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Health condition · Clinically reviewed

Hand arthritis, from thumb-base OA to inflammatory disease - the whole picture.

More than one condition, and each with its own ladder of treatment - hand therapy, targeted injections, disease-modifying drugs and, when it fits, surgery.

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Why trust this guide

  • 01

    Clinically reviewed

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

  • 02

    Sourced from guidance

    Checked against NICE, BSR, BSSH and peer-reviewed rheumatology and hand-surgery sources.

  • 03

    Current for 2026

    Reflects modern UK practice - hand therapy, targeted injections, DMARDs, biologics and joint surgery.

Key facts

Hand arthritis at a glance.

The essentials in plain English - what it is, which joints get hit, and how each type is treated in the UK today.

  • What it is

    An umbrella term for arthritis affecting the small joints of the hand and wrist - degenerative, inflammatory, crystal-driven or infective.

  • Main types

    Osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, CPPD, septic arthritis, haemochromatosis and lupus arthropathy.

  • Where it hits

    OA favours the DIP, PIP and first CMC (thumb base). RA favours the MCP, PIP and wrist, usually symmetrically.

  • What it costs

    Grip strength, dexterity, sleep and the small daily tasks - jars, keys, buttons, phones and pens.

  • Diagnosis

    Pattern recognition, blood tests (RF, anti-CCP, urate, HLA-B27), X-ray and, where needed, ultrasound or MRI.

  • Modern management

    Hand therapy and splinting, topical and oral analgesia, targeted injections, DMARDs and biologics, and selective surgery.

Why this guide matters

Name the type, then treat it properly.

Hand arthritis is not one condition. The three points below shape everything that follows - from tests to therapy to surgery.

  • Pattern names the disease

    DIP and thumb-base wear points to OA. Symmetrical MCP and wrist swelling points to RA. Sausage fingers and nail pitting point to PsA. See our focused guides on hand and wrist osteoarthritis and finger joint arthritis.

  • Early treatment protects joints

    For inflammatory arthritis, starting DMARDs within weeks - not months - is one of the strongest predictors of long-term function.

  • Surgery is a scalpel, not a hammer

    Trapeziectomy for the thumb base, joint fusion or replacement for painful finger joints - the right operation at the right time is transformative. Full detail sits in our hand and wrist osteoarthritis guide.

How the diagnosis is made

From painful hand to a clear plan.

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

  1. 01

    Assessing

    History and joint pattern

    Which joints, one side or both, morning stiffness, swelling, skin changes and family history - the first clues to the type.

  2. 02

    Assessing

    Focused hand examination

    Tender joints, synovitis, Heberden and Bouchard nodes, thumb-base squaring, grip and pinch strength, tendon involvement.

  3. 03

    Assessing

    Function and ADL impact

    How arthritis affects grip, pinch, writing, dressing, cooking and sleep - measured with validated hand scores.

  4. 04

    Confirming

    X-ray of hands and wrists

    Shows joint-space loss, osteophytes, erosions, chondrocalcinosis and alignment - the foundation investigation.

  5. 05

    Confirming

    Rheumatology bloods

    RF and anti-CCP for RA, urate for gout, HLA-B27 where PsA or spondyloarthritis is suspected, plus ESR, CRP and full blood count.

  6. 06

    Preparing

    Ultrasound or MRI

    Ultrasound picks up synovitis and early erosions. MRI is used for the wrist and difficult cases.

  7. 07

    Preparing

    Rheumatology or hand-surgery review

    Inflammatory disease heads to rheumatology. Advanced OA or thumb-base disease goes to a hand surgeon for surgical planning.

Typical timeline: a first visit to a settled plan in weeks, not months.

Symptoms

What hand arthritis actually feels like.

Pain, stiffness, swelling, deformity and dropped grip - and the features that mean it is time to escalate.

