Arthritis in fingers is an inflammatory process affecting the metacarpophalangeal, metatarsophalangeal and interphalangeal joints of the extremities. Arthritis is characterized by soreness at the junctions of the phalanges of the fingers at rest and during movement, swelling of the joints, restriction of their mobility and shape change. The diagnosis of arthritis in fingers provides for a comprehensive laboratory and instrumental examination: general and biochemical blood analysis, finger radiography, MRI. Treatment of arthritis in fingers is carried out with the help of drug therapy (antibiotics, chondroprotectors, anti-inflammatory drugs), physiotherapy, massage, therapeutic gymnastics. If necessary, arthroplasty or endoprosthetics can be performed.
ICD 10
M13.8 Other refined arthritics
Meaning
Arthritis in fingers is peripheral arthritis that occurs with inflammatory changes in the small joints of the hands and feet. Most often, finger arthritis is not an independent disease, but acts as a secondary syndrome in the clinic of rheumatic, metabolic, and infectious diseases. At the same time, the metacarpophalangeal and interphalangeal joints of the hands are more often affected. In practical rheumatology, arthritis in fingers is 3-5 times more often diagnosed in women, which is due to their greater employment in manual labor, increased stress on the joints and a high frequency of flexion-extensor movements. Arthritis in fingers can rightfully be attributed to socially significant problems, since the disease often leads to the loss of professional skills, self-service skills and disability.
Causes
Most often, small joints are affected by autoimmune, infectious and allergic processes, metabolic disorders and injuries. Immunocomplex reactions underlie the development of rheumatoid arthritis. The immediate manifestation of the disease can be facilitated by a viral and bacterial infection (influenza, measles, herpes, mumps, hepatitis B, scarlet fever, tonsillitis), a stressful situation, hypothermia, vaccination, physiological hormonal restructuring due to puberty, pregnancy, menopause, etc. The defeat of the finger joints is included in the symptom complex of arthritis in gout (gouty arthritis) and psoriasis (psoriatic arthritis).
Post-traumatic arthritis can be the result of various sports and household injuries (bruises, dislocations of fingers, intra-articular fractures of the fingers of the hand and foot, ruptures of ligaments and tendons, etc.), surgical interventions. Often, arthritis in fingers develops in persons of certain professions engaged in manual labor (hairdressers, jewelers, seamstresses, tailors) and receiving microtrauma of the joints in the process of work. Arthritis of the toes may be associated with increased pressure on the joints with overweight and flat feet. Also, ballet dancers often suffer from this type of disease, which is why arthritis of the toes has been called “ballerinas’ disease”.
Classification
There are primary and secondary arthritis. Depending on the leading cause , primary arthritis in fingers can be :
- infectious;
- exchange;
- rheumatoid;
- post-traumatic.
Secondary lesions of small joints develop against the background of allergic, autoimmune, somatic diseases. Most often, arthritis in fingers proceeds according to the type of oligo- and polyarthritis; in some cases, local inflammation (monoarthritis) develops, for example, risarthritis – arthritis of the first metacarpal joint.
Symptoms of arthritis in fingers
Rheumatoid arthritis
In rheumatoid arthritis, the metacarpophalangeal joints of the index and middle fingers, as well as the wrist and elbow joints, are usually involved in the inflammatory process. At the same time, there is a symmetrical lesion of the joints of the right and left hands. It is possible to develop arthritis of the toes, as well as knee and ankle joints. As a rule, the metacarpophalangeal joint of the 1st finger and distal interphalangeal joints are not affected.
Joint pain in rheumatoid arthritis tends to increase in the second half of the night and in the morning with some weakening in the daytime. The joints look swollen; due to morning stiffness of movements, patients experience a feeling of “tight gloves on their hands.” When walking, pain occurs at the base of the toes; painful callosities form on the plantar surfaces of the distal phalanges.
