Stuttaford answers your questions on arthritis and rheumatism

Q1: I am no longer able to make a fist due to arthritis of the middle joints of my fingers. Are there surgical options for fingers as there are for hip replacements? They are very painful and apart from Difene or Voltoral type gel rubs are there any stronger pain relief remedies? R Smith, Dublin

A: The reader hasn't told us his or her age nor whether the arthritis is the result of rheumatoid arthritis or osteoarthritis.

I would guess that the reader's troubles are the result of osteoarthritis as the middle and the terminal joints in the fingers are the ones more likely to be affected in osteoarthritis than are the first joints of the fingers. In rheumatoid arthritis it is usually the proximal finger joints between the fingers and the hands and those of the wrists that suffer most. Furthermore you have made no mention of troubles elsewhere in your body, and usually in rheumatoid arthritis the joint involvement is more widespread and doesn't often, for example, only affect the hands, feet or knees as it may do in osteoarthritis in which a joint may be subjected to some specific prolonged overuse or trauma.

Surgery is always an option but the rule is this should only be considered to relieve pain. Hip replacements when successful offer complete pain relief in well over 90 per cent of cases. Likewise knee joint replacements are usually successful in achieving this. Techniques for knee replacement are improving almost by the month. The first joint in the fingers, that between the hand and the fingers, are being successfully replaced in some cases with a plastic implant, but the decision to do this would have to be reached by your surgeon and rheumatologist. I would expect that they would be reluctant to undertake surgery in cases of osteoarthritis unless the pain couldn't be controlled by other means.

I have never been hugely enthusiastic about trying to achieve pain relief by rubbing in analgesic anti-inflammatory creams and balms and have preferred anti-inflammatory drugs taken by mouth. The problem with these NSAIDs drugs is that in older people, or those with a history of indigestion or dyspepsia, there is much higher incidence of gastro intestinal bleeding than is realised. The COX II inhibitors are excellent at relieving pain, less likely to cause gastro intestinal bleeding (that is occasionally fatal) but there is strong evidence that some of them may increase fractionally the chances of having an acute heart problem. Despite this when I have an acute attack of gout I take Arcoxia, a COX 2 inhibitor that so far has a clean bill of health as regards side effects but I wouldn't even recommend taking this COX 2 inhibitor permanently. My favourite NSAIDs is Arthrotec as it includes a constituent that is alleged to reduce the risk of gut haemorrhage or perforation.

The disadvantage of all joint replacements is that not only may they become loose and painful so that in time they inevitably fail but there is always the danger of infection. Finger replacements that I have seen carried out successfully have usually been done because of rheumatoid rather than osteo-arthritis.