Heberden’s osteoarthritis is characterized by painful hand and finger joints with nodule formation. Stiff fingers, swelling and pain are defining features of the condition, which is usually chronic.
What is Heberden’s osteoarthritis?
Schematic diagram difference between healthy joint, arthritis and osteoarthritis. Click to enlarge. Heberden osteoarthritis belongs to the group of forms known as degenerative joint disease, which affects the hands and fingers. Because this form of joint disease occurs as polyarthrosis, both hands and all fingers are usually affected to varying degrees. Heberden’s arthrosis is an inflammatory cartilage disease that progresses chronically. The rheumatic disease is named after the physician William Heberden, who lived in England from 1710 to 1801. It is mistakenly assumed that Heberden’s arthrosis is purely a symptom of old age, but this is not the case, although the disease occurs more frequently after the age of 50. The wear and tear in the finger joints can already be detected in many a thirty-year-old. In the case of arthritic changes in the large joints, both sexes are affected equally in percentage terms, but not so in the case of Heberden’s arthrosis, because women are statistically ten times more likely to be affected by this particular form of finger joint arthrosis. Like other arthritis diseases, Heberden’s arthrosis also develops gradually.
Causes
Finger polyarthrosis is a so-called idiopathic clinical picture, so no definite cause has been found to date. However, there is concrete evidence that genetic disposition is a decisive factor in the onset of the disease. In addition, the risk of the disease increases after the age of 50. After the end of menstruation, postmenopause, women are frequently affected by Heberden’s arthrosis. It has been found that Heberden’s arthrosis is caused by a defect in the cartilage layer of the finger joints. Skin and hair grow back, but damaged cartilage structures do not in adulthood. In addition, cartilage damage can only be repaired poorly or not at all with increasing age. On the basis of this cartilage wear and tear, the typical clinical picture of Heberden’s arthrosis develops over time as a result of inflammatory changes. In most cases, the finger middle and finger end joints of both hands are affected; likewise, the thumb saddle joint as well as, in the wrist, the connections between ulna and radius or scaphoid and radius can be affected by Heberden’s arthrosis.
Symptoms, complaints and signs
Heberden’s arthritis takes a gradual course. Often, there are no symptoms at first, which is why the disease usually goes unnoticed for a long time. As the disease progresses, increasingly severe pain occurs that can radiate from the hand to the fingers. The fingers feel stiff and tend to swell. The complaints initially occur only during movements and eventually persist even at rest. The mobility of the fingers is increasingly reduced, often affecting only individual fingers or certain areas of the hand. Joint swelling, redness and overheating may occur in phases. If the finger end joints are involved, cystic thickenings develop on the fingers, from which gelatinous fluid may leak. In the later stages, bony thickening may occur on the right and left sides of the joints, often also associated with severe pain. If Heberden’s arthrosis is not treated early, it can lead to further discomfort and complications. Typically, joint wear and tear sets in after several months to years, manifested by severe pain and restricted movement. In advanced stages, the affected hand can no longer be moved or can only be moved with severe pain.
Diagnosis and progression
Diagnosis and progression of finger joint osteoarthritis are directly related to early or late symptoms. A medical diagnosis should be made as early as possible in order to initiate adequate treatment promptly and thus slow the progression of the disease process. However, Heberden’s arthrosis is not considered curable. In most cases, the diagnosis can be made by a general practitioner or rheumatologist on the basis of the clinical symptoms. Typical early symptoms include fatigue pain, pain on exertion, and radiating pain.If no treatment is given, the clinical picture solidifies over time and leads to constant pain, restricted mobility, with pronounced sensitivity to the weather and night pain. The anamnesis and the visual diagnosis of the typical nodules allow in many cases a diagnosis that can be corroborated together with the clinical symptoms and imaging techniques. The conventional radiograph of the hands is still considered the “gold standard” for the reliable diagnosis of Heberden’s arthrosis. Particularly in the late stages of the disease, so-called sclerosis, joint space narrowing and osteophytes can be detected in the X-ray image. The course of the disease is usually insidious, progressive-chronic.
Complications
Due to Heberden’s osteoarthritis, the patient suffers from severe pain in the hands and joints in most cases. In the process, this pain leads to severe restrictions in movement and everyday life in most patients, and thus to a reduction in the quality of life. The joints of the fingers usually become stiff and pain occurs. The pain can also occur in the form of pain at rest and thus lead to sleep problems for the patient. Knots also form on the joints of the fingers. The patient’s ability to cope with stress decreases extremely due to this pain and in many cases the affected person withdraws from life. Diagnosis of Heberden’s arthrosis is relatively simple by means of an X-ray, so that treatment can begin at an early stage. In many cases, however, the symptoms are ignored at first if the pain is not particularly severe. However, it is not possible to treat Heberden’s arthrosis causally. For this reason, the pain and movement restrictions that occur as a result of this disease are treated first and foremost. This does not lead to further complications. Surgical intervention is also usually possible.
When should you go to the doctor?
