"It's just age, nothing can be done." That remains the most frequent statement heard in clinic about finger osteoarthritis, and it is the least accurate. Osteoarthritis is not inevitable mechanical wear, and most patients are relieved without ever needing surgery. This article covers the finger joints, particularly the distal interphalangeal joints at the fingertip. The thumb base, which follows a different logic, is covered in detail on the thumb base arthritis page.
A disease of the whole joint, not worn-out cartilage
The image of cartilage wearing down like a shoe sole is outdated. Osteoarthritis combines cartilage degradation, a reaction of the underlying bone, and inflammation of the synovial membrane lining the joint. These three feed one another, and it is the local inflammatory component that explains painful flares, swelling and the cyclical course of the disease.
The causes are multiple and go well beyond age. Inserm notes that osteoarthritis affects 3% of people under 45, 65% of those over 65 and 80% of those over 80, and that it is promoted by metabolic disorders — diabetes and obesity in particular — as much as by mechanical load. In the hand, two further factors are decisive: a strong familial predisposition, and a hormonal component, with onset clustering in women around the menopause.
Which fingers, and why it shows
In the Osteoarthritis Initiative cohort of 3,588 participants, radiographic hand osteoarthritis was present in 41.4% of people, but symptomatic disease in only 12.4%. The gap matters: seeing osteoarthritis on an X-ray does not mean being in pain, and a patient's pain is not judged from their films.
The distal interphalangeal joints are most often affected, ahead of the thumb base, with the proximal interphalangeal joints last. Distal involvement is more frequent in women, and incidence peaks between 55 and 64. The bony outgrowths that deform the finger are named by site: Heberden's nodes at the fingertip joint, Bouchard's nodes at the middle joint.
One key pointer: the metacarpophalangeal joints at the base of the fingers, and the wrist, are usually spared by primary osteoarthritis. Involvement there should prompt a search for something else — inflammatory arthritis, post-traumatic damage, or a metabolic disease such as haemochromatosis. Finger osteoarthritis does, however, cluster with carpal tunnel syndrome and trigger finger, as detailed in the update on peritrapezial conditions.
{{FIGURE_1}}The erosive form, the one not to miss
There is a more aggressive variant, erosive interphalangeal osteoarthritis. Its prevalence is estimated at 2.8% of adults over 55, roughly one in ten of those with symptomatic hand osteoarthritis; the Framingham study reports 9.9% in women against 3.3% in men.
It stands out through frankly inflammatory flares, red and swollen joints, visible bone destruction on X-ray, and a functional burden comparable to inflammatory arthritis. The presence of erosive joints is also the strongest predictor of radiographic progression. This is the form that warrants a rheumatology opinion, because it is readily mistaken for early rheumatoid arthritis.
Diagnosis rests on examination and X-ray
It is usually clinical: where the pain sits, palpable nodes, deformity, loss of grip strength, difficulty opening a jar or turning a key. Hand X-rays confirm the diagnosis and stage it. No blood test is needed to establish osteoarthritis: inflammatory markers are normal, and they are requested only to rule out inflammatory arthritis when there is doubt.
Four features should call the diagnosis into question: morning stiffness lasting more than thirty minutes, soft warm swelling rather than a hard lump, involvement of the joints at the base of the fingers, and personal or family psoriasis.
One manifestation deserves to be known, as it often brings patients straight to the surgeon: the mucous cyst. This small translucent swelling on the back of the last joint is a consequence of distal osteoarthritis. It frequently deforms the nail with a longitudinal groove, which resolves once the cause is treated.
Medical treatment, and it always comes first
The 2018 European recommendations for hand osteoarthritis are clear and ranked. They rest first on non-drug measures offered to every patient: information about the disease, training in ergonomic principles, activity pacing and adaptation, assistive devices for forceful tasks, and above all exercises targeting function and muscle strength.
Orthoses are recommended primarily for the thumb base, with a benefit maintained over the long term. For the fingers, small night orthoses can relieve a joint in flare.
As for drugs, the rule is to prefer topical over systemic routes for safety reasons. Topical anti-inflammatory gels are the first-line pharmacological treatment. Oral anti-inflammatories should be considered only for a limited duration. Chondroitin sulfate may be used for pain and function. Corticosteroid injections are not routinely recommended in hand osteoarthritis, but may be considered for a particularly painful interphalangeal joint. Finally, disease-modifying antirheumatic drugs, conventional and biological alike, are explicitly discouraged: they have not proved effective in this indication.
{{FIGURE_2}}What surgery can offer, and when
It applies to established structural damage after other treatments have failed — never as a first step. For a very painful or deformed distal interphalangeal joint, surgically fusing the joint durably removes the pain, at the cost of movement that this joint barely used. A mucous cyst is treated by a simple procedure addressing both the cyst and its cause. Return-to-activity timescales after these procedures are covered in the update on sick leave. For the thumb base, the options are more numerous and detailed on the dedicated page.
Seeing a hand surgeon is justified for pain resisting several months of well-conducted treatment, deformity interfering with daily tasks, a mucous cyst, or diagnostic doubt. In every other case, the rheumatologist and the general practitioner remain the right people to consult.
