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    woman holding her wristWhat Is Arthritis?

    Arthritis is not one disease. Learn about the different types of arthritis, how they differ and why it’s important.

    microbesInflammation and the Immune System

    Body-wide inflammation is at the root of most chronic diseases — and you may have more control over it than you think.

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    A new arthritis diagnosis can be overwhelming. These tips can help.

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    Woman holding shoulderWebinar: Touch Therapies for Pain Management

    Learn the evidence behind popular touch therapies for arthritis, including what to try and what to avoid, for how long and when.

    Managing Arthritis Care Costs

    Learn the basics about health care costs and financial tools available to you.

    Man with head in hands on bedWebinar: Arthritis Fatigue Causes and Solutions

    Learn the various causes of arthritis-related fatigue and strategies to combat weariness.

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    Woman with upset stomachMicrobiome, Gut Health & Arthritis

    Microbiome, microbes, microorganisms – these terms may be confusing, but the types of bacteria living in and on our bodies can impact arthritis. Learn what helps or harms the microbiome and the health of your gut and discover dietary changes that can make a difference. This episode was originally released on January 19, 2021.

    man exercisingStairs Workout Demo

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    woman consoling anotherArthritis and Mental Health

    Learn about the connection between arthritis, depression and anxiety and how these conditions can make your arthritis worse.

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    2023 JA Family Summit

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    Transforming Clinical Interactions

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    The Arthritis Foundation is mobilizing patients and their families to engage in studies comparing the effectiveness of treatments for juvenile arthritis and funding research for more options.

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Five Surgeries for Thumb Arthritis

Learn about five procedures used to treat joint damage and pain caused by thumb arthritis.

Most activities that involve grasping or pinching are possible because of the thumb’s remarkable range of motion. But dexterity comes at a price – an increased risk of osteoarthritis (OA) in the first carpometacarpal (CMC) joint, where the thumb meets the trapezium bone in the wrist. Sometimes the joint becomes so damaged that surgery is necessary. 

How Thumb Arthritis Develops  

Problems often start when the thick ligaments that hold the joint together loosen, allowing it to slip out of place. Over time, the articular cartilage that cushions the ends of the bones wears away, causing pain and limiting movement. Rheumatoid arthritis (RA) and other forms of inflammatory arthritis can also damage the CMC joint in the thumb, also known as the trapeziometacarpal joint (TMC). 

David S. Ruch, MD, chief of the hand surgery at Duke Health in Durham, North Carolina, says women, especially those older than 50, are 10 to 20 times more likely than men to develop thumb arthritis, though no one is quite sure why. Both women and men respond well, at least initially, to conservative measures such as anti-inflammatory medications, splints, activity modification and limited steroid injections. For some, says Dr. Ruch, these may be the only treatments needed. 

“[These therapies] make people feel better, but they don’t stop disease progression, and eventually surgery may be necessary,” he says. 

The best surgical approach depends on the stage of the disease and severity of symptoms.  

Five Types of Thumb Surgery 

Ligament Reconstruction 

This procedure stabilizes the CMC joint by removing a portion of the damaged ligament and replacing it with a piece of the patient’s wrist flexor tendon. 

“The transposed tendon reconnects and restores mechanical function of the thumb with the rest of the hand,” says Stephen Trigg, MD, an orthopedic hand surgeon at Mayo Clinic in Jacksonville, Florida. 

Who can benefit: Adults with no cartilage loss whose symptoms result from looseness in the joint. 

Pros:  Most people with very early arthritis experience good to excellent pain relief. Studies suggest ligament reconstruction also prevents disease progression in a majority of patients. 

Cons:  The procedure stabilizes the joint but does not repair damaged cartilage or bone. 

Ligament Reconstruction and Tendon Interposition (LRTI) 

In use for more than 40 years, LRTI is the most commonly performed surgery for thumb arthritis. The damaged joint surfaces are removed and replaced with a cushion of tissue that keeps the bones separated. To accomplish this, surgeons remove all or part of the trapezium bone in the wrist at the base of the thumb. A nearby tendon is detached at one end and passed through a hole drilled in the thumb’s metacarpal bone. The remaining tendon is rolled like an anchovy and placed into the space where the bone was removed. Surgeons can also use artificial “anchovies” that eliminate the need to move a tendon. 

Who can benefit:  Adults with moderate to severe arthritis who have pain and difficulty pinching or gripping. 