Since in Heberden’s arthrosis there is a significant worsening of symptoms and no self-healing, this disease must be examined and treated by a doctor in any case. As a rule, a doctor should be consulted if the affected person suffers from very stiff finger joints. These can no longer be moved easily, so that there are severe restrictions in the daily life of the affected person. Severe pain in the fingers themselves can also occur and also indicate Heberden’s arthrosis. This pain also spreads to the hand. Small nodules often form on the finger joints, which are also a symptom of Heberden’s arthrosis and should be examined. Frequently, those affected also suffer from sensitivity to the weather or from pain at night, which can also have a negative effect on the patient’s psyche. The diagnosis of the disease can be made by a general practitioner or by an orthopedist. Further treatment depends on the patient’s condition and is usually performed by various exercises or by cortisone injections.
Treatment and therapy
A causal, i.e., cause-related, therapy of Heberden’s arthrosis is not possible; all available therapeutic measures are aimed at enabling the patient to live as pain-free a life as possible and at promoting the preservation of the mobility of the finger joints as best as possible. The focus of the therapeutic measures is therefore, in addition to the constant improvement of the symptoms and the complaints, a delay of the progression. The pain symptoms are mainly caused by inflammatory processes at the degenerative cartilage changes. Accordingly, a reduction of the pain symptoms can be achieved by the high-dose administration of anti-inflammatory drugs. So-called non-steroidal anti-inflammatory drugs such as ibuprofen, acetylsalicylic acid or paracetamol are used. In severe cases, cortisone can also be used to reduce inflammation. Because of the considerable side effects, continuous oral medication with cortisone is now only indicated in exceptional cases. In addition, high doses of glucocorticoids can be injected directly into affected finger joints. However, the use of these and other pharmaceuticals should be limited to periods of inflammation and pain. In addition to these drugs, physical therapy with mud packs or exercise treatments is an important pillar of treatment. The last option is stiffening surgery of the finger end joints.
Outlook and prognosis
Osteoarthritis is generally considered incurable. Only in children can the articular cartilage regenerate. The disease progresses continuously in all other cases. Therapy can only delay the development. The prognosis can therefore be described as mixed. Patients do not have to suffer pain, however, thanks to appropriate care. If osteoarthritis is not treated at all, it quickly progresses to loss of motor skills. Women suffer from Heberden’s arthrosis excessively often after menopause. Compared to men of the same age, their risk is ten times higher. They form the largest group in relation to all sufferers. Statistically, just under 200 out of every 100,000 women are afflicted by arthrosis. In the final stage, severe movement restrictions of the hands are typical. A loss of strength makes everyday hand movements difficult. Women and men are often dependent on help in the household. Affected persons alleviate the known complaints via general measures, pharmacological treatment and physiotherapy. Physiotherapy in particular proves to be extremely effective. General measures include orthopedic aids. The consumption of foods containing omega 3 fatty acids has also proven effective.
Prevention
No specific prevention of Heberden’s osteoarthritis exists. Nor has it been demonstrated that diet or the performance of specific occupational activities could have any influence on the pathogenesis or onset of Heberden’s arthrosis. In cases of genetic predisposition or clustered familial occurrence of Heberden’s arthrosis, diagnosis should be made as early as possible to delay the chronic course of the disease as long as possible by appropriate therapeutic measures.
Follow-up
In Heberden’s arthrosis, some aftercare measures are available to the affected person. First and foremost, early detection and treatment of this disease is important to prevent further complications or discomfort. Even at the first symptoms and signs of Heberden’s arthrosis, a doctor should be consulted in order to prevent further complications or a further worsening of the symptoms. In this disease, self-healing cannot occur. The treatment is carried out by taking medications. Sufferers are primarily dependent on regular intake and also on the correct dosage of the medication so that the symptoms can be properly alleviated. In the event of side effects or interactions, a doctor should always be consulted first. Likewise, physiotherapy is often necessary to treat Heberden’s arthritis. Many of the exercises from such therapy can also be performed in the patient’s own home, thereby alleviating the symptoms. Patients are often dependent on the help and support of their own family and friends. Above all, psychological upsets or depression are prevented or alleviated. The patient’s life expectancy is usually not reduced by Heberden’s osteoarthritis.
What you can do yourself
Regular exercise helps to strengthen the finger joints and maintain their mobility in cases of Heberden’s arthritis. Squeezing a softball has proven particularly effective; range-of-motion exercises performed in water are also very effective and are usually found to be pleasant. Warm baths with the addition of hay flowers or mud substances are also beneficial. Acute arthritis attacks characterized by inflammatory symptoms, on the other hand, should be treated with cold applications in the form of ice packs or cold quark compresses. In addition, pain and inflammation therapy under medical supervision is usually necessary, and herbal medications can be used to support this. The root of the devil’s claw, which has an analgesic and anti-inflammatory effect, should be mentioned here in particular; preparations of nettle, willow bark and arnica can also alleviate the symptoms. Taking a few precautions in everyday life can reduce the force exerted on the finger joints and counteract any deterioration. Heavy loads should never be carried on one side and not with fingers extended. When wringing out wet laundry, it is advisable to use a wringing aid; when hanging up laundry, clip-on clothespins without spring tension are preferable to conventional clothespins.Craftsmen should prefer large tools that allow the hand to remain wide open during use. If the mobility of the fingers is already severely limited, aids such as electric can openers, special bottle openers and pen holders make everyday life easier.