an important role.
Secondary arthritis of small joints, as a rule, is a complication of allergic, atopic and autoimmune conditions, common infectious or an underlying medical condition such as gout, diabetes mellitus or psoriasis. In the pathogenesis of reactive arthritis, a leading role is played by a history of tuberculosis, dysentery, hepatitis, granulomatosis, influenza, measles, mumps, scarlet fever, tonsillitis and chronic tonsillitis, borreliosis, Reiter's syndrome and sexually transmitted diseases. In children, vaccination can play a role of a provoking factor.
The likelihood of an inflammatory process in the joints of the fingers increases with frequent microtrauma of the articular structures during manual labor. The disease is common among tailors, seamstresses, shoemakers, watchmakers, and jewelers.
Exacerbations of chronic arthritis of the fingers can be triggered by hypothermia, dampness or change in weather, vibration, stressful situations and changes in the hormonal status of the body. Since fluctuations in hormonal levels are more common in women, the incidence of finger arthritis among them is 3–5 times higher than among men. Arterial hypertension, old age, poor diet, bad habits and diseases of the excretory system also increase the likelihood of arthritis.
Forms
Arthritis of the fingers is characterized by a variety of manifestations that influence the choice of therapeutic strategies and medications. Depending on the nature of the course of the disease, acute and chronic forms of arthritis are distinguished, and in the course of identifying the main etiological factors, they differentiate primary arthritis of the fingers as an independent nosological form and secondary arthritis of the fingers as a symptom complex in the clinic of concomitant infectious, rheumatic and metabolic diseases. It should be noted that secondary arthritis of the fingers is much more common than an independent disease.
With polyarthritis of the fingers, 4 or more joints are involved in the pathological process
Based on the number of affected joints, polyarthritis and oligoarthritis of the fingers are distinguished: in the first case, four or more small joints are involved in the inflammatory process, in the second - from two to four. Monoarthritis is extremely rare; of these, the most common is rhizarthritis - inflammation of the first metacarpal-carpal joint.
Stages
Finger arthritis is a rapidly progressive disease. Depending on the degree of joint damage, four stages of the pathological process are distinguished.
- In the absence of clinical symptoms, x-rays of the hand show early signs of inflammation. Periodically there is a slight stiffness of movements.
- As the inflammatory process develops, exudate accumulates in the joint capsule, destroying the articular structures. In the area of the affected joints, swelling, swelling and redness appear; the local temperature may be increased, the movement of the fingers is difficult and accompanied by severe pain and severe crepitus. Due to a violation of the blood supply, the skin of the hand becomes dry, cold and thin.
- The progressive destruction of the joints leads to severe deformities of the fingers and constant severe pain in the hands; due to limited mobility of the hand, muscle atrophy and tendon contractures are observed.
- Ankylosis of the articular heads of the bones manifests itself in irreversible deformation of the joints and complete immobilization of the fingers, as a result of which the patient loses the ability to perform elementary everyday activities.
Arthritis stages
Symptoms of finger arthritis
The clinical picture of finger arthritis is highly variable and depends on the etiological form and stage of the disease. The early stage of rheumatoid arthritis is characterized by joint stiffness in the morning and after prolonged rest. At the same time, there is a characteristic feeling of tight gloves limiting the mobility of the hand. In some cases, the patient may not have any complaints at all, and the only manifestations of the disease are early radiological signs of arthritis of the fingers:
- thickening and hardening of soft tissues;
- slight narrowing of individual inter-articular fissures;
- periarticular osteoporosis;
- single cystic enlightenments in bone tissue;
- roughness and erosion on the articular heads of the bones.
Typical signs of inflammation of the joints of the fingers, as a rule, are observed at stage II of the disease, starting with the appearance of painful swelling, erythema and crepitus in the affected joints, and multiple narrowing of the inter-articular fissures, cyst-like enlightenment of the bone tissue and marginal deformities of the epiphyses of the bones are added to the radiological signs. Dislocations, subluxations and ankylosis of the joints are detected mainly in the terminal stages of the disease.
