Symptoms of hand arthritis

Managing Symptoms of Arthritis in Your Hands

Exercises That Help Relieve Arthritis in the Fingers and Hands

“If someone is pain free, it is critical to keep joints in good range of motion. Simple shoulder shrugs, wrist, and finger range of motion exercises help keep joint range of motion,” says physical therapist Charles J. Gulas, PT, PhD, GCS, dean of the School of Health Professions at Maryville University of St. Louis. Being pain free is the key, Gulas stresses, especially when doing exercises intended to build strength. When pain acts up, rest and pain management may be a better bet.

Try these range-of-motion exercises to keep your hands, fingers, and thumbs (which affect about 60 percent of grip strength) flexible and to ease symptoms of arthritis in the fingers and in the hands overall:

  • Close your fist and then gradually open your hand, stretching your fingers out, then close slowly into a fist again.
  • Make circle motions with your thumb, keeping it straight.
  • Stretch your thumb away from the palm of your hand, then use it to touch each fingertip.

Repeat these exercises 3 to 10 times daily. Stop if you feel pain in a joint or if you’re experiencing additional pain (lasting more than two hours) once you’re done. Some people find that doing these hand exercises under warm water is helpful. If you have osteoarthritis, you may need to wear a splint, wear a compression glove, or use another type of support to help reduce wear and tear on your joints during your daily activities. Ask your doctor or a physical therapist to recommend the type of device that may help you.

You can also try squeezing a soft ball to build grip strength and help lessen symptoms of arthritis in your hands, although this is not recommended if you have rheumatoid arthritis.

Staying Physically Active Despite Hand Arthritis

Your doctor will tell you — and probably has already — that staying physically active is an important part of managing arthritis. In fact, according to a study of 5,715 adults with arthritis over age 65, a lack of regular, vigorous physical activity doubled the risk of functional decline. In other words, the less physically active the participants were, the more likely they were to become disabled.

Of course, despite data showing that physical activity helps people with arthritis become stronger and more flexible, anyone with arthritis will tell you that sometimes pain or stiffness makes it hard to get going, let alone lift weights at the gym. People with arthritis often give up activities they think of as optional, such as exercising or gardening, in order to have enough energy for the activities they feel obligated to do, such as cleaning the house. One study found that only 13 percent of men and 8 percent of women with arthritis met federal guidelines of at least 150 minutes of moderate-intensity activity per week.

If symptoms of arthritis in your hands or elsewhere are preventing you from participating in the physical activities you used to enjoy — and that are good for you — it may be time to find new ways to be active. For example, you may want to experiment with water activities (which are easier on the joints) such as swimming, or try tai chi, dance, or walking (which has the added benefit of being low-cost).

If symptoms of arthritis in your hands are starting to trouble you, it is important to keep both your hands and body active. If you have doubts about how to do this safely, talk to your doctor. Exercise is a wise investment in your long-term comfort and health.

Explain the pain – Is it osteoarthritis or rheumatoid arthritis?

If opening jars becomes more difficult because of painful hands, or if climbing stairs produces pain in your knees, “arthritis” is often the first thing that comes to mind. The two most common forms of arthritis—osteoarthritis and rheumatoid arthritis—can cause similar aches and pains, but there are a few key differences between them. For example:

Onset. Osteoarthritis occurs when cartilage (tissue in your joints that cushions your bones) wears away. Pain occurs when bone rubs against bone. This type of arthritis pain tends to develop gradually and intermittently over several months or years.

Osteoarthritis is the most common type of arthritis affecting 27 million Americans. Many people believe it’s a crippling and inevitable part of growing old. But things are changing. Treatments are better, and plenty of people age well without much arthritis. If you have osteoarthritis, you can take steps to protect your joints, reduce discomfort, and improve mobility — all of which are detailed in this report. If you don’t have osteoarthritis, the report offers strategies for preventing it.

Rheumatoid arthritis, on the other hand, is an inflammatory condition in which your immune system attacks the tissues in your joints. It causes pain and stiffness that worsen over several weeks or a few months. And joint pain isn’t always the first sign of rheumatoid arthritis—sometimes it begins with “flu-like” symptoms of fatigue, fever, weakness, and minor joint aches.

