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Health condition · Clinically reviewed

Finger joint arthritis, hand therapy, injections and the right surgery for the right joint.

Not just "wear and tear" - the pattern of joints tells you the diagnosis, and the diagnosis dictates the treatment.

Jump to treatment
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BSSH, BSR and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including hand therapy, injections, trapeziectomy and small-joint fusion or replacement.

Key facts

Finger joint arthritis at a glance.

The essentials, in plain English - what it is, the main types, and how it’s assessed and treated in the UK today.

  • What it is

    Arthritis of the finger and thumb joints - most often osteoarthritis, but inflammatory causes (rheumatoid, psoriatic, gout) are important to distinguish.

  • Osteoarthritis

    Typically affects the DIP joints (Heberden nodes), PIP joints (Bouchard nodes) and the base of the thumb (first CMC), producing squaring and grip loss.

  • Rheumatoid

    A symmetrical inflammatory arthritis of the MCP and PIP joints with morning stiffness, ulnar deviation, swan-neck and boutonnière deformities.

  • Psoriatic and gout

    Psoriatic disease loves the DIP with skin or nail changes and dactylitis; gout and CPPD cause acute, hot, painful attacks.

  • Assessment

    A structured hand exam, plain X-rays and (when inflammatory) bloods - CRP, ESR, rheumatoid factor, anti-CCP, urate and HLA-B27.

  • Treatment ladder

    Hand therapy and splinting first, then targeted injections, DMARDs for inflammatory disease, and surgery (trapeziectomy, fusion or replacement) when needed.

Why this guide matters

The pattern tells you the plan.

Which joints, which pattern and which features drive the diagnosis - and the treatment ladder that follows.

  • Diagnosis is a pattern, not a scan

    DIP and thumb-base disease is usually osteoarthritis - see our arthritis guide. Symmetrical MCP and PIP disease is more likely rheumatoid.

  • Hand therapy comes first

    Splinting, joint protection and targeted strengthening from a specialist hand therapist controls most hand osteoarthritis without surgery.

  • The right operation for the right joint

    Trapeziectomy for thumb-base OA, fusion for DIP disease, replacement for selected PIPs and MCPs - one size does not fit all.

How the diagnosis is made

From first stiffness to a clear plan.

The steps a UK GP, rheumatologist or hand surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and hand use

    Which joints, how long, morning stiffness, occupation, hobbies and impact on activities of daily living all shape the diagnosis.

  2. 02

    Assessing

    Structured hand examination

    Pattern of joints involved, deformity, tenderness, swelling and range of movement - including a Watson test and a CMC grind test.

  3. 03

    Assessing

    Distinguish OA from inflammatory

    DIP and CMC pattern with hard nodes suggests OA; symmetrical MCP and PIP with warmth and long morning stiffness points to rheumatoid.

  4. 04

    Confirming

    Plain X-rays of the hand

    Joint space narrowing, osteophytes and subchondral cysts in OA; marginal erosions in RA; pencil-in-cup in psoriatic disease.

  5. 05

    Confirming

    Bloods for inflammatory disease

    CRP and ESR, rheumatoid factor and anti-CCP, urate for gout and HLA-B27 when a spondyloarthritis is suspected.

  6. 06

    Planning

    Rheumatology or hand surgery

    Rheumatology leads on inflammatory disease and DMARDs; a specialist hand surgeon leads on structural OA and reconstructive options.

  7. 07

    Planning

    Hand therapy assessment

    A specialist hand therapist measures grip and pinch, fits splints and builds a tailored strengthening and joint-protection plan.

Typical timeline: a first visit to a settled plan in a few weeks.

Symptoms

What finger joint arthritis looks like.

The mix of pain, stiffness, swelling, nodes, deformity and grip loss - and the features that mean it’s time to escalate.

  • Pain and stiffness

    Deep aching pain with use and stiffness after rest - long morning stiffness (over an hour) suggests inflammatory disease.