The mobility of the wrist, metacarpophalangeal and interphalangeal joints decreases sharply: patients suffering from arthritis in fingers can hardly perform everyday household movements. Due to a violation of the blood supply, the skin on the hands becomes thinner, becomes dry; atrophy of the muscles of the hands is noted. The active and prolonged course of rheumatoid arthritis leads to persistent deformation of the fingers of the hands: fusiform swelling, deformities such as “boutonniere” and “swan neck”, ulnar deviation of the fingers with incomplete dislocation in the metacarpophalangeal joints. The main types of deformities of the feet include “fingers in the form of claws”, or hammer-like fingers. When the metatarsal joints are involved in the inflammatory process, valgus deformity of the foot develops.
Psoriatic arthritis
Psoriatic arthritis develops more often in patients with psoriatic manifestations on the skin and scalp. For arthritis in fingers with psoriasis, axial inflammation is characteristic, which is characterized by swelling of all joints, which causes the fingers to acquire a sausage-shaped shape. The skin above the joints has a purplish-bluish hue. As a rule, with psoriatic arthritis, the joints are affected asymmetrically, i.e. on one arm or leg or on different fingers. There is no morning stiffness of movements; mainly, joint flexion is limited.
Gouty arthritis
For gouty arthritis, the most typical lesion of the joint of the first (big) toe, less often of the hand. Clinical symptoms are characterized by gouty attacks – acute, unexpected attacks of unbearable pain, swelling of the joints, local hyperthermia, bright red (purple) skin coloration. The attacks continue for several days, then suddenly subside, but after a while they repeat again. Under the skin of the joints, as well as in the subcutaneous fat of the extremities, yellowish painless nodules with a diameter of 1-2 cm (tofuses) are determined, which are deposits of uric acid salts. During the next gouty attack, tofuses can be opened with the release of a white curd mass.
Diagnostics
Only a competent rheumatologist or arthrologist can correctly determine the etiological form of arthritis in fingers. During the initial examination, attention is drawn to the connection of the onset of arthritis with acute or chronic diseases of the patient, the number and symmetry of joint damage, the presence of deformity, the nature of pain, extra-articular manifestations and other clinical signs. If necessary, the patient should be consulted by a traumatologist, allergist-immunologist. Mandatory diagnostic complex includes:
- radiography of fingers and feet;
- Ultrasound of small joints;
- MRI, CT scan.
Biochemical blood test involves determining the level of uric acid, CRP, fibrinogen, rheumatoid factor, sialic acid, seromucoid, cryoglobulins, CEC, etc. To confirm the diagnosis and etiology of arthritis in fingers, it is important to study the synovial fluid obtained by percutaneous aspiration under the control of ultrasound.
Arthritis in fingers treatment
In the event of rheumatoid, psoriatic, gouty arthritis occurring with the defeat of small and large joints of the extremities, complex pathogenetic and symptomatic treatment is carried out, including medication and physiotherapy methods:
- Gravity blood surgery. Methods of extracorporeal hemocorrection (leukocytapheresis, cryoapheresis, cascade plasma filtration) are used to relieve exacerbation and prolong remission.
- Pharmacotherapy. With arthritis in fingers, a course of nonsteroidal anti-inflammatory drugs, corticosteroids, vasodilators, chondroprotectors, vitamin complexes, etc. is prescribed.
- External therapy. It involves the use of anti-inflammatory ointments, dimexide applications, hand and foot therapeutic baths.
- Physical therapy. At the stage of remission, physiotherapy treatment (paraffin therapy, mud applications, magnetotherapy, diadin therapy, electrophoresis, UVI), massage, therapeutic gymnastics are connected.
In many cases, patients with arthritis of the toes are shown orthosis and wearing orthopedic shoes. With the development of persistent dysfunction and disabling deformities of the finger joints, surgical intervention may be required – arthroplasty or endoprosthetics of the metacarpophalangeal joints, resection of hammer-shaped deformity of the toes, etc.
Prognosis and prevention
The prognosis of the course of arthritis in fingers is ambiguous; it is determined by the characteristics of the primary disease and the severity of local changes in the joints. In the outcome of arthritis in fingers, complete recovery and restoration of all joint functions is possible. In severe or advanced cases, destruction and irreversible deformation of the joints may occur, with their subsequent ankylosing. Preventive measures are similar to the prevention of causally significant diseases and injuries of the fingers and feet.