Location. Both osteoarthritis and rheumatoid arthritis can affect the hands. However, osteoarthritis often affects the joint closest to the tip of the finger, whereas rheumatoid arthritis usually spares this joint. And while rheumatoid arthritis can appear in any joint, its most common targets are the hands, wrists, and feet.

Type of stiffness. People often describe vague muscle aches as “stiffness,” but when doctors talk about “stiffness,” they mean that a joint doesn’t move as easily as it should. Stiffness may be prominent even when joint pain is not.

Mild morning stiffness is common in osteoarthritis and often goes away after just a few minutes of activity. Sometimes people with osteoarthritis also notice the same type of stiffness during the day after resting the joint for an hour or so. In rheumatoid arthritis, however, morning stiffness doesn’t begin to improve for an hour or longer. Occasionally, prolonged joint stiffness in the morning is the first symptom of rheumatoid arthritis.

For more about diagnosing and treating rheumatoid arthritis pain, buy Rheumatoid Arthritis, a Special Health Report from Harvard Medical School.

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Arthritis of the Wrist and Hand

What is arthritis?

Arthritis is a disease of the various tissues inside the joints. A joint is a point at which two or more bones meet. Arthritis can occur as a result of acute (short-term) or chronic (long-term) inflammation (irritation and swelling) in a joint and its surrounding soft tissues. It can also occur after trauma to the joint (such as a broken finger) or possibly from genetic (inherited) and environmental causes.

With arthritis, joints continue to worsen as the cartilage wears down. (Cartilage is the smooth “cushioning” tissue that lines joints.) This wear-down of cartilage causes changes in the structure that can be seen on X-rays. The surrounding soft tissues may also get weaker. (Soft tissues are the tendons, ligaments, muscles, and synovial membranes that connect, support, or surround the joint.)

Arthritis is frequently, but not always, painful and may result in a reduced range of motion in the joint, joint deformity, and loss of function. Although almost any joint in the body can be affected, the hand and wrist are common locations for many of the common types of arthritis.

Who is affected by arthritis?

Osteoarthritis affects virtually everyone, especially older people. Women are usually affected more than men and often at an earlier age. X-rays reveal joint damage in approximately 60% of adults over age 60, and in 80% to 90% of patients over age 75.

Rheumatoid arthritis affects about 1% of the adult population. Women are three times more likely than men to develop this disease. Though it may strike persons of any age, it typically begins between the ages of 20 and 40.

What are the types and causes of arthritis?

Osteoarthritis (also known as degenerative arthritis) is the most common type of arthritis. It may affect one or more joints anywhere in the body. Osteoarthritis usually occurs later in life and commonly affects the hands and larger weight-bearing joints, such as hips and knees. Osteoarthritis can cause pain and deformity and can limit the range of motion of the joint.

A number of factors are thought to be important in the development of osteoarthritis. Mechanical considerations (for example, joint stability and alignment, or arrangement) affect how forces are distributed across the joint, and therefore have an impact on how long the joint will last. Also, certain substances (biochemical factors) in the cartilage itself are thought to play a role in the eventual abnormal changes of this tissue.

Risk factors for osteoarthritis include age, traumatic injuries (such as a broken wrist), joint infections, and possibly overuse. Some people inherit the tendency to develop osteoarthritis. How this happens is not well understood. These people are usually affected at an earlier age.

Arthritis may also result from inflammatory conditions that can occur anywhere in the body. The most common inflammatory condition is rheumatoid arthritis. Other inflammatory “arthropathies” include lupus, gout, pseudogout, ankylosing spondylitis, and arthritis related to inflammatory bowel disease or psoriasis.

Rheumatoid arthritis is an inflammatory and presumed autoimmune disease that affects the entire body, especially the joints. (Autoimmune means the body’s immune system attacks its own tissue.) With regard to the joints, rheumatoid arthritis targets the synovium. Synovium is a tissue that lines and nourishes joints and tendons throughout the body. As part of this condition, the synovium grows, causing local damage to bones, joints, and soft tissues.