  • Joint pain

    Aching, activity-related pain in the DIP, PIP, MCP, thumb base or wrist - the hallmark of hand arthritis.

  • Morning stiffness

    A short warm-up in OA. Prolonged stiffness of an hour or more suggests an inflammatory arthritis.

  • Swelling and synovitis

    Boggy, warm swelling of the MCP or PIP joints points to RA, PsA or another inflammatory arthritis.

  • Nodes and nodules

    Heberden nodes at the DIP and Bouchard nodes at the PIP are classic in OA. Rheumatoid nodules can appear at pressure points.

  • Deformity

    Ulnar drift, swan-neck, boutonnière and thumb-base squaring - late changes that follow long-standing disease.

  • Reduced grip and pinch

    The functional bottom line - reduced grip and pinch strength that shows up in jars, keys and buttons.

  • Dactylitis and skin clues

    A whole-finger sausage-swelling with nail pitting or a psoriasis plaque points strongly to psoriatic arthritis.

  • Red flag - hot swollen joint

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

Treatment

How hand arthritis is treated in the UK.

Hand therapy and splinting first, targeted injections and disease-modifying drugs next, and selective surgery for the joints that need it.

  • Hand therapy and splinting

    Occupational-therapy-led programmes - joint protection, exercises and custom splints for thumb-base OA, RA and PsA. See also our guide to hand and wrist splinting.

  • Topical and oral analgesia

    Topical NSAIDs and capsaicin work well for small joints. Oral NSAIDs and paracetamol are used carefully with cardiovascular, renal and gastric review.

  • Adaptive equipment

    Jar openers, chunky pens, ergonomic keyboards and thumb splints protect the joints and preserve independence.

  • Corticosteroid injection

    Targeted, image-guided steroid injection at the thumb base, DIP or PIP - useful for OA flares and difficult inflammatory joints. See cortisone injection (large joint) for our injection service.

  • DMARDs

    Methotrexate, sulfasalazine, leflunomide and hydroxychloroquine - the mainstay for RA and many PsA cases, started early to prevent erosions.

  • Biologics and targeted therapies

    Anti-TNF, IL-6, IL-17, IL-23, JAK inhibitors and rituximab - used for inflammatory arthritis that fails DMARDs, always under rheumatology.

  • Gout and crystal disease

    Urate-lowering therapy (allopurinol or febuxostat) for gout, plus colchicine or short NSAID courses for flares. CPPD is managed similarly.

  • Hand surgery

    Trapeziectomy for thumb-base OA, PIP and DIP fusion or arthroplasty for painful stiff joints, four-corner fusion for advanced wrist OA. See our surgical guides for detail.

The MDT behind hand arthritis care

Rheumatology, hand surgery and hand therapy - working together.

Great hand-arthritis care is a team sport - a rheumatologist to steer disease-modifying treatment, a hand surgeon for structural problems, and a specialist hand therapist to translate all of it into daily function. Related conditions like hand fractures and simple gout often share the same MDT.

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 hand and history and can tell you which parts apply to you. If in doubt, get seen.

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

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

  • NICE. Spondyloarthritis in over 16s: diagnosis and management (NG65).

  • British Society for Rheumatology (BSR). Guidelines on DMARDs, biologics and gout management.

  • British Society for Surgery of the Hand (BSSH). Patient information on hand arthritis and joint surgery.

Red flags

When hand arthritis needs urgent attention.

Most hand arthritis is managed in primary and secondary care. These are the situations that need a same-day or same-week specialist opinion.

  • Hot, swollen, exquisitely tender joint

    A single, hot, red joint with fever is septic arthritis until proven otherwise. Same-day A&E - do not wait.

  • Rapid deformity or loss of function

    A sudden change in joint shape, alignment or the ability to grip - urgent rheumatology or hand-surgery review.

  • Systemic features

    Fever, weight loss, night sweats and drenching morning stiffness point to systemic inflammatory disease - not simple OA.

