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You’ve been experiencing pain in your wrists. At first you might chalk it up sleeping funny, or an overuse injury from your yoga class. But if the pain endures, and depending on the specific mix of your symptoms, you may be wondering whether it could it be carpal tunnel, a form of arthritis, or something else.

For some people, however, it’s often not an either-or situation. Having arthritis raises your risk of developing carpal tunnel, so you could have both conditions at the same time.

In this article, we’ll explain why arthritis may be a cause of carpal tunnel and share information about carpal tunnel symptoms, diagnosis, and treatment.

Arthritis vs. Carpal Tunnel Syndrome

While both arthritis and carpal tunnel can affect the wrists, hands, and fingers, the causes for the symptoms differ.

Rheumatoid arthritis is an autoimmune disease, which means your body’s own immune system attacks the joints, causing inflammation, pain, and swelling. Here are other common symptoms of rheumatoid arthritis.

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Osteoarthritis is the “wear-and-tear” type that occurs when cartilage that cushions joints wears away. Here are other common osteoarthritis symptoms.

Carpal tunnel syndrome occurs when a major nerve in the hand — the median nerve — becomes compressed in the carpal tunnel, a narrow passageway on the palm side of your wrist that also houses the tendons that bend the fingers.

The floor and sides of this inch-wide tunnel are formed by small wrist bones called carpal bones, which are linked together by a ligament that overlies the top of the carpal tunnel. (The word carpal comes from the Latin “carpus,” which means wrist.)

Repetitive hand motions, such as those that occur when someone works on an assembly line, often contribute to carpal tunnel syndrome. With excessive motion, the tendons of the fingers can get swollen or inflamed and squeeze the median nerve. Despite common thinking that typing causes CTS, even heavy computer use did not make people more likely to develop it, according to one study.

A number of health problems can also cause swelling of this area. Arthritis is one, but diabetes and thyroid issues are also associated with carpal tunnel syndrome, as are hormonal changes that occur during pregnancy. Injuries, such as a wrist fracture, can contribute to the onset of carpal tunnel syndrome.

How Arthritis Can Cause Carpal Tunnel Syndrome

“It’s very common to have carpal tunnel syndrome when you have rheumatoid arthritis, especially if you have rheumatoid arthritis of the wrist,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and medical advisor for CreakyJoints.

If you have rheumatoid arthritis, chances are it does affect your wrists — research shows they’re the most common site for RA in the upper body and that 75 percent of people with RA have wrist involvement.

Though its impact isn’t usually as great as RA, even osteoarthritis (OA), the wear-and-tear type of arthritis, increases the risk of carpal tunnel too. OA in the wrist can cause swelling and bony changes that crowd the carpal tunnel.

“The wrist is a very small area and if it gets inflamed for any reason, it can cause pressure on the nerve that leads to carpal tunnel syndrome,” says Robert Gotlin, DO, a sports and spine physician in New York City and an associate professor of rehabilitation medicine and orthopedics at the Icahn School of Medicine at Mount Sinai.

Interestingly, carpal tunnel, like rheumatoid arthritis, is three times more likely to affect women than men, possibly because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain.

Like OA, carpal tunnel is more likely to occur with age; more than three-quarters of people develop symptoms between the ages of 40 and 70.

Luckily, despite some similarities in symptoms between carpal tunnel syndrome and arthritis, doctors usually don’t have much trouble telling the two conditions apart. Even better, there’s some overlap between treatments for both conditions.

Telltale Symptoms of Carpal Tunnel Syndrome

When carpal tunnel develops, it has a typical pattern, says Dr. Gotlin. Some key signs, which can help differentiate carpal tunnel from different kinds of arthritis, include:

1. Numbness and/or tingling in the first three fingers (thumb, index finger, and middle finger)

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Most types of arthritis cause swelling, but the swelling of dactylitis is something else all together. “My fingers feel like they are going to burst,” psoriatic arthritis (PsA) patient Emily Terbrock told us on Facebook. This incredibly painful, red, and hot swelling can cause fingers to look like sausages, giving dactylitis the nickname “sausage fingers.”

Dactylitis, though, can be distinguished from regular joint swelling. “Dactylitis is the swelling of an entire digit — finger or toe — rather than just a knuckle within the finger or toe,” says rheumatologist Arthur M. Mandelin II, MD, PhD, associate professor of medicine at Northwestern University Feinberg School of Medicine in Chicago. “Usually, the affected digit is most swollen in the middle and less swollen at the ends, taking on a cigar-shaped appearance.”