Rheumatoid arthritis commonly begins in the hands, wrists, ankles, and feet, and often affects the same joints on each side of the body. Eventually, many other joints are affected. The cause of rheumatoid arthritis is unknown, though genetic factors are thought to be critical.

What are the symptoms of arthritis?

Not all patients with arthritis will complain of pain, loss of motion, or deformity. The severity of the symptoms is only loosely linked with the severity of arthritis as seen on X-rays.

Minor joint injuries may aggravate existing joint damage, resulting in arthritic symptoms that the patient has not had before. These symptoms are more likely to be caused by the pre-existing arthritis, and not by the recent, relatively minor traumatic injury.

Symptoms of osteoarthritis and rheumatoid arthritis are in some ways the same. However, rheumatoid arthritis often will cause more long-lasting morning stiffness and lead to more swelling and redness of the joints. This inflammation of the soft tissues surrounding the joints can eventually result in deformities that limit patients’ ability to use their hands. In addition, patients in the early stage of rheumatoid arthritis may have such symptoms as weakness/tiredness, general discomfort, and loss of appetite.

Symptoms of arthritis from any cause can include:

  • Pain that is limited to the joint itself. This is the main symptom. At first, the pain will come and go and is made worse when in use (such as when gripping heavy objects). However, pain is relieved with rest. There may be days or weeks without pain, but also periods of constant discomfort. As the disease advances, the pain becomes more constant, even occurring at rest. The pain changes from a dull ache to a sharp pain, which sometimes extends beyond the joint area.
  • Loss of motion in the joints as arthritis progresses. However, sometimes as motion is lost, pain is lessened.
  • Joint motion that is accompanied by grinding, clicking, or cracking as the cartilage continues to wear down.
  • Joints that swell and often become red and tender to the touch. This is a sign of damage to the tissues surrounding the joint and the body’s response to the constant irritation. The deformity occurs as these stabilizing soft tissues are worn away.
  • Weakness that results from joint pain, loss of motion, and joint deformity.

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Recognizing Osteoarthritis in the Hand

Pain and stiffness due to arthritis in a hand(s) can affect a person’s ability to do everything from preparing meals to using a cell phone. Recognizing the symptoms of hand osteoarthritis and getting an accurate diagnosis are the first steps to getting treatment and making everyday tasks easier.

See Osteoarthritis Symptoms and Signs

Symptoms of Osteoarthritis of the Hand

There are a number of key signs and symptoms practitioners look for when diagnosing osteoarthritis in the fingers and wrists:

  • Pain and stiffness. People with hand arthritis often complain of localized pain in the thumbs, knuckles (DIP/PIP), and/or wrists. Stiffness may be worse after periods of inactivity. Everyday tasks such as using a smartphone or buttoning a shirt may become more difficult to perform.
  • Hand weakness. A person with hand osteoarthritis may notice that the affected hand(s) seems weaker than it was before osteoarthritis symptoms occurred. Gripping and pinching objects may be more difficult. For example, a person may have trouble opening jars or turning the ignition key of a car.
  • Carpal tunnel syndrome. When arthritis changes the bony and soft tissue structures in the wrist, an area within the wrist called the carpal tunnel can shrink, becoming more narrow. As the tunnel shrinks, it squeezes the nerve that travels through it, causing numbness and/or tingling in the thumb, index finger, long finger, and half of the ring finger.
  • Bouchard’s nodes. These bony growths develop in the middle knuckle, or PIP joint, making the knuckle look bigger or swollen. Bouchard’s nodes can make it difficult to get a ring on and off a finger.
  • Heberden’s nodes. Like Bouchard’s nodes, Heberden’s nodes are bony growths that develop in the end-most knuckle, or DIP joint.
  • Knobby-looking thumb. People who have osteoarthritis at the basilar joint of their thumbs may notice the base of the thumb looks “knobby” or “squared off.” This is a sign that bony growths have developed on the bones of the joint.

If hand pain comes on suddenly, it is more likely to be caused by trauma or another condition, not by osteoarthritis. If fingers, palms and/or wrists feel hot or the skin around a joint turns red, then osteoarthritis is probably not the culprit. An infection, rheumatoid arthritis, or another condition may be the cause, and consultation with a medical professional is advised.

