Arthritis in the hands: getting through the day
The early signs of arthritis in the hands, what the bumps on finger joints mean, how to tell it from rheumatoid arthritis, and the treatments that help.
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Arthritis in the hands usually announces itself over something small. A jar of jam that won't give. A key that no longer turns cleanly. A shirt button that takes three tries before breakfast. The hands have done these things thousands of times without a thought, and then one morning they protest, and keep protesting.
The joints won't go back to being twenty, but much of what makes the day hard can be eased at home. The clearest way to show how is to walk through an ordinary day and fix the moments where it pinches, then look at what doctors offer when home measures aren't enough.
What arthritis in the hands looks like
Most hand arthritis is osteoarthritis, in which the smooth cartilage that cushions a joint thins and the bone underneath thickens. It settles most often into the end and middle joints of the fingers and the joint at the base of the thumb, the one you use for every pinch. The signs are an ache that worsens with use and eases with rest, stiffness that is worst in the morning, a grip that has slowly weakened and, often, small bony bumps on the finger joints.
Those bumps have names. A bony swelling on the joint closest to the fingernail is a Heberden's node; on the middle joint it is a Bouchard's node. Both are the body laying down new bone to steady a joint whose cartilage has thinned. In a 2022 multi-center study of people with hand osteoarthritis, 86% had Heberden's nodes and 37% had Bouchard's nodes, most often on the middle finger. The same study found that Bouchard's nodes went along with poorer hand function while Heberden's nodes on their own did not, so a knobby fingertip doesn't mean you will lose your grip.
A less common but more urgent form is rheumatoid arthritis, an autoimmune disease that tends to strike the same joints on both hands, with morning stiffness that lasts an hour or more. We come back to the difference below, because rheumatoid arthritis needs a doctor's treatment. For ordinary osteoarthritis, the day is yours to manage, and it starts the moment you wake up.
Mornings: warm the hands before you use them
Arthritic hands are stiffest in the first hour, after a night of stillness. The instinct is to force them open and get going. The better move is to warm them first: run them under warm water at the sink, soak them in a bowl for a few minutes, wrap them around the first hot mug of the day, or keep a microwavable heat pack by the bed.
Once they are warm, wake them gently. Open and close each hand into a loose fist a few times, spread the fingers wide and relax them, and touch the thumb to each fingertip in turn. Two minutes of this makes the buttons and the coffee scoop that follow much less of a fight.
Getting dressed without the struggle
Buttons, zippers and clasps are designed for nimble fingers and a firm pinch, which is exactly what hand arthritis takes away. A button hook and a zipper pull turn fiddly fastenings into one easy motion. Front-opening clothes, larger buttons, elastic waists and slip-on shoes remove whole categories of struggle, and our guide to adaptive clothing covers the options.
Occupational therapists call the principle behind this joint protection: use your biggest, strongest joints for the job, and avoid a tight pinch whenever a broader grip will do. Push a drawer shut with a flat palm instead of a hooked finger. Carry a bag on your forearm instead of pinched in your fingers. Spread a load across two hands. When dressing and grooming have become the hardest part of the day, a caregiver's help with personal care can make the morning calm again.
The kitchen, where grip is everything
So much of cooking is grip and twist: lids, can openers, peeling, chopping, lifting a full pan. Nearly all of it has a workaround that moves the effort off the small finger joints.
- Jars. A wall-mounted or electric jar opener, or a rubber grip pad, does the twisting. Running a stubborn lid under hot water loosens it.
- Cutting. Keep knives sharp, because a dull blade takes more force, and choose thick, cushioned handles. A rocker knife cuts with a downward press instead of a grip.
- Lifting. Slide heavy pots instead of carrying them, use two hands and padded mitts, and fill the kettle only as much as you need.
When cooking has become too much on its own, that is often the first reason families ask about help at home. A few hours of homemaker services each week covers meal preparation and the chores that lean hardest on the hands.