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Which Types of Arthritis Does Dactylitis Occur With?

Dactylitis is associated with spondyloarthritis, which is an umbrella category of arthritis that notably causes symptoms in the spine, as well as other joints.

“Dactylitis can be associated with all of the spondyloarthropathies, including IBD-related inflammatory polyarthritis and reactive arthritis, but it’s most commonly with psoriatic arthritis,” says Mona Indrees, MD, a rheumatologist at AnMed Health in South Carolina. “Dactylitis can also be seen in other conditions such as sickle cell disease, gout, sarcoidosis, TB, and syphilis.”

These conditions can be differentiated by other clinical features and laboratory tests, says rheumatologist and researcher Dafna Gladman, MD, professor of medicine at the University of Toronto.

Because of the close connection between dactylitis and psoriatic arthritis, its presence can be used to diagnose psoriatic arthritis and distinguish it from other forms of arthritis.

“I have PsA and my first symptom was pain in my finger, which was misdiagnosed as tendinitis for months. It got to the point where my finger couldn’t bend at all, swelled twice its size, and was extremely hot,” Erin Jean Wheller told us on Facebook. “My rheumatologist took one look at me and immediately knew it was [psoriatic] arthritis.”

Other patients also told us dactylitis was one of their first PsA symptoms as well; its presence can be helpful in leading to a quick and accurate diagnosis.

What Causes Dactylitis?

“Dactylitis is caused by uncontrolled inflammation that results from spondyloarthropathies, and can be associated with flaring of the underlying joint disease,” Dr. Idrees says. “The swelling is diffuse and continuous throughout the tissue, affecting tendons, ligaments, synovium — the space that contains the joints and joint capsule — and adjacent soft tissue.” (Here’s more information about synovitis.)

In terms of why there’s such a strong association between dactylitis and psoriatic arthritis, there’s still no definitive answer, but Dr. Mandelin has some ideas. “It isn’t clear why dactylitis happens, but it is likely that its origin is related to the fact that patients with psoriatic arthritis have a tendency to develop inflammation of tendons and the surrounding tendon sheaths in addition to inflammation of the actual joints,” he says.

What Does Dactylitis Feel Like?

Dr. Idrees says the condition is often painful and can also severely limit functionality. The patients we heard from bore this out, describing incredible pain from their hands touching anything at all; a heavy, hot feeling; and not being able to bend or use their fingers.

“When it happens it starts out as a tightness, and eventually gets to the point where the skin is stretched so tight that it becomes itchy,” Lyin Despres described on Facebook. “Each movement of the affected finger is excruciating. It feels as though the nerves are being compressed by the swelling and if you move you will be tortured. You can’t get dressed or undressed, eat, use the bathroom, or do much of anything unassisted when this happens to both hands at the same time.”

Does Dactylitis Signal Worsening Disease?

Unfortunately, the presence of dactylitis often denotes more severe disease, Dr. Gladman says. “Digits with dactylitis are more likely to have damage than those without dactylitis,” she says. Dr. Mandelin says it’s important to note, though, that this is just an increased risk, and not a guaranteed outcome. “The take-away message is that patients with dactylitis should probably be watched more closely and have their disease controlled more tightly in order to try to counteract this risk,” he says.

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How Is Dactylitis Medically Treated?

Many patients we heard from said once they were diagnosed and found the right medicines for them, their dactylitis subsided. “I have had dactylitis in my fingers and a toe,” Joan Wzontek Alba told us on Facebook. “Now I’m on biologics and haven’t had a sausage finger since I found one that works.”

All three doctors we talked with agreed that biologics are more effective in treating dactylitis than conventional disease-modifying antirheumatic drugs (DMARDs).

“Even if joint disease responds to traditional DMARDS, dactylitis can be resistant, and at that point we may add a biologic,” Dr. Idrees says. “Research so far shows the most effective control of dactylitis comes from the use of biologics, including TNF inhibitors and some of the newer agents like ustekinumab and secukinumab, but one has to weigh the risks versus benefits.”

In addition to biologics, Dr. Mandelin advises patients with dactylitis to strongly consider “the new small-molecule JAK inhibitor agents, as these are clearly more effective against dactylitis than traditional DMARDs such as methotrexate.”

