Ask the Doctors June 2017 Issue

Hand Arthritis & Swimming for Exercise

Dr. Steven Maschke

Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

Q: I have stiff and painful joints in my hands. How can I tell if this is rheumatoid arthritis or osteoarthritis?

A: Both osteoarthritis (OA) and rheumatoid arthritis (RA) can affect the joints in the hands, but usually in a different distribution. OA develops when the cushioning cartilage that covers the ends of bones at the joints deteriorates, leading to pain and stiffness. RA is an autoimmune disease, in which the body’s immune system mistakenly attacks tissues around joints. It can then damage the cartilage as well. This causes inflammation, pain and stiffness. Morning stiffness usually lasts much longer with RA (sometimes hours or all day). With OA, the stiffness lasts an hour or so.

The joint most susceptible to OA is the one nearest the fingertip (the distal interphalangeal, or DIP, joint). RA usually does not affect this joint. The joint at the base of the thumb, where it meets the wrist (the first carpometacarpal, or CMC, joint), is also susceptible to OA. RA usually attacks the wrist, middle joint of the finger (the proximal interphalangeal, or PIP, joint) and the large knuckle where the finger meets the rest of the hand (the metacarpophalangeal, or MCP, joint).

The characteristics of your symptoms can also provide a clue to the diagnosis. With RA, usually both hands will be affected, which isn’t necessarily true for OA. Both OA and RA cause joint pain and stiffness. But some people with RA have non-joint symptoms as well, such as fever, fatigue and loss of energy.

Ultimately, a physician can make the diagnosis by assessing your symptoms, conducting a physical examination and ordering blood or imaging tests if RA is suspected. The presence of certain antibodies, such as rheumatoid factor, can help distinguish RA from OA.

Q: I used to like jogging, but I can’t do it anymore because it hurts my arthritic joints too much. Is swimming an adequate substitute?

A: Like running and bicycling, swimming is a good aerobic exercise. In addition to benefiting your heart, it helps build and maintain muscle strength, which is good for people with arthritis. An advantage of swimming is that the buoyancy of the water supports your weight, easing stress on joints.

Aside from swimming, you can do other kinds of exercises in the water, such as jogging or marching. In fact, most exercises that can be done on land can also be done in the water. The deeper the water the more it supports your weight. If you stand in water up to your waist, the buoyancy of the water supports 50 percent of your weight. If the water is up to your chest, it is supporting 75 percent of your weight. And water up to your neck supports 90 percent of your weight.

There is evidence to support the benefits of water exercise for people with osteoarthritis in the knee or hip. A review of nine studies published in the Cochrane Database of Systematic Reviews (March 2016) showed that 12 weeks of water exercise resulted in a short-term improvement in pain and disability.

Pools and water exercise classes are available at many health clubs and YMCAs. The Arthritis Foundation has a list of aquatic exercise programs. One possible difference between swimming and other water exercises is the temperature of the water. Some lap pools tend to have cooler water, while pools for water exercise usually are warmer.

Keep in mind that swimming and water exercise won’t help bone density. For that you need a weight-bearing activity, such as walking or running.

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