Keys, doorknobs and pill bottles
Leaving the house means a string of small twisting motions, each one aimed at the base of the thumb. Round doorknobs are among the worst. Lever handles, which you can push down with a whole hand or even an elbow, are one of the most useful changes you can make at home, and lever faucets do the same at the sink.
A key turner gives you a fat handle to grip instead of a thin key to pinch. Ask your pharmacist for easy-open caps instead of child-resistant ones, and use a weekly pill organizer with large compartments so you aren't wrestling a bottle every morning.
A few minutes of hand exercises
Once a day, when the hands are warm, give them a few minutes of gentle movement. Exercise won't reverse arthritis, but it keeps joints from stiffening, maintains the muscles that support them and can ease pain. The evidence is stronger than most people expect. In the SARAH trial, published in The Lancet in 2015, adults with rheumatoid arthritis of the hands who followed a daily home program improved their hand function about twice as much over a year as those on usual care alone. Move slowly, stop short of pain, and skip the squeezing on days a joint is hot and flaring.
- Gentle fist. Slowly curl the fingers into a loose fist with the thumb on the outside, then open and spread them wide. About ten times per hand, without squeezing.
- Finger bends. Bend one finger at a time toward the palm, hold for a second or two, and straighten.
- Make an O. Curve all the fingers until the tips touch the thumb, hold a few seconds, then straighten.
- Thumb touches. Touch the thumb tip to each fingertip in turn, then to the base of the little finger.
- Table lifts. Rest the hand flat on a table and lift one finger at a time a little way off the surface, then lower it.
A soft foam ball or therapy putty adds gentle resistance once the joints tolerate it. An occupational or hand therapist can build a routine around your particular joints and check your form.
When a flare hits
Some days a joint wakes up hot, swollen and sore no matter how careful you have been. Rest it for a day or two instead of pushing through. Where heat loosens a stiff joint, a cold pack often calms an inflamed one better; try both and use whichever helps. A splint, especially one supporting the base of the thumb, takes the load off while it settles. Drop resistance exercises until the flare passes, but keep up the gentlest movements so the joint doesn't stiffen.
Evenings: setting up tomorrow
A warm soak while you wind down leaves the joints looser for bed. Some people find a night splint keeps a painful thumb from settling into an awkward position overnight; a doctor or therapist can say whether it suits you. Then make tomorrow easy: lay out front-opening clothes, leave the button hook and key turner where you'll find them, and fill the pill organizer in the evening, when the hands are warm and cooperative.
Osteoarthritis or rheumatoid arthritis
Call a doctor if a joint suddenly turns hot, red and swollen, which can mean infection or gout, and be seen the same day if a fever comes with it. Get evaluated if several joints flare together, if the same joints on both hands are swollen and warm, or if morning stiffness regularly lasts more than an hour.
The two kinds of arthritis leave different fingerprints. Osteoarthritis builds slowly and often unevenly, one thumb giving out before the other, and favors the end and middle finger joints and the thumb base. Its morning stiffness fades within about half an hour, and, as Harvard Health notes, it rarely makes a joint warm or brings fatigue or fever.
Rheumatoid arthritis is an autoimmune disease in which the immune system attacks the lining of the joints. It tends to appear over weeks or months, in both hands in mirror image, favoring the knuckles, middle finger joints and wrists while usually sparing the joint nearest the fingernail. Morning stiffness lasts an hour or longer, with swelling, warmth and a flu-like tiredness. The National Institute of Arthritis and Musculoskeletal and Skin Diseases explains that early treatment with disease-modifying drugs can slow the joint damage it causes, which is why a prompt rheumatology referral matters. A rheumatologist confirms it with an exam, blood tests for rheumatoid factor and anti-CCP antibodies, and X-rays. Negative blood tests don't rule it out, because some people with rheumatoid arthritis never test positive.
What doctors recommend when home care isn't enough
The 2019 American College of Rheumatology and Arthritis Foundation guideline is the clearest map of the evidence. For hand osteoarthritis it strongly recommends four things: exercise, self-management programs, a splint for the base of the thumb and oral anti-inflammatory drugs. It gives weaker, conditional support to topical anti-inflammatories, cortisone injections, heat treatments such as paraffin baths, kinesiotaping of the thumb base, chondroitin sulfate and acetaminophen.