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Diagnosing Osteoarthritis of the Hand

There is no single test for osteoarthritis of the hand. Rather, doctors use several approaches to decide whether hand symptoms are caused by osteoarthritis or something else.

  • Patient interview. The doctor will ask the person about which joints hurt, what activities make the pain worse, and how long he or she has been experiencing symptoms. Some patients may be asked to fill out a questionnaire about how pain affects their everyday activities. The doctor may also ask if the patient has a family history, previous injury, or job that puts him or her at higher risk for hand osteoarthritis.
    • In This Article:

      • When Hand Pain Is Osteoarthritis
      • Risk Factors for Hand Osteoarthritis
      • Recognizing Osteoarthritis in the Hand
      • Treatments for Osteoarthritis in Hands
      • Hand Osteoarthritis Video
  • Clinical evaluation. Just looking at the hands can give a doctor an idea whether or not a person has osteoarthritis. Bouchard’s nodes, Heberden’s nodes, and a knobby-looking thumb are all indicators of osteoarthritis. The doctor will also try to trigger pain by palpating the hands—feeling them and pressing on certain areas—and asking the patient to do certain tasks, such as grasping an object.
  • Medical imaging. X-rays can show the development of bony growths called osteophytes, loss of joint space caused by the loss of articular cartilage, and other changes.
  • See What Is Cartilage?

  • Lab testing. There are no lab tests that confirm osteoarthritis in the hand. However, a doctor may order lab tests to rule out other possible causes of hand pain, such as rheumatoid arthritis or psoriatic arthritis.

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Many people experience hand pain and stiffness. Recognizing these symptoms and getting a diagnosis can lead to an individual treatment plan that makes day-to-day living easier and less painful.

Symptoms


Rheumatoid arthritis

Symptoms affecting the joints

Rheumatoid arthritis mainly affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.

Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this is not always the case.

Pain

The joint pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.

Stiffness

Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist.

Like joint pain, the stiffness is often worse in the morning or after a period of inactivity.

Morning stiffness that is a symptom of another type of arthritis, called osteoarthritis, usually wears off within 30 minutes of getting up, but morning stiffness in rheumatoid arthritis often lasts longer than this.

Swelling, warmth and redness

The lining of joints affected by rheumatoid arthritis become inflamed, which can cause the joints to swell, and become hot and tender to touch.

In some people, firm swellings called rheumatoid nodules can also develop under the skin around affected joints.

Arthritis in Your Hands: Early Signs of Hand Arthritis, and What to Do About It

If you’ve been experiencing persistent pain in your hands, you may be wondering if arthritis could be to blame. But which type of arthritis in your hands might be the issue? The answer isn’t always obvious.

The two most common forms of arthritis — osteoarthritis (OA, or degenerative arthritis caused by wear and tear on the joints) and rheumatoid arthritis (RA, an inflammatory type of arthritis caused by inflammation in the joint) — share many symptoms in common. Plus, there are other, less common forms of inflammatory arthritis that affect the hands that your doctor will need to consider as well.

Types of Arthritis in the Hands

Both osteoarthritis and inflammatory arthritis can cause pain, stiffness (particularly in the morning), swelling, and tenderness of the joints in the hands. But people with inflammatory forms of arthritis like rheumatoid arthritis may display additional symptoms that aren’t seen in those with OA.

“OA patients lack the warmth and redness in the hands that patients with inflammatory arthritis have,” says Kevin Wayne Byram, MD, assistant professor of medicine, division of rheumatology and immunology and director of the Vanderbilt Vasculitis Clinic at Vanderbilt University Medical Center. “In addition, both hands are usually affected in those with inflammatory arthritis, while symptoms of OA are typically worse in the patient’s dominant hand.”

How long morning stiffness lasts can be revealing in determining which kind of hand arthritis you may have, he adds. People with inflammatory arthritis usually experience prolonged stiffness that lasts an hour or longer, while stiffness often eases in just five to 15 minutes in those with OA.

If your hand arthritis symptoms suggest inflammatory arthritis, Dr. Byram says the most likely culprit is rheumatoid arthritis (which often begins in the hands) but it could also be psoriatic arthritis (PsA), which commonly affects the hands too. Other symptoms of PsA include having puffy fingers and toes that resemble sausages (a condition called dactylitis), skin plaques, and pitted nails.

