Arthritis of thumb a pain, but correctable

By DAVID BEARD

Special to The Capital-Journal

Painful arthritis at the base of the thumb is common in many people and usually increases as we age. The most commonly affected joints in the hand are the joints of the fingers and the base of the thumb.

Painful arthritis of the thumb can be limiting to one's lifestyle and affect one's ability to work around the home and enjoy recreational endeavors.

Arthritis is the disruption of the normal cartilage structure and function in any joint which can lead to pain and limitation of function.

Patients with thumb arthritis have pain at the base of their thumb and fat pad of their thumb when pinching, gripping, opening jars and lids and turning keys.

Patients can exhibit some swelling at the base of their thumb. This is usually found in the later stages of osteoarthritis.

Initial treatment options are directed at non-operative methods. These consist of modifying activities to avoid those activities that cause the most discomfort.

Soft and firm splints can be used to immobilize the base of the thumb as needed for painful activities. Oral nonsteroidal anti- inflammatory agents can be utilized to decrease inflammation and discomfort.

An injection of cortisone into the joint can also be helpful, but is attempted after a trial of nonsteroidal anti-inflammatory medication and splinting.

New on the market are the "cartilage pills." These consist of glucosamine and chondroitin sulfate. Multiple studies have been done concerning the use of glucosamine and chondroitin sulfate for the treatment of osteoarthritis.

Results have been mixed, and better studies need to be done. The thought behind the "cartilage pills" is they replace and rebuild the components of the cartilage and the joint fluid.

At this point research has been mainly focused on large joints of the body, specifically the knee and the hip. Time will tell if these pills are effective in treating arthritis at those joints and prolonging its onset.

Ways may be found in the future that gene screening can be done at an early age and treatment for arthritis begun early or even gene therapy may be available in the future.

This might seem outlandish at this point, but medical research and arthritis research are moving forward at a tremendous pace. Drug companies are already utilizing genes and knowledge of genes to produce medications directed at specific diseases.

Surgical options for the treatment of painful arthritis of the thumb are available, depending on the severity of the disease.

In the early stages of the disease, treatment options vary. In patients who have mild symptoms, looseness of the thumb joint on examination and absent to minimal arthritis changes, a ligament reconstruction to tighten up the joint can be done to increase patient comfort and function.

In several studies it has been noted this might delay the onset of arthritis. Other operative options for more advanced arthritis of the base of the thumb joint are a soft tissue interposition arthroplasty (joint replacement). This is not like the metal and plastic joint replacement that occurs at the knee, hip, elbows and shoulders.

Pain relief is usually quite dramatic after this operation, and function increases.

A thumb fusion at the site of arthritis can be done in people who wish not to have interposition arthroplasty. This allows for the painful arthritic joint to be fused and to diminish base of thumb discomfort and increase function.

Loss of motion occurs at the fused joint, but patients remain functional.

David Beard is a Topeka orthopedic surgeon.

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