It also advises against some things. Capsaicin cream is not recommended for the hands: the evidence there is thin, and it easily ends up in an eye. Biologic drugs used for rheumatoid arthritis don't help osteoarthritis. Acetaminophen is a reasonable option for someone who can't take anti-inflammatories, as long as they stay under the daily limit; our guide to taking acetaminophen safely explains why that limit matters more with age.
Splints and heat
A thumb-base splint comes in two common kinds: a rigid one molded by a hand therapist, and a softer neoprene sleeve. Both can ease thumb pain. Many people wear the soft one during the day because it gets in the way less, and the rigid one at night or for specific painful jobs. Heat, from a paraffin bath, a warm soak or a microwavable pack, loosens stiffness for a while, which is why it belongs before exercises or a task you know will hurt.
Diclofenac gel
Topical diclofenac gel, sold over the counter since 2020, is labeled for arthritis pain in the hands, wrists and elbows as well as the knees, ankles and feet. Less of the drug reaches the bloodstream than with a pill, so doctors often prefer it for people over 75 and for anyone with a history of stomach bleeding, kidney problems or blood thinner use. The guideline's support for it on the hands is conditional, partly for a practical reason: handwashing takes it off. Apply it after washing and again before bed, and give it up to a week to start working. Ask a pharmacist whether it is safe with your other medications.
Cortisone injections and surgery
A cortisone injection into a single painful joint, often the base of the thumb, can give relief for weeks to months. Doctors usually limit how often any one joint is injected. Surgery is considered mainly for severe thumb-base arthritis that hasn't responded to months of splinting, exercise, medication and injections. The usual operation removes the small trapezium bone at the base of the thumb, often filling the space with a rolled tendon. Recovery means several weeks in a splint and then hand therapy, and results are generally good. For the finger joints, fusing or replacing a joint is possible in selected cases. A hand surgeon makes that call.
Help with the tasks stiff hands find hardest
Living well with arthritic hands is rarely about one big fix. It is many small adjustments across an ordinary day: the warm soak before the buttons, the lever handle instead of the knob, the jar opener on the counter, the pill organizer filled the night before. Each one removes a little friction.
When the tasks that need hands start to crowd out the rest of life, steady help is often what keeps someone in their own home and routine. A caregiver can button the cardigan, open the jars, cook dinner and fill the pill organizer, leaving your parent's hands for the things they still enjoy. Our Middlesex County office serves families across the county, and our office directory lists every county we serve.
This article is general information, not medical advice. Talk with your doctor or an occupational therapist about diagnosing and managing hand arthritis, and before starting a new exercise or treatment.
Common questions
Click or tap a question to see the answer.
What are the first signs of arthritis in the hands?
The earliest sign is usually stiffness that is worst first thing in the morning or after the hands have been still, and that eases once you start moving them. With osteoarthritis, that stiffness usually fades within about 30 minutes. Other early signs are a deep ache in the finger joints or at the base of the thumb that gets worse with use and better with rest, and a weaker grip that makes jars, keys and buttons harder. Over time, osteoarthritis can leave small bony bumps on the middle and end joints of the fingers. Several of these together in an older adult usually point to hand arthritis and are worth mentioning to a doctor.
Are the bumps on my finger joints a sign of arthritis?
Usually, yes, and usually osteoarthritis. A bony bump on the joint closest to the fingernail is a Heberden's node; the same bump on the middle joint is a Bouchard's node. Both form slowly as cartilage thins and the body adds new bone at the edge of the joint. In a 2022 multi-center study of people with diagnosed hand osteoarthritis, 86% had Heberden's nodes and 37% had Bouchard's nodes. A fully formed node is often painless; the joint underneath is what aches. A lump that appears suddenly, looks red or warm, or sits on a different joint should be checked, because cysts, gout and rheumatoid nodules can look similar.
What is the best way to relieve arthritis pain in the hands?
