Hand osteoarthritis: do female hormones play a part?

18 October 2021
A lady opening a jar with a gadget to help her.

Hand osteoarthritis is more common in women, often developing around the menopause (the time when a women’s menstrual periods stop), suggesting changes in hormones may be important in its development.

We’ve asked Prof Fiona Watt and Megan Goff, Trial Manager from our Centre for Osteoarthritis Pathogenesis Versus Arthritis at the University of Oxford to answer some of your most frequently asked questions on the subject. Here’s what they have to say.

I’ve been told there’s nothing I can do about the osteoarthritis in my hand, is this right?

Whilst there are currently no medications that stop or slow down the progression of osteoarthritis, there are many different ways to manage the condition.

Joints in the hand like everywhere else need exercise and respond to it. Daily hand exercises, which maintain the range of movement of the joints, can make them stronger and try to stop joints becoming stiff, as well as helping with hand pain. Reducing overloading the hands is important too, for example avoiding carrying heavy shopping bags.

There are also specially designed devices to help with tasks which can often be useful, such as jar openers, while sometimes splints (supports for joints) can be used to help pain, protect joints and to try to reduce changes in shape of the joints. These can be purchased or may be provided or made by hand therapists to treat hand issues.

Various pain-relieving medications, including anti-inflammatory gel have been shown in research studies to help the pain of osteoarthritis and are useful if you are experiencing regular pain.

Surgery on finger and thumb joints can be done, but only tends to be offered if these other types of treatments have failed to help. This is something a hand clinic would assess. Discussing your options again with your GP would be a good next step.

What is a hand clinic? How do get I get a referral?

A hand clinic is typically run by either hand therapists, which includes occupational therapists or physiotherapists with specialist training in treating the hand or by hand surgeons, who are usually orthopaedic surgeons or plastic surgeons with specialist training in managing hand problems. Hand clinics are usually, but not always, hospital based.

Alternatively, you may be referred to a rheumatologist (a doctor who specialises in treating arthritis and other musculoskeletal conditions), particularly if your GP is uncertain about the type of arthritis that you have.

Your GP can refer you to a relevant service if they feel you would benefit from either hand therapy, rheumatology or surgical input in your care.

Can hormone replacement therapy (HRT) prevent or slow down the damage caused by osteoarthritis of the hand in post-menopausal women?

Researchers have known for some time that hand osteoarthritis is more common in women and that some women seem to develop their hand osteoarthritis around the time of their menopause.

However, there is a lack of information on whether giving hormone replacement therapy (HRT) to ‘top up’ hormones that are lost during the menopause is helpful in terms of managing osteoarthritis. This includes whether HRT prevents onset of osteoarthritis if given early enough or can slow the progression of arthritis down or help pain in hand osteoarthritis.

To date there haven’t been any clinical trials of HRT specifically in people with hand osteoarthritis. A possible role for HRT in slowing down osteoarthritis was supported by information from the large ‘Women’s Health Initiative’ study of HRT in America, where women receiving estrogen had lower rates of both hip and knee joint replacement, compared with women taking placebo (inactive) medication.

More recently, a study using existing UK healthcare data suggested that women already on HRT may be protected from developing hand osteoarthritis. However, at the moment there is not enough information to recommend this type of treatment should be prescribed for osteoarthritis of any kind.

What research is Versus Arthritis funding to find out more?

Researchers at the Centre for Osteoarthritis Pathogenesis Versus Arthritis are also involved in the HOPE-e study supported by National Institute of Health Research (NIHR). The study is testing whether taking a tablet of an estrogen-containing therapy once daily for 6 months improves hand pain in women with hand OA, when compared with taking a placebo tablet (inactive medication). You can also read about what it’s like to take part in a clinical study, from the perspective of Joanne who is a participant in HOPE-e.

Research led by Dr Malvika Gulati, also at the University of Oxford, is exploring the impact that gender, menopause and sex hormones have on the duration and severity of hand osteoarthritis. The researchers are using clinical information (X-rays and blood results going back many years) in people with hand osteoarthritis to look for predictors of osteoarthritis and different durations of the condition. To confirm the findings, they are also observing people recently diagnosed with hand osteoarthritis, to track their pain symptoms and condition over time to see if the predictors are accurate.

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