What is Distal Interphalangeal Arthritis – Symptoms and Treatment
Distal interphalangial (DIP) arthritis is the best known manifestation of psoriatic arthritis of the hand. Psoriatic arthritis is a chronic disease that causes inflammation of the skin as well as joints. It has been found to affect about 5% of the population in the United States of America.
The involvement of DIP joint (first joint in the fingers or toes, from the tip) is a unique feature of psoriatic arthritis. Sometimes, in addition to the joint, the tip of the finger and it’s nail are also known to be significantly involved. As a result, the joint turns hot and red, becomes swollen looking like a sausage and gets very painful; resulting in a condition better known as Heberdens nodes.
As the disease progresses, the affected joints appear to be larger, they become stiff and painful, and most often than not, usually feel worse with prolonged use through the day.
Symptoms of Distal Interphalangial Arthritis
- In the beginning,the bone starts eroding at the margins of the joint and then moves towards the center, dislodging the surfaces of the bone from one another.
- Over a period of time this process of erosion and separation leads to distinctly demarcated bones, pencil and cup appearance, whisker and bone fusion.
- Bone enlargements commonly called Heberdens nodes and Bouchards nodes are very typical of this condition.
- Small mucous cysts may also form at the tips of fingers on the bone.
- Some of them may experience acute inflammatory episodes which eventually lead to ankylosis of some joints.
- Though dislocation of these joints is rare and unusual, they have been reported and recorded in various medical journals.
Up to 60% of osteoarthritis cases are believed to be due to genetic factors. That apart, the incidence in women is found to be greater than in men, particularly common in post menopausal women who are in their 40s. Early diagnosis and treatment usually can prevent joint destruction.
Diagnosis is done with certainty based on the patient’s case history followed by a detailed clinical examination. X-rays and other radiology procedures can be used to confirm the clinical findings. Generally, other imaging techniques like CT scan are not necessary for diagnosing this condition.
In the year 1990, the American college of rheumatology mandated certain criteria for accurately diagnosing DIP arthritis. These criteria were based on the enlargement of hard tissue and degree of joint swelling. The criteria are highly sensitive and accurate for diagnosing hand osteoarthritis compared to other types of arthritis.
Treatment for Distal Interphalangial Arthritis
Treatment usually starts when joint pains begin to first occur. Even this occurs only on heavy use and might require administration of mild anti-inflammatory drugs and analgesics.
Cortisone injections are the option of treatment during the next level of pain management. Here, the injection is given into the finger joint. It is a very powerful anti-inflammatory medicine. Pain relief lasts from several weeks to a few months. Infection from injections is a known risk that one takes with precaution.
Rehabilitation, Occupational therapy, use of assisting devices, stretching exercises and dietary supplements like glucosamine and chondroitin sulfate have proven to be beneficial in treating mild to moderate forms of the disease.
Fusion (Arthodesis) of a joint eliminates pain by allowing the bones that have been operated upon, to grow or to fuse into a single solid bone. This is a more reliable and easier method than joint replacement, where one to trying to save the mobility of the joint.
Arthoplasty is a procedure for replacement of affected joints with artificial finger joints.These are plastic or metal prostheses used by surgeons to replace the joint. This forms a new hinge, thus enabling free motion and also pain relief. Proper rehabilitation after surgery is a must.