Combine several small measures. Warmth is the most dependable: a warm soak, a paraffin bath, a heat pack or a warm mug loosens stiff joints, while a cold pack can calm a hot, swollen joint during a flare. Rest an irritated joint for a day or two instead of pushing through. A thumb splint supports a painful thumb base. Gentle daily range-of-motion exercises keep the joints moving. Topical diclofenac gel or an oral pain reliever can take the edge off; ask a pharmacist or doctor which is safe with your other medications. Pain that is constant or wakes you at night is a reason to see a doctor about other options.
Do hand exercises actually help arthritis?
Yes. Exercise won't reverse joint damage, but it keeps joints from stiffening, maintains the muscles that support them and can ease pain and improve how well the hand works. The 2019 American College of Rheumatology and Arthritis Foundation guideline strongly recommends exercise for hand osteoarthritis. In the SARAH trial, published in The Lancet in 2015, adults with rheumatoid arthritis of the hands who followed a daily home exercise program improved their hand function about twice as much over a year as those who received usual care alone. Move slowly, stop short of pain, and skip squeezing exercises during a flare.
What is the best cream for arthritis in the hands?
Topical diclofenac, an anti-inflammatory gel sold over the counter since 2020 (Voltaren Arthritis Pain is one brand), is labeled for arthritis pain in the hands, and the American College of Rheumatology guideline conditionally recommends topical anti-inflammatories for hand osteoarthritis. Because less of the drug reaches the bloodstream than with a pill, doctors often prefer it for people over 75 and for anyone with stomach ulcers, kidney problems or other reasons to avoid oral anti-inflammatories. The gel has to stay on the skin, so apply it after handwashing and before bed, and give it up to a week to work. The same guideline advises against capsaicin cream on the hands, because the evidence there is thin and it is easy to get in the eyes.
What gadgets help with arthritis in the hands?
The useful ones let big muscles and an open hand do the work instead of small joints and a tight pinch. In the kitchen, try a jar opener, thick-handled utensils, a rocker knife and a lightweight kettle. Around the house, lever door handles and faucet levers replace round knobs, and a key turner gives leverage on stiff locks. For dressing, a button hook and zipper pull help. Ask your pharmacist for easy-open pill caps instead of child-resistant ones, and use a weekly pill organizer with large compartments. An occupational therapist can match tools to the tasks you find hardest.
How can I tell if it is osteoarthritis or rheumatoid arthritis in my hands?
Osteoarthritis comes on gradually, often one hand or one joint first, and favors the end and middle finger joints and the base of the thumb. Its morning stiffness usually lasts less than 30 minutes, and the joints are rarely warm. Rheumatoid arthritis is an autoimmune disease that tends to affect the same joints on both hands, favors the knuckles, middle finger joints and wrists, and usually spares the joint nearest the fingernail. Its morning stiffness often lasts an hour or more and comes with swelling, warmth and tiredness. Rheumatoid arthritis needs prompt treatment to protect the joints, so see a doctor for that pattern. A rheumatologist confirms it with an exam, blood tests and X-rays.
When does someone with hand arthritis consider surgery?
Surgery is usually considered only after months of conservative care have failed: exercises, a splint, anti-inflammatory medicines and often a cortisone injection. The most common operation for hand osteoarthritis is at the base of the thumb, where the small trapezium bone is removed and often replaced with a rolled tendon for cushioning and stability. Recovery takes weeks in a thumb splint followed by hand therapy, and heavy gripping usually waits a few months. Pain relief is generally good and lasting, though grip strength may stay a little below the other hand. A hand surgeon makes the decision.
Can arthritis in the hands be reversed?
No, but it can be managed for many years. In osteoarthritis, worn cartilage doesn't grow back and bony nodes are permanent. What does change is how much a joint hurts and how well the hand works, and both respond to regular exercise, a splint during heavy use, tools that take load off the small joints and, when needed, medication or an injection. Rheumatoid arthritis is different: disease-modifying medicines can sometimes bring it into remission, though damage already done stays, which is why early diagnosis matters so much.