  • Heberden and Bouchard nodes

    Bony swellings at the DIP (Heberden) and PIP (Bouchard) joints - the classic pattern of hand osteoarthritis.

  • Squaring at the base of the thumb

    A visible squared appearance of the first CMC joint - a hallmark of thumb-base osteoarthritis.

  • Swelling and warmth

    Soft, warm, boggy swelling across MCPs and PIPs points to an inflammatory arthritis rather than OA.

  • Reduced grip and pinch strength

    Difficulty opening jars, turning keys or holding a pen - grip and pinch loss is often the first functional complaint.

  • Deformity

    Ulnar deviation of the MCPs, swan-neck and boutonnière deformities in rheumatoid; angulation and subluxation in advanced OA.

  • Nail and skin changes

    Pitting, onycholysis and psoriatic plaques with DIP disease and dactylitis suggest psoriatic arthritis.

  • Red flag - hot, single, painful joint

    A single hot, exquisitely tender joint with fever is septic arthritis until proven otherwise - a same-day emergency.

Treatment

How finger joint arthritis is treated in the UK.

Conservative care first - hand therapy, splinting and analgesia - then targeted cortisone injections, DMARDs for inflammatory disease, and specialist hand surgery when appropriate.

  • Hand therapy and splinting

    Specialist hand therapy with a Neoprene short opponens or custom thermoplastic splint for the CMC, and buddy taping for unstable PIP joints.

  • Topical and oral analgesia

    Topical NSAIDs (such as Voltarol gel) first, with short courses of oral NSAIDs or paracetamol - reviewed alongside a full medication check.

  • Corticosteroid joint injection

    A targeted intra-articular cortisone injection into the CMC, PIP or DIP - see our guide on cortisone injections for large joints.

  • Hyaluronic acid (selective)

    Occasionally used for thumb-base osteoarthritis in specialist hands - not a routine first-line option in UK practice.

  • DMARDs and biologics

    For rheumatoid and psoriatic arthritis - methotrexate, sulfasalazine and biologic therapy under rheumatology.

  • Urate-lowering therapy for gout

    Allopurinol or febuxostat once acute attacks are controlled - see our guide to gout for the full plan.

  • Trapeziectomy (with LRTI)

    Removal of the trapezium, often with ligament reconstruction and tendon interposition - the workhorse operation for thumb-base OA.

  • Small-joint fusion or replacement

    DIP and selective PIP fusion for painful end-stage joints, or pyrocarbon and Silastic replacement in selected PIPs and MCPs.

Surgery, in plain English

The right operation depends on the joint and the pattern.

  • Trapeziectomy (with LRTI) is the workhorse for advanced thumb-base osteoarthritis - see our guide to trapeziectomy.
  • Thumb CMC arthroplasty uses modern implants in selected patients - a joint-preserving alternative in specialist hands.
  • PIP and DIP joint replacement - Silastic or pyrocarbon implants - can preserve motion in selected PIP joints.
  • Arthrodesis (fusion) is preferred for the DIP joint and selected PIP joints - see finger joint fusion.
  • Synovectomy can help selected rheumatoid patients, alongside optimised DMARD therapy.
  • MDT care - specialist hand surgery, rheumatology and hand therapy working together - gets the best long-term result.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, rheumatologist or hand surgeon knows your hands, imaging and history - and can tell you which parts of this apply to you. If in doubt, get seen.

  • NICE. Osteoarthritis in over 16s: diagnosis and management (NG226).

  • NICE. Rheumatoid arthritis in adults: management (NG100).

  • British Society for Rheumatology (BSR). Guidelines on rheumatoid, psoriatic arthritis and gout.

  • British Society for Surgery of the Hand (BSSH). Patient information on thumb-base and small-joint arthritis.

Red flags

When hand arthritis needs urgent attention.

Most hand arthritis is managed calmly in primary care and hand therapy. These are the situations that are different - and where a specialist opinion is needed quickly.

  • Septic arthritis

    A single hot, red, painfully swollen joint with fever or feeling unwell - a same-day emergency for aspiration and antibiotics.