Arthritic hands
The localization of the inflammatory process and the nature of joint deformities are also of great diagnostic value. In rheumatoid arthritis, the first signs of inflammation involve the second and third metacarpophalangeal joints and the third proximal interphalangeal joint. Later, the pathological process spreads to the distal interphalangeal joints, and then to the osteoarticular structures of the wrist, as well as the styloid process of the ulna. Joint damage is usually symmetrical. In the late stages of the disease, characteristic deformities of the hand are observed: curvature of the fingers like "boutonniere" or "swan neck", fusiform hand and ulnar deformities caused by partial dislocations of the metacarpophalangeal joints.
In the case of reactive and psoriatic arthritis, the joints are affected asymmetrically. The psoriatic form is characterized by thickening of the joints and sausage-shaped fingers. Morning stiffness of movements, as a rule, is not observed; mainly limited functions of flexion.
In the reactive form of arthritis, inflammation of the joints of the fingers proceeds against a background of fever, chills, headache, conjunctivitis and symptoms of infectious inflammation of the urinary tract.
With gouty arthritis, the metacarpophalangeal joint of the thumb is mainly affected, in the area of which elastic subcutaneous tophus nodules filled with urate crystals are formed.
Features of the course of arthritis of fingers in children
In childhood, infectious and reactive arthritis is more often diagnosed, most often developing against the background of streptococcal infection. The clinical picture of finger arthritis in children is more pronounced than in adults: severe pain and severe deformities of the joints are accompanied by severe fever and general intoxication of the body.
In children, arthritis of the fingers can develop against the background of streptococcal infection
Rheumatoid arthritis in children is characterized by a persistent course and a poor response to therapy. Inflammation of the joints of the fingers usually develops against the background of damage to large joints and internal organs. If it is not possible to detect the etiological factor of inflammation of the finger joints in a child, a diagnosis of juvenile idiopathic arthritis is made.
Diagnostics
A vivid clinical picture of the inflammatory process in the joints of the fingers makes it possible to diagnose arthritis with a high degree of confidence, however, to clarify the etiological form and stage of the disease, it will be necessary to undergo a number of additional diagnostic procedures.
In the course of collecting anamnesis, the doctor draws attention to the connection between the manifestations of arthritis with previous infectious diseases, metabolic and somatic pathologies, as well as with the influence of damaging factors. During physical examination, the size, shape and temperature of the joints, the color of the skin, the nature of painful sensations, functional tests, the presence of extra-articular manifestations, etc., become a valuable source of diagnostic information. Sometimes, consultations of other specialists - an orthopedic traumatologist, dermatologist and allergist-immunologist - are necessary. Identification of characteristic changes in the joints of the fingers requires the use of instrumental techniques - radiography, MRI and CT of the hands, ultrasound of small joints.
Arthritis of the fingers on the X-ray
Laboratory diagnosis plays a crucial role in determining the cause of the inflammatory response. A complete blood count reliably reveals signs of an inflammatory process. In the course of a biochemical blood test, the level of uric and sialic acid is determined, which allows to confirm or exclude the diagnosis of gouty arthritis. High rates of rheumatoid factor and C-reactive protein, fibrinogen, seromucoid, cryoglobulins, etc. indicate rheumatoid pathology. In some cases, a laboratory study of synovial fluid punctate is shown.
Finger Arthritis Treatment
The medical strategy for finger arthritis is based on a combination of pathogenetic and symptomatic approaches. During the acute phase of the disease, the main goal is to eliminate inflammation and pain. In the early stages, a course of analgesics, muscle relaxants, nonsteroidal anti-inflammatory drugs is usually sufficient, and in some cases it is possible to do with the external use of ointments containing cyclooxygenase-1 (COX-1) blockers, pain relievers and vasodilators. For infectious and reactive arthritis, antibiotics are included in the treatment regimen; in the presence of an allergic component - antihistamines, and in case of rheumatoid arthritis - immunosuppressants and immunomodulators.