  • Neurovascular compromise

    Numbness, weakness or cold fingers alongside joint disease - assess for carpal tunnel, cervical involvement or vasculitis.

  • Tendon rupture

    A sudden inability to straighten a finger, especially in RA - a hand-surgery emergency needing prompt review.

  • Suspected inflammatory arthritis

    Symmetrical MCP or PIP synovitis in a young or middle-aged adult - refer within three weeks. Early DMARDs change the disease course.

  • Uncontrolled gout with tophi

    Repeated flares or tophaceous deposits need urate-lowering therapy titrated to target - not just flare relief.

  • Skin or nail changes

    Psoriasis plaques, nail pitting or dactylitis alongside joint pain - screen for and refer possible psoriatic arthritis.

  • Iron overload clues

    MCP arthritis in a middle-aged adult with fatigue, diabetes or liver changes - check ferritin and transferrin saturation for haemochromatosis.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - joint protection, gentle movement, early treatment for inflammatory disease, and asking about surgery in time.

A quiet reminder

Small, consistent habits beat heroic weeks.

Daily joint protection and a few minutes of hand exercises done reliably do more than a once-a-month blitz.

  1. 01 Protect

    Joint protection first

    Bigger tools, two-handed lifts and short frequent rests take load off the small joints - the single biggest daily win.

  2. 02 Move

    Little and often exercise

    Gentle range-of-movement and grip exercises, guided by a hand therapist, keep the joints supple without provoking flares.

  3. 03 Treat

    Treat inflammation early

    For RA or PsA, early DMARDs prevent erosions and deformity. Time-to-treatment is one of the strongest predictors of outcome.

  4. 04 Escalate

    Ask about surgery in time

    For painful thumb-base OA or a destroyed PIP, surgery is transformative - but works best before deformity is fixed.

Frequently asked

Everything we get asked about hand arthritis.

Quick answers on diagnosis, tests, DMARDs, injections and surgery.

  • What is hand arthritis?

    A group of conditions in which the small joints of the fingers, thumb and wrist become painful, stiff and often swollen. The commonest causes are osteoarthritis and rheumatoid arthritis, but psoriatic arthritis, gout, CPPD, lupus and haemochromatosis all affect the hand. Septic arthritis is a rare but emergency cause.

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

    OA usually favours the DIP, PIP and thumb base, with short morning stiffness and hard bony nodes. RA favours the MCP, PIP and wrist, is often symmetrical and produces prolonged morning stiffness with warm, boggy swelling. Blood tests, X-rays and sometimes ultrasound help make the call. See our separate guides to hand and wrist osteoarthritis and finger joint arthritis for more detail.

  • Which tests will I need?

    A hand-focused examination, X-rays of the hands and wrists, and blood tests including full blood count, ESR, CRP, RF, anti-CCP, urate and, where appropriate, HLA-B27. Ultrasound or MRI is added when synovitis is suspected but not obvious, or when the wrist is heavily involved. A private MRI scan can shorten the diagnostic pathway when clinical urgency is high.

  • Do I really need DMARDs or biologics?

    If you have rheumatoid or psoriatic arthritis, yes - almost always. DMARDs such as methotrexate, and biologics for those who need more, are what prevent joint erosion and long-term deformity. The window in the first few months matters. In OA, DMARDs are not used.

  • When is surgery worth considering?

    When pain, stiffness or deformity outstrip what medication, splinting and injections can manage. Trapeziectomy for thumb-base OA and PIP or DIP fusion or arthroplasty for individual finger joints are well-established. Four-corner fusion is a wrist option for advanced OA. A hand surgeon will match the operation to your joint, hand and lifestyle.

  • What about a hot, swollen finger with fever?

    That is a red flag for septic arthritis or a severe crystal flare and needs same-day assessment - A&E or an urgent hand-surgery review. Septic arthritis destroys cartilage within days without prompt washout and antibiotics.

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