  • Acute gout or pseudogout

    A rapidly painful, hot, red joint reaching peak within 24 hours - needs urgent assessment, aspiration and targeted treatment.

  • New early inflammatory arthritis

    Symmetrical small-joint swelling with morning stiffness lasting over an hour deserves early rheumatology referral - the first three months change outcomes.

  • Rapid deformity or function loss

    Sudden loss of grip, new deformity or a "trigger" or locking finger warrants prompt hand-surgery review.

  • Tendon rupture in rheumatoid

    A sudden inability to extend a finger in someone with rheumatoid disease can be extensor tendon rupture - refer urgently.

  • Neurological symptoms

    Numbness, tingling or wasting in the hand may be a nerve compression (median or ulnar) rather than joint disease alone.

  • Systemic features

    Weight loss, fevers, rash, mouth ulcers or dry eyes and mouth alongside joint pain need urgent rheumatology assessment.

  • Psoriatic features

    New DIP disease with nail pitting, onycholysis or a whole-finger swelling (dactylitis) is psoriatic arthritis until proven otherwise.

  • Uncontrolled pain or sleep loss

    Pain that wakes you at night or stops normal daily tasks is a signal that the current plan is not enough.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - joint protection, gentle daily movement, adaptive equipment and knowing when to step up.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits - kept up for months - do more than a heroic week that doesn’t last.

  1. 01 Protect

    Joint protection

    Use larger, softer grips, spread load across bigger joints, and avoid sustained pinch grips - a hand therapist will retrain your daily habits.

  2. 02 Move

    Range and strength daily

    Gentle daily range-of-movement and grip work maintains function - heat before, ice after flares can make it comfortable to do.

  3. 03 Adapt

    Adaptive equipment

    Jar openers, key turners, tap levers and lightweight kitchen tools transform daily life - occupational therapy and Access to Work can help.

  4. 04 Escalate

    Don’t settle for pain

    If splints, therapy and injections aren’t enough, a specialist hand surgeon can offer trapeziectomy, fusion or replacement - ask for a referral.

Frequently asked

Everything we get asked about finger joint arthritis.

Quick answers on OA versus rheumatoid, thumb-base squaring, splints, trapeziectomy and small-joint fusion or replacement.

  • What is finger joint arthritis?

    It is inflammation and damage of the small joints of the fingers and thumb. Most commonly it is osteoarthritis of the DIP, PIP and first CMC joints, but rheumatoid, psoriatic, gout, pseudogout, septic and post-traumatic arthritis all affect the hand and each has a different treatment.

  • How do I know if it is osteoarthritis or rheumatoid?

    Hand osteoarthritis usually affects the DIP joints, PIP joints and the base of the thumb, with hard bony nodes and short morning stiffness. Rheumatoid arthritis is symmetrical, warm and boggy at the MCPs and PIPs, with morning stiffness lasting over an hour. Blood tests and X-rays confirm the pattern.

  • What is squaring of the thumb?

    It is the visible squared appearance of the base of the thumb caused by osteoarthritis of the first carpometacarpal (CMC) joint - the trapezium slides sideways as the joint wears, and the metacarpal base sits more prominently.

  • Do splints and hand therapy really help?

    Yes. For thumb-base osteoarthritis a Neoprene short opponens or a custom thermoplastic splint, combined with specialist hand therapy, is often enough to control pain and improve pinch grip. Buddy taping helps unstable PIPs. Most people improve without surgery.

  • What does a trapeziectomy involve?

    It is the standard operation for advanced osteoarthritis of the thumb base. The trapezium bone is removed, often with a ligament reconstruction and tendon interposition (LRTI). Most patients get lasting pain relief and a strong pinch, though recovery takes several months.

  • When is fusion or joint replacement used?

    DIP fusion is a very reliable operation for painful end-stage DIP arthritis. Selected PIP joints are fused or replaced with pyrocarbon or Silastic implants, and MCP replacements are used in rheumatoid disease. Choice depends on which finger, which joint and what you need the hand to do.

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