Treatment of Obese Woman With Hand OA (Osteoarthritis)

Case Study: Obese Woman with Hand Osteoarthritis – Causes, Symptoms, and Treatment

Osteoarthritis (OA) is not limited to the knees or hips; it can also affect the hands, causing pain, stiffness, and difficulty performing daily tasks. Hand osteoarthritis is especially common in middle-aged and elderly women, and obesity is an important risk factor that worsens the condition. This case study highlights the presentation, diagnosis, and management of hand osteoarthritis in an obese woman.

Patient Presentation

A 56-year-old obese woman presents with:

  • Chief Complaint: Gradual onset of pain and stiffness in both hands for the last 3 years.

  • Associated Symptoms:

    • Swelling and tenderness in finger joints (especially near the tips and base of thumb)

    • Reduced grip strength (difficulty opening jars, holding utensils, or writing)

    • Morning stiffness lasting less than 20 minutes

    • Visible bony enlargements on finger joints (nodes)

  • Medical History:

    • Hypertension, managed with medication

    • BMI: 33 (obese)

    • Family history of arthritis (mother had similar symptoms)

Clinical Examination

On examination:

  • Heberden’s nodes (bony swellings at distal finger joints)

  • Bouchard’s nodes (bony swellings at middle finger joints)

  • Tenderness and reduced movement at the base of the thumb (first carpometacarpal joint)

  • No redness or warmth (rules out inflammatory arthritis)

  • Decreased grip strength measured with a dynamometer

Diagnosis

The patient was diagnosed with Hand Osteoarthritis based on:

  • X-ray Findings: Joint space narrowing, osteophyte formation, and bone spurs in finger joints and thumb base.

  • Blood Tests: Normal inflammatory markers (ruled out rheumatoid arthritis and gout).

  • Clinical History & Examination: Typical presentation of OA with nodes and obesity as a contributing factor.

Causes and Risk Factors

Hand osteoarthritis in obese women develops due to a combination of:

  1. Obesity – Increases inflammatory markers and mechanical stress, even on non-weight-bearing joints like the hands.

  2. Genetic Predisposition – Family history strongly increases risk.

  3. Hormonal Changes – Post-menopausal women are more vulnerable due to decreased estrogen.

  4. Age-related Degeneration – Cartilage breakdown with advancing age.

  5. Repetitive Hand Use – Activities requiring repetitive finger movement accelerate wear and tear.

Management and Treatment

Management of hand osteoarthritis aims to control pain, improve hand function, and slow progression.

1. Lifestyle Modifications

  • Weight Loss: Reduces systemic inflammation and decreases OA progression.

  • Hand Protection Techniques: Using jar openers, ergonomic tools, and avoiding repetitive stress.

  • Physiotherapy & Hand Exercises: Strengthening small muscles of the hand to improve grip.

2. Medications

  • NSAIDs (Ibuprofen, Naproxen) for pain relief.

  • Topical gels and creams with diclofenac or capsaicin.

  • Analgesics (Acetaminophen) for mild pain.

3. Supportive Therapies

  • Splints or braces for thumb base support.

  • Hot or cold therapy for stiffness and swelling.

  • Occupational therapy to learn joint-sparing techniques.

4. Injections

  • Corticosteroid injections into thumb joints for severe pain.

  • Hyaluronic acid injections (in selected cases) to improve joint lubrication.

5. Surgical Options

Reserved for advanced cases where conservative treatment fails:

  • Arthrodesis (fusion surgery) – stabilizes painful joints.

  • Joint replacement (especially for thumb base) – improves mobility and reduces pain.

Prognosis

With early treatment and lifestyle modifications, many women can continue daily activities without major disability. However, obesity accelerates progression, so weight management is the most important step for long-term relief.

Preventive Tips for Obese Women with Hand Osteoarthritis

  • Maintain a healthy weight to reduce systemic inflammation.

  • Perform daily hand exercises to maintain strength and flexibility.

  • Use ergonomic tools to reduce strain.

  • Avoid smoking, as it worsens cartilage degeneration.

  • Eat an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids.

FAQs

1. Can obesity cause osteoarthritis in the hands?
Yes, obesity increases systemic inflammation and contributes to cartilage damage even in non-weight-bearing joints like the hands.

2. How is hand osteoarthritis different from rheumatoid arthritis?
Hand OA usually affects finger tips and thumb base with bony nodes, while RA affects knuckles and wrist with redness, swelling, and prolonged morning stiffness.

3. Can hand osteoarthritis be reversed?
No, cartilage loss cannot be reversed, but pain and stiffness can be controlled with treatment.

4. What exercises help hand osteoarthritis?
Hand squeezing, finger stretching, and thumb opposition exercises improve flexibility and grip strength.

5. When is surgery required for hand osteoarthritis?
Surgery is considered in severe cases with persistent pain and loss of function despite conservative treatment.

Conclusion

Hand osteoarthritis in obese women is a chronic but manageable condition. Obesity plays a significant role in worsening symptoms due to increased inflammation. Early diagnosis, lifestyle changes such as weight loss, physiotherapy, and appropriate medications can help maintain independence and hand function. In advanced cases, surgical intervention offers relief.


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