Rheumatoid arthritis vs. osteoarthritis — different diseases, different approaches

This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.

I didn't realize how much I took my hands for granted until I watched my mother struggle to open a jar. She sat at the kitchen table with a jar of pasta sauce, trying to get the lid off, and eventually she just handed it to me. The jar wasn't tight. She just couldn't grip it hard enough. Later, she mentioned that buttoning her shirts had become a problem, too. And writing had become difficult. And picking up her phone made her hands hurt.

What struck me was how much of her independence was tied up in her hands. Not in the dramatic way that we usually think about disability. Her hands weren't paralyzed. She wasn't unable to move them. She could still do most things, but not without pain, and often not as effectively as she wanted. Simple tasks that she'd done thousands of times without thinking now required problem-solving and effort. And some things she just couldn't do anymore, period.

Osteoarthritis of the hands is one of those problems that doesn't get much attention until it's already significantly affecting someone's life. It's not like knee or hip arthritis, which are more visible and obvious. Hands are small and personal. People often manage alone without telling anyone how much they're struggling. But hand arthritis changes everything about daily living, from how someone eats to how they bathe to how they communicate through writing or typing.

When Hands Stop Working

Your parent might start struggling with things you don't immediately notice. Opening jars becomes difficult or impossible. Gripping a pen with enough control to write legibly becomes painful. Buttoning shirts or zipping zippers becomes a slow, painful process. Picking up small objects becomes hard. Doing up buttons is nearly impossible.

Typing becomes painful if your parent uses a computer. They might make more mistakes because they can't control their fingers the way they used to. Texting becomes arduous. Writing checks or signing documents becomes difficult or painful.

Everyday tasks in the kitchen become frustrating. Opening a can with a can opener requires gripping strength. Turning on the water faucet might hurt. Holding a knife to chop vegetables becomes difficult. Even holding a coffee mug or a glass becomes something your parent has to think about.

Personal hygiene becomes more challenging. Washing and grooming become painful. Brushing teeth, combing hair, washing hair. Holding a toothbrush firmly enough to clean teeth while also managing the pain makes these simple tasks exhausting.

Your parent might start avoiding things rather than dealing with the pain and frustration. They might stop writing letters or cards because it hurts. They might ask you to open jars instead of doing it themselves. They might wear clothes that are easier to fasten. They might stop doing hobbies that require fine motor control, like sewing or needlework or crafts.

What starts as discomfort with certain tasks can become a significant withdrawal from activities. Your parent's world shrinks because the things that made it enjoyable or full have become painful.

What's Happening

In osteoarthritis of the hands, the cartilage that cushions the joints has worn away. The surfaces of the bones that form the joint are rougher now. They're rubbing against each other with less of the smooth cartilage buffer. The joints become inflamed. The bones themselves can develop small bony growths called osteophytes or bone spurs.

This usually happens in the joints closest to the fingertips and in the joints at the base of the thumb. These are the joints your parent uses most intensively in daily activities. The wear and tear accumulates over decades.

The inflammation causes pain, swelling, and stiffness. Morning stiffness is common, where your parent's hands feel particularly stiff and achy when they first wake up. As they move around and warm up, the stiffness often improves slightly, but the underlying discomfort remains.

Your parent might notice nodules, which are small bony growths that develop at the joints. They're not dangerous, but they're cosmetically bothersome for some people. They can interfere with function if they limit the range of motion in the joint.

The pain has a particular quality to it. It's often described as a dull, aching pain that's present much of the time, punctuated by sharper pain when using the affected joints. Cold weather often makes it worse. Overuse makes it worse. Morning often makes it worse.

What makes hand arthritis particularly frustrating is that it's on display in ways other joint problems aren't. Your parent's hands are visible. People see the joints are swollen or distorted. People might comment on it or stare. Your parent might feel self-conscious about their appearance. They might avoid physical contact like shaking hands because their hands are sore or look unusual.

Pain and Function

The pain is bad. That matters. Chronic pain is exhausting and demoralizing. It colors everything. But the loss of function is worse in many ways because it takes away your parent's ability to do things that matter to them. Pain you can sometimes ignore or work around. Inability to do something you need or want to do is harder to work around.

Your parent might care much less about the pain if they could still do the things they want to do. If opening a jar hurt a little bit but they could still open it, that would be different than being unable to open a jar at all. If writing hurt but they could still write legibly, that would be manageable. But when pain becomes severe enough that the function is actually lost, that's when your parent's independence and quality of life are genuinely affected.