Anti-inflammatory drugs are included in the treatment of finger arthritis
In more severe forms of arthritis, it may be necessary to evacuate exudate from the articular cavity, followed by the administration of corticosteroids with a 1% solution of lidocaine or novocaine. Rapid relief is brought by hemocorrection performed by an extracorporeal method - cryoapheresis, leukocytapheresis or cascade filtration of blood plasma.
After achieving remission, the therapeutic strategy focuses on the normalization of trophism and local metabolism in the area of the affected joints, stimulation of regeneration processes in the articular structures and restoration of hand functions. The individually tailored combinations of physiotherapy and exercise therapy accelerate the patient's rehabilitation, helping to return to an active lifestyle as soon as possible.
In the treatment of arthritis of the fingers, the following physiotherapy procedures give a good effect:
- electrophoresis and phonophoresis;
- UHF;
- magnetotherapy;
- treatment with sinusoidal modulated currents;
- diadynamic therapy;
- applications of Dimexidum and bischofite;
- balneotherapy;
- therapeutic massage of the hands;
- paraffin and mud baths for hands.
In case of persistent deformities of the joints, conservative treatment is ineffective. In order to prevent disability of the patient, arthroplasty or endoprosthetics is recommended.
Dieting for arthritis of the fingers helps to prolong remission. During exacerbations, it is necessary to refrain from protein foods - meat products and legumes, as well as salty, fried, fatty and spicy foods, chocolate, muffins, strong tea, coffee, cocoa and alcoholic beverages. After stopping the inflammatory process, food restrictions become less - it is enough to avoid alcohol and limit the consumption of meat, smoked meats and heavy meals rich in saturated fats and instant carbohydrates.
With arthritis of the fingers, therapeutic exercises are indicated
With gouty arthritis, red meat, offal and smoked meats are also strongly contraindicated. A dairy-vegetarian diet is preferred, with the exception of vegetables and fruits containing solanine. Eggplants, tomatoes, pumpkin, green onions, sorrel, rhubarb and hot peppers should be eaten as little as possible.
The patient's diet must contain foods with a high content of polyunsaturated fatty acids, easily digestible protein and vitamin C:
- fatty sea fish (tuna, sardines, salmon);
- buckwheat, oatmeal, rice and millet porridge;
- lean poultry;
- dairy products;
- fresh apples, apricots and peaches;
- citrus fruits, kiwi and papaya;
- nuts and seeds;
- garlic;
- turmeric;
- ginger root.
Possible complications and consequences
In acute infectious arthritis of the fingers, in the absence of adequate treatment, the risk of developing purulent-septic complications that threaten the patient's life increases. A protracted course of the disease threatens to result in irreversible deformation of the joints of the fingers, which leads to the patient's disability. The most dangerous complications of finger arthritis include osteomyelitis, osteolysis, and bone necrosis, often followed by generalized sepsis.
Severe side effects of long-term use of non-steroidal anti-inflammatory drugs have also been reported. In some patients who received COX-1 inhibitors in injectable and oral form for a long time, cases of gastroduodenitis, enterocolitis and peptic ulcer disease were observed due to regular irritation of the mucous membranes of the gastrointestinal tract; nephropathies were somewhat less common.
Forecast
The outcome of finger arthritis depends on the nature of the primary manifestations and etiological form, response to therapy, the patient's age at the time of onset of the disease, as well as on the presence and severity of concomitant pathologies. Early diagnosis and early treatment increases the chances of recovery.
Prevention
In order to prevent arthritis of the fingers, it is necessary to monitor the state of health in general and consult a doctor in a timely manner if signs of infection, metabolic disorders and other pathologies appear. It is especially important to prevent the formation of chronic foci of infection, give up alcohol and control nutrition. Moderation in food with a sufficient amount of vitamins and minerals in the diet reduces the likelihood of arthritis and gout, in particular, you should not abuse heavy meat and fatty foods. An active lifestyle, exercise and hardening can improve the condition of the joints, however, injuries and hypothermia of the hands should be avoided. With frequent manual labor, it is recommended to pause every 2-3 hours and do finger exercises.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