Your doctor will also need to consider whether your symptoms are due to palindromic rheumatism (PR), an episodic form of inflammatory arthritis (though palindromic rheumatism is rare). PR can attack any joint, but most commonly affects the hands.

Gout, a type of arthritis caused by high levels of uric acid in the body, could also be the culprit. However, while gout can affect the wrist and fingers, it is most likely to attack your big toe.

Other Possible Causes of Hand Pain

Hand pain is also a sign of Dupuytren’s contracture, a condition in which the tissue of the palm and fingers becomes thickened and tight, causing the fingers to curl inward. It’s not clear why Dupuytren’s contracture develops, though those who smoke, drink a lot of alcohol, and have seizures or diabetes are more vulnerable to developing it.

Your doctor will also consider whether your hand pain could be due to carpal tunnel syndrome, says Dr. Byram. “RA can be a cause of carpal tunnel syndrome, so if we see someone who has carpal tunnel, we’ll want to make sure they don’t have RA.” Carpal tunnel is a condition that occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist, according to the American Academy of Orthopaedic Surgeons.

How Doctors Diagnose Arthritis Hand Pain

To determine what’s behind your hand pain, your doctor will rely on your medical history, a physical exam, and imaging and blood tests to make a diagnosis and determine what kind of arthritis hand pain (if any) you have.

“Feeling a patient’s joints during the exam can help differentiate between OA and inflammatory arthritis,” Dr. Byram says. “The swelling feels harder in those with OA because extra bone at the joints, called osteophytes, forms over time. The swelling in RA and other inflammatory disease feels softer.”

Imaging tests, such as X-rays or an MRI, can reveal joint erosion (seen in patients with inflammatory arthritis) and osteophytes and loss of cartilage (characteristic of OA).

If your doctor suspects inflammatory arthritis, they will also order blood tests to detect the presence of certain antibodies, such as rheumatoid factor or anti-CCP, that help identify RA and other types of inflammatory arthritis.

How Arthritis in the Hands Is Treated

If you’re diagnosed with an inflammatory form of arthritis, you have more treatment options than someone with OA. While nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage the pain of both types of arthritis, the development of disease-modifying antirheumatic drugs (DMARDs) and biologics has vastly improved the prognosis of those with inflammatory forms of arthritis by reducing inflammation and preventing further joint damage.

Cortisone injections can be useful for those with OA and conditions such as RA, though they’re usually used in patients whose inflammatory arthritis is limited to just one or two joints, Dr. Byram says. Injections of hyaluronic acid can be helpful for those with OA (the substance helps lubricate the joints), but these are better for managing pain in larger joints like the knees rather than the hands.

At-Home Therapies for Hand Arthritis

Fortunately, there are several at-home therapies that can help ease symptoms of both osteoarthritis and RA and other kinds of inflammatory arthritis in the hands.

“I recommend using a combination of both heat and ice,” Dr. Byram says. “Heat therapy is helpful in the morning to loosen up the joint, while ice therapy is best later after a day’s worth of activity.”

He also recommends that patients with arthritis of the hands work with hand therapists. These medical professionals can show you how to make everyday activities easier and help you avoid stressing your painful joints by using assistive devices.

“A lot of these devices are designed to provide a larger area for people to grip,” Dr. Byram explains. “For example, there are grips you can slide onto eating utensils and tools that make it easier to open jars and put on your socks and shoes.”

Hand therapists can also provide you with simple exercises to maintain range of motion in your fingers, and may also recommend using splints to ease stress on your joints.

Keep Reading

  • 9 Signs You’re Seeing the Right Rheumatologist (and 5 Signs You Might Need a New One)
  • Advice for Making Household Chores with Arthritis Easier
  • 30 Tips and Tricks to Prevent Arthritis Morning Stiffness

Wrists & hands

How are wrists and hands affected by arthritis?

Any joint in your fingers, thumbs, knuckles and wrists can be affected by arthritis. Many different types of arthritis can affect your hands and cause joint pain, swelling and stiffness. People with hand arthritis often find their grip weakens and it becomes harder to do fine movements, such as turning a key or tying shoelaces.