This is where the depression and mood problems often begin. Your parent was someone who could do things. Someone who was competent and capable. Now there are simple things they can't do. Asking for help becomes necessary, and for many older people, that's deeply difficult. They're losing not just the ability to do these tasks, but also their identity as a capable person.

The functional loss also creates isolation. If your parent enjoyed certain hobbies or activities, hand arthritis might make those impossible. If they enjoyed writing letters to friends, they can't do that anymore. If they enjoyed needlework or playing an instrument, those are now off the table. The social connections that came through these activities diminish.

Treatment Options

Pain management is usually the first approach. Over-the-counter anti-inflammatory medications like ibuprofen or naproxen can help reduce pain and inflammation. Acetaminophen might help with pain, though it doesn't reduce inflammation. These work better for some people than others.

Applying heat helps some people. Warm water, heating pads, warm paraffin wax baths can soothe painful joints and make movement easier. Cold helps other people, particularly if joints are swollen.

Splints can be enormously helpful. A splint that stabilizes the thumb or a particular finger can reduce pain when using that hand. Splints for nighttime wear can reduce morning stiffness. They're often custom-made to fit your parent's hand specifically. A good splint designed by an occupational therapist can make a tremendous difference.

Hand exercises can help maintain and sometimes improve function. Gentle range-of-motion exercises, stretching, strengthening exercises that don't stress the joints too much. A physical or occupational therapist can design a program specific to your parent's needs and limitations. Consistent exercise helps prevent further decline in function.

Corticosteroid injections directly into affected joints can provide relief that lasts weeks or months. This is particularly helpful for the thumb joints, which bear a lot of stress from daily activities. Your parent's doctor can perform these injections in the office.

There are newer biologic medications that can help with inflammatory arthritis, though the evidence for these in osteoarthritis is less clear than for rheumatoid arthritis. This is something for your parent to discuss with their rheumatologist or primary care doctor.

In severe cases, surgery can be considered. Joint fusion, where the bones on either side of a damaged joint are surgically fused together, eliminates motion but can eliminate pain. Arthroplasty, where the joint is replaced or reshaped, can improve both pain and function. Surgery is usually considered only when conservative treatments have been exhausted and the limitation of function is severe enough to warrant surgical risk.

Adapting Daily Life

Adaptive tools can make a huge difference in your parent's ability to continue doing things independently. There are jar openers that provide mechanical advantage. There are ergonomic pens that are easier to grip. There are button hooks that allow your parent to button shirts without gripping buttons with painful hands. There are specialized forks and spoons designed for people with weak grip. There are keyboards and mice designed for people with hand arthritis. There are specialized can openers.

These tools aren't failures. They're not admissions of defeat. They're practical ways for your parent to maintain independence and do things they want to do. A jar opener that lets your parent open jars independently is not a sad thing. It's a wonderful thing because it means they don't have to ask for help.

Modifying routines also helps. If buttoning is difficult, your parent might prefer pullover shirts and pants with zippers or elastic waists. If holding things is difficult, your parent might eat foods that require less gripping. If writing is painful, your parent might use larger pens or type on a computer instead. If typing is painful, they might voice-to-text software.

The goal is not to do everything the way it's always been done. The goal is to do the things your parent wants to do, adapted in whatever way makes that possible.

Occupational therapy is incredibly valuable. An occupational therapist specializes in helping people maintain function in daily activities. They can assess what's difficult for your parent, observe how your parent is trying to accomplish tasks, and suggest adaptations and tools that would help. They can teach your parent better ways to do things to minimize pain. They can recommend specific adaptive equipment and often show where to find it.

Your parent should know that many of these adaptive tools are available through medical supply companies, online retailers, and organizations focused on aging. The costs vary. Some things are inexpensive. Some are more costly. But they exist, and they work.

Heat before activity helps. If your parent knows they're going to do something that requires hand function, warming their hands first with warm water or a heating pad can reduce pain and improve function during the activity.

Your parent should also avoid overuse. If an activity causes significant pain, scaling back how much of it they do helps. This is different from avoiding things altogether. It's about doing things in a way that your parent can sustain without making pain worse.

Accepting that hands might not work the way they used to is also part of this. Your parent might not be able to do things as quickly as they used to. They might need to take breaks more often. They might need to ask for help sometimes. These aren't failures. They're adaptations to a changed reality. And they allow your parent to keep doing things that matter, which is what independence really is.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you are concerned about your parent's hand pain, joint health, or ability to perform daily activities, consult with their healthcare provider or an occupational therapist for guidance and support.