Here are a few more medical tips on treating dactylitis:

• Talk with your doctor to see which medication is right for your symptoms—and make sure you adhere to your medication regimen, Dr. Idrees says.
• If you have psoriatic arthritis, Dr. Mandelin advises to make sure you’re seeing a rheumatologist and a dermatologist, as the disease is complicated and needs to be addressed from all sides. “Psoriatic arthritis is more complex than many other forms of arthritis, and can affect the body in several unusual ways that aren’t always a concern with other forms of arthritis — dactylitis is only one such example,” he says.
• Let your doctor know right away if you experience dactylitis. “It is important to treat dactylitis immediately so that it does not become a chronic problem,” Dr. Gladman advises.

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Home Remedies for Dactylitis

In addition to medical treatments, some patients we heard from had suggestions for treating dactylitis at home. Talk to your doctor before trying home remedies.

• Use cold packs or soak hands in cold water.
• Wear compression gloves, or finger sleeves like volleyball and basketball players use.
• Try warm paraffin wax, icy hot, or other warming treatments.
• Keep fingers moving with crochet or knitting, a stress ball, or even just flex and release.
• Do regular range-of-motion exercises for fingers and toes.

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When the average person hears the word arthritis, chances are they think of osteoarthritis. Although there are over 100 different kinds of arthritis, osteoarthritis is the most common and well-known. It is largely a mechanical disorder that’s often caused by overuse or normal wear and tear on the joints as people get older. (However, osteoarthritis can occur at any age — the idea that osteoarthritis only affects older adults is a common myth.)

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About 30 million Americans have osteoarthritis. By comparison, about 1.5 million have rheumatoid arthritis, which is among the most common inflammatory types of arthritis.

In osteoarthritis, the cartilage that cushions the ends of bones wears down until the bones are (painfully) rubbing against each other. This usually develops slowly and gets worse over time. Many experts believe that anyone who lives long enough will eventually develop some degree of osteoarthritis, depending on factors like how heavily a joint has been used and whether it’s ever been injured. Not surprisingly, the weight-bearing joints like the knees, hips, and spine are particularly vulnerable to osteoarthritis. The hands, wrists, and shoulders are also common spots.

Osteoarthritis and Inflammatory Arthritis: Similarities and Differences

Osteoarthritis and inflammatory arthritis like rheumatoid arthritis share part of a name — the word “arthritis” means joint inflammation — but they are very different conditions. While rheumatoid arthritis is an autoimmune disease in which the body’s own immune system attacks the joints and causes inflammation, osteoarthritis is a much more mechanical disorder.

Unfortunately, having one kind of arthritis doesn’t confer any immunity against developing another. People with inflammatory arthritis are still at risk of developing osteoarthritis.

Sometimes the same joints are affected with both types of arthritis, and sometimes different joints are targeted. There is an increased risk of developing OA in a joint already affected by RA. When this occurs, it’s called secondary osteoarthritis. Secondary osteoarthritis can also occur after a joint injury or other medical condition.

“That’s why it’s extremely important to get early treatment and good treatment for RA or any inflammatory arthritis. This helps prevent secondary osteoarthritis,” says Nancy Ann Shadick, MD, a rheumatologist at Harvard’s Brigham and Women’s Hospital in Boston. The good news, according to Dr. Shaddick, is that “these days, because we have very good treatment for inflammatory arthritis, you don’t see as much secondary osteoarthritis.”

The risk of someone with RA developing osteoarthritis in other joints — joints unaffected by inflammatory arthritis — is the same as the general population’s. It would not be uncommon, for example, for someone to develop rheumatoid arthritis of the hands in middle age, and then develop osteoarthritis in the knee or hip decades later. That type of OA, which occurs with age and use but has no other underlying conditions or causes, is known as primary osteoarthritis.

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Osteoarthritis Symptoms

Here are some common early symptoms of osteoarthritis you should know (and here are symptoms of rheumatoid arthritis). If you experience any of these, make sure you let your rheumatologist know rather than assuming that what you’re feeling is simply a new manifestation of your RA or another inflammatory arthritis. Your rheumatologist will make sure you get the right treatment for both.

1. Pain

Pain is the most prominent symptom of both osteoarthritis and rheumatoid arthritis, but it’s not the same pain. “In osteoarthritis the joint pain is worse with use, worse as the day goes on, and feels better with rest,” explains Dr. Shadick.

