How is arthritis diagnosed in a young female with aching finger joints?

Presentation of finger joint pains on exertion and repetitive movements in a young patient is getting more common. A full assessment has to be made to rule out the causes of joint pain:

• Full history, including family history of arthritis and autoimmune disorders,
• a detailed clinical examination,
• X-rays,
• other imaging modalities such as ultrasound or MRI scans,
• blood tests to screen for gout,
• autoimmune disorders and
• chronic inflammatory conditions.

It will be ordered accordingly based on the clinical judgment of the doctor. The treatment will then depend on the findings of these tests and investigations.

More frequently, I encounter young patients who suffer from repetitive strain injury in their hands due to chronic overuse of:

• the computer,
• mobile devices and
• gaming consoles.

It is noteworthy that repetitive strain injury is a diagnosis of exclusion, once the doctor has eliminated the rest of the causes of joint pain.

Treatment options may range from:

• simple rest,
• splinting,
• oral medication and supplementation,
• hand occupational therapy and
• invasive treatments such as injections and surgery.

For repetitive strain injuries, ergonomic work station re-organization and hand occupational therapy sessions are the mainstay of effective treatment.

The pain in the thenar eminence which is aggravated by movement may be arising from the underlying muscle, tendon, joint or bone. The cyst in the thumb may or may not be related to this. It may be a good consideration to seek an opinion from a hand and wrist specialist to address all of the problems listed above.

The aches and pain in your hand may not be entirely due to just "overuse". Arthritis means inflammation in the joints, typically we classified into 4 categories:

1. "Normal" wear and tear/ Aging (For e.g Osteoarthritis, Spondylosis) - these happens in every person, when you age, there will be more wear and tear, althought not everyone will have pain. It is very similar to a car, when the mileage hits a certain number, there is bound to be some wear and tear in the tyres.

2. Post traumatic/ post injury arthritis - if you sustain a bad accident to the joint (for eg, intra-articular fracture, ligament rupture), the chances of post traumatic arthritis is much higher than normal because the smooth surface of the joint is being damaged directly. Again, you can draw parallelism to a car being involved in a accident and sustained significant damages to the moving mechanism.

3. Crystals arthropathy (For e.g, Uric Acid/ Gout) - Arthritis happens when uric acid crystals are being deposited in the joints (you can imagine that some pebbles are being found in your car engines, how great the damage will be!) Uric Acids appeared in the form of Purines and are abundant in our normal daily diets, and these purines will then be converted to uric acids in our bodies. The uric acids are deposited in the joints usually when we over-consumed foods high in purine content (typically after Chinese New Year Reunion Dinners!), or when some individuals cannot handle/ process uric acids effectively.

4. Auto-immune related (for e.g, Rheumatoid Arthritis) - this is the most worrying/ severe form of arthritis in which your body's own immune system mistaken your own joints/ other organs to be an "enemy" and starts to launch attacks to your own joints/ other organs. It typically affects women much more often than men. The diagnosis of rheumatoid arthritis is quite complicated and involves blood tests/ physical examination and clinical history taking.

Because you are so young, the normal "wear and tear/ aging" arthritis should not happen to you, and if you did not have any major injuries to the hand, post traumatic arthritis do not apply to you as well. Gout tends to happen in the middle aged and tends to affects the legs much more often than the hands.

Hence I'd strongly suggest you to go to a Orthopaedic Surgeon for a check up first, we will perform quick screening X rays and some blood tests. If you are really suffering from autoimmune related arthritis, you will be referred to the Rheumatologists for further follow up and the medical treatment. Corrective orthopaedic surgeries are usually not needed in the early stages of the rheumatoid arthritis and they can be very well controlled with medication from the Rheumatologists.

Hope that clear some doubts for you.

Cheers,

Dr. Henry Chan

Consultant Orthopaedic Surgeon

Dr Henry has already provided an excellent summary to the different types of arthritis that can occur.

Just wanted to add that the cyst could be a simple ganglion from your computer use. Sometimes with excessive pressure, these can develop and the easiest way to manage them is simply to modify your activities.

You can certainly see a surgical colleague, but an alternative might be to see a primary care physician for a general assessment, including blood tests etc., before seeing a rheumatologist or MSK/Sports physician. Most of them will be able to look through your blood results and provide a same day ultrasound scan of your hands +/- treatments.

Hope things improve soon. Bw

Dr Dinesh