Find out about aids and equipment that can make everyday tasks easier. Learn ways to protect your hands and manage your symptoms.

How can I protect (rest) my sore hands?

The first thing to do is to become more aware of how you are using your sore joints. For example, try watching how you make a hot drink. What is happening to your wrist and fingers as you turn on the tap or lift a heavy kettle? Does it cause pain? Try to think of another way of doing this activity which will reduce those aches and strains. You might try picking up the kettle with two hands. Or use a tap turner to make it easier to grip the tap. These are examples of ‘joint protection’. It doesn’t mean you should stop using your joints. It just means that you should use them differently to reduce the amount of stress going through your joints.

Here are some ways to protect the joints in your hands:

  • Take notice of pain – it can serve as a warning that your joints are being overworked. Rather than giving up an activity altogether, try taking regular rests during the activity and learning ways to manage pain. You will usually find you can still do the things you enjoy without discomfort.
  • Use larger, stronger joints – for example, carry your shopping bags over your shoulder rather than in your hands.
  • Spread the load over several joints – try carrying things with two hands.
  • Reduce the effort you have to put in – there is a wide range of labour-saving tools and equipment available. Buy pre-cut vegetables and meat to make cooking easier.
  • Avoid gripping things tightly – find out about gadgets that can make gripping and holding objects easier.
  • See an occupational therapist to learn more ways to make daily tasks easier and take pressure off your joints.
  • Visit an Independent Living Centre. These centres have a wide range of tools and equipment on display. You can get advice, including where to purchase equipment, in person or over the phone. Occupational therapists are also available at the centres to provide advice about equipment. Although you can drop in at anytime, it is preferred that you call the telephone enquiry service beforehand.

Are splints useful?

Splints may be helpful in some cases. They are often used to support the joint at the base of the thumb and for hands affected by rheumatoid arthritis. Splints are usually worn only when the joint is painful or to protect the joint during certain activities. Splints should not stop you from moving or using your hands as this can cause the muscles to weaken and waste. An occupational therapist can advise whether hand splints will be useful for you.

Should I exercise my hands?

Don’t be afraid to use your hands. Regular exercise is important in reducing stiffness and keeping your joints and muscles working. Try to make sure you move any affected joints in your fingers, thumbs, knuckles and wrists as far as is comfortable several times a day. You could also see an occupational therapist or physiotherapist for specific hand exercises.

What else can I do?

There are other treatments that may help you deal with pain and stiffness:

  • Medicines: Many different types of medicines can help the symptoms of hand arthritis. Your doctor or pharmacist can help you understand which medicines are right for you and how best to use them.
  • Heat and cold: Applying heat, such as a hot pack (microwaveable wheat pack), heating pad or hot water bottle to stiff, painful joints may help relieve these symptoms. If your joints are hot and swollen you may find it useful to apply an ice pack. Try applying heat or cold to the painful area for 15 minutes. Always have a layer (such as a tea towel) between your skin and the heat or ice pack. You can repeat this whenever you need to throughout the day. Make sure the temperature of the skin returns to normal in between applying heat or ice packs to prevent damage to the tissues.
  • Creams: Applying creams or ointments containing anti-inflammatory medicines, capsaicin (an ingredient in cayenne and chilli peppers) or Arnica gel (a herbal medicine) may help control pain. Talk to your doctor or pharmacist about these types of creams.
  • Low level laser therapy: There is some scientific proof that low level laser therapy (by a physiotherapist) can help reduce pain and swelling, particularly in the hands of people with rheumatoid arthritis. See your physiotherapist for more information.
  • Glucosamine and chondroitin: It is unclear if glucosamine or chondroitin are useful for hand arthritis.
  • Fish oils: Fish oils may be useful for some forms of arthritis that affect the hands.
  • Herbal therapies: Creams containing Arnica gel may help control pain. There is no conclusive proof that other herbal medicines are effective in treating arthritis of the hands.

CONTACT YOUR LOCAL ARTHRITIS OFFICE FOR MORE INFORMATION AND SUPPORT SERVICES.

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