By contrast, the pain of RA tends to be felt more at rest, and isn’t made worse by use. Also, people with RA may feel generally tired and ill from the disease, but OA’s symptoms are usually localized — limited to pain in and around the joints.

2. Stiffness

The stiffness of OA is mostly felt after inactivity, and can usually be relieved by gently stretching or moving the affected area. “People with OA don’t have a lot of stiffness in the morning — generally less than 30 minutes — while people with inflammatory arthritis can have morning stiffness that lasts for hours,” explains Dr. Shadick.

3. Mild swelling

In osteoarthritis, the joints may feel achy and tender, but they might not look very swollen or feel warm (the way joints affected by RA do). There may be more swelling after physical activity, and more swelling as the condition becomes more advanced.

4. Bone spurs

Extra bits of bone may be deposited around affected joints in osteoarthritis, making the ends of the fingers look somewhat deformed, for instance, or make the base of the big toe look larger.

5. Reduced flexibility

Joints affected by osteoarthritis may have a decreased range of motion, which can compromise movement. Osteoarthritis in the hips makes it more difficult to bend over. Osteoarthritis in the knees means the legs may not be able to bend as completely. Either can affect walking and stair climbing, among other activities.

6. Slow onset

Osteoarthritis develops very slowly, generally over many years. RA, on the other hand, can develop relatively quickly — over weeks or months.

7. Clicking or cracking sounds

The clicking or cracking that people may hear when they move joints affected by osteoarthritis are the sounds of bones rubbing together without enough cartilage to cushion them.

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8. Location in the hands

The hands are a common site for both osteoarthritis and rheumatoid arthritis, but the conditions tend to target different joints within the hands. “Osteoarthritis and rheumatoid arthritis look a little different,” says Dr. Shadick. “In the hands, for instance, RA tends to affect the knuckles, whereas OA tends to affect the end joints.” (Here’s what to know about osteoarthritis in the base of the thumb.)

9. Asymmetry

It’s common for osteoarthritis to affect a joint on only one side of the body, such as the left knee rather than the right (or vice versa). In RA the disease affects both sides of the body symmetrically, especially as it becomes more advanced.

10. Normal lab results

Osteoarthritis is usually diagnosed based on physical examination and X-rays. There are no specific blood test abnormalities associated with osteoarthritis.

How Osteoarthritis Is Treated

Medical treatment for OA is fairly straightforward, primarily consisting of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen to control pain and inflammation. Steroid injections in an affected joint can sometimes provide relief.

“There aren’t as many disease-modifying agents for OA as there are for inflammatory arthritis,” says Dr. Shadick. “There aren’t as many medications that can stop osteoarthritis dead in its tracks.” The race to discover or develop medications dubbed “DMOADs” — disease-modifying osteoarthritis drugs — that would halt or reverse joint degeneration is currently a very active area of research.

Right now there’s no way to reverse the joint damage that has occurred as a result of osteoarthritis. “But there’s still a lot that can be done to reduce the pain and disability,” says Dr. Shadick, citing physical therapy, joint-strengthening exercises, support (such as knee braces), and pain control. (Here are some exercises to help osteoarthritis in the knee, for example.)

The progression of osteoarthritis can be slowed with lifestyle changes, too. “There’s been some very interesting work done on a healthy diet — a diet that’s not high in sugar, high fructose corn syrup, fast food — and how it’s actually shown been shown to slow the progression of OA,” says Dr. Shadick. A so-called anti-inflammatory diet, which may help all types of arthritis, includes fatty fish, healthy fats like canola oil, flaxseed, beans, nuts, seeds, fruits, and green leafy vegetables.

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Weight loss, when appropriate, is also helpful, as it reduces the force on the joints. It’s estimated that every pound lost means up to five pounds of decreased pressure on weight-bearing joints like the knees and hips. Losing 20 pounds may relieve 100 pounds of pressure on these joints. “And the most important thing, with both OA and RA, is not to have weakness and muscle atrophy around an affected joint,” says Dr. Shadick. “Once you lose muscle strength around an affected joint the wear and tear can get worse.”

When a joint is damaged beyond repair from OA, and the pain and disability are no longer tolerable even with treatment, joint replacement surgery can help. Surgery used to be more common for people with RA, “but it’s done less now because the drugs for RA are so much better at controlling it,” says Dr. Shadick. But hip and knee replacement surgery is still common for osteoarthritis.

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