Pros: Removing the entire trapezium eliminates the possibility of arthritis returning and, according to Dr. Ruch, LRTI has a 96 percent success rate. “Most patients achieve complete pain relief and mobility equal to that of a healthy thumb, with results lasting at least 15 to 20 years,” he says. 

Cons: LRTI has a lengthy and sometimes painful recovery and rehabilitation period, including at least four weeks of wearing a thumb cast. Patients may experience decreased pinch strength, making it difficult to grasp and hold objects. LRTI also noticeably shortens the thumb. When the entire trapezium is removed, there are few repair options if symptoms persist after surgery. 

Hematoma and Distraction Arthroplasty 

In this simple, somewhat controversial procedure, surgeons remove the trapezium bone in the wrist and, with a wire, temporarily immobilize the thumb. The wire is removed six weeks later. The idea is that, without the constant friction caused, in part, by the trapezium, the body can heal itself. 

Who can benefit: People with moderate to severe arthritis who want a less complicated surgical procedure; older, less active patients; and those who have had a failed reconstruction procedure. 

Pros: Most patients get complete pain relief, an increase in grip strength and improved overall function. This procedure avoids complications associated with tendon harvesting and more complex operations. 

Cons:  Removal of the trapezium has been known to come with significant complications, including loss of pinch strength and thumb shortening. Proponents of the procedure claim immobilizing the joint for a few weeks prevents these complications. 

Total Joint Replacement (Arthroplasty) 

Like hip or knee replacement, this procedure removes all or part of the damaged thumb joint and replaces it with an artificial implant. Early implants were made of silicone. Surgeons now use metal or pyrocarbon prostheses and cushioning synthetic spacers that sit between the bones. 

Who can benefit:  Metal joint replacements are an option for older patients with few functional demands because the implants tend to fail with heavy use. Spacers, which have lower failure rates but higher complication rates, are generally reserved for younger or very active adults with more advanced disease. 

Pros:  Thumb arthroplasty is a less invasive surgery (because there is no grafting) with faster recovery and rehabilitation times. Some implants are placed without removing the trapezium, thereby preserving healthy tissue, improving strength and providing options if additional procedures are needed. 

Cons:  Spacers have high complication rates for some patients, including bone damage (osteolysis), persistent pain and inflammation. So far, other prostheses have not proved as reliable or durable as tendon grafts, Dr. Ruch says. 

Fusion (Arthrodesis) 

Arthrodesis eliminates pain by fusing the bones in the joint together. Surgeons create a socket by hollowing out the thumb’s metacarpal bone and then shaping the trapezium into a cone that fits inside the socket. A metal pin holds bones together to maintain proper alignment and prevent movement while the bones fuse. 

Who can benefit:  Younger, active patients who have post-traumatic arthritis or physically demanding jobs (and may therefore wear out an implant quickly); people with RA; and those who have undergone thumb surgery but haven’t gotten relief from symptoms. 

Pros:  Arthrodesis produces a stable, pain-free thumb that can grasp and pinch. 

Cons: The procedure has a relatively high complication rate, can damage nearby joints and cause loss of mobility in the CMC joint, including the ability to lay the palm flat and put the fingers and thumb together in a cone shape. Complications are more likely in people older than 40, according to a 2014 Journal of Bone and Joint Surgery study. Arthrodesis fails in 8 to 21 percent of people, requiring a repeat surgery. 

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Live Yes! INSIGHTS


Give Just 10 Minutes.

Tell us what matters most to you. Change the future of arthritis.

By taking part in the Live Yes! INSIGHTS assessment, you’ll be among those changing lives today and changing the future of arthritis, for yourself and for 54 million others. And all it takes is just 10 minutes.

Your shared experiences will help:

- Lead to more effective treatments and outcomes
- Develop programs to meet the needs of you and your community
- Shape a powerful agenda that fights for you

Now is the time to make your voice count, for yourself and the entire arthritis community. 

Currently this program is for the adult arthritis community.  Since the needs of the juvenile arthritis (JA) community are unique, we are currently working with experts to develop a customized experience for JA families. 

How are you changing the future?

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Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. They contribute $2,000,000 to $2,749,000

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Our Visionary partners help us plan for a future that includes a cure for arthritis. These inspired and inventive champions have contributed $1,500,00 to $1,999,999.

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