For people with rheumatoid arthritis and osteoarthritis, moist heat in the form of warm compresses or paraffin dips can help reduce the pain when hand inflammation is mild to average. Paraffin is a waxy substance derived from petroleum. It melts when heated to about 120°F to 130°F. The hands are dipped several times so that a film of paraffin forms that keeps the temperature warm for about ten to 15 minutes. This modality is usually done at occupational-therapy centers, but home kits are also available. Care should be taken to avoid temperatures over 130°F, or burns may occur. An alternative is a microwavable gel pack or a heating pad wrapped in a towel. The heat treatment should be applied for ten to 15 minutes. Cold compresses or cold packs are helpful when there is marked inflammation of the hands or other joints. One can use ice cubes or crushed ice wrapped in a towel, a frozen gel pack, or a frozen bag of peas. Cold application should last ten to 15 minutes and can be repeated throughout the day. Care has to be taken with two other rheumatic problems that can involve the hands: Raynaud’s phenomenon and hand vasculitis. In Raynaud’s phenomenon there is hyperreactivity (excessive reaction) of hand arteries to cold temperatures, resulting in abnormal narrowing (vasospasm) of the arteries when the hands or the body is cooled. Narrowing of the arteries results in decreased blood circulation, which causes the fingers to become mottled bluish or white, painful, and tingly. When the fingers are warmed up after such an episode, they become dusky red. Eventually the same reaction may be seen in the toes, and at times can be triggered by emotional stress. Raynaud’s phenomenon can exist by itself (primary or Raynaud’s disease) or as a part of a rheumatic disease like scleroderma, systemic lupus, or pulmonary hypertension. At times Raynaud’s may precede scleroderma by several years. It is best to prevent Raynaud’s phenomenon. A person with this problem should keep the hands, feet, and body warm, and avoid immersion of the hands in cold water. Vasculitis is inflammation of blood vessels, usually arteries. The inflamed blood vessels may develop narrowing or even blockage by a clot, which decreases or cuts off blood circulation of the area. When vasculitis involves hand arteries it is manifested by red painful areas, purpura (a purplish rash referred to as “blood spots”), ulcers of the fingertips, or even gangrene. In gangrene blood circulation is cut off, the fingertips become dark blue-purple, very painful, and eventually turn black. Such areas of gangrene may eventually need amputation of the necrotic (dead) tissue. Vasculitis may occur as an independent condition or as part of systemic lupus. With hand vasculitis, contact with hot or cold water can cause pain and perhaps more tissue damage, and should be avoided. So, regarding your coworker, the answer is yes, she could have Raynaud’s or vasculitis in particular, which are made worse by immersing her hands in water of various temperatures. Learn more in the Everyday Health Arthritis Center.
