Exercises for arthritic hands

Dear Dr. Roach: I am a 69-year-old woman developing arthritis in my fingers. I do various exercises.

I recently visited a hand orthopedist to get a steroid injection. He advised me to avoid exercising my fingers because it puts extra strain on the joints and may accelerate the symptoms. Are you aware of evidence for or against hand exercise? — J.G.

It is true that symptoms of osteoarthritis in the hand will often get worse after exercise. I doubt that stretching and straightening exercises are doing harm: It’s high-impact exercises that should be avoided.

Moreover, there is sufficient data from clinical studies to make us reasonably sure that regular hand exercises, done consistently over a period of time ranging from three to six months, reduced hand stiffness and pain, and improved hand function. My advice is to avoid overdoing hand tasks.

Dear Dr. Roach: I have been bothered by the fungi on my toenails! I asked my doctor for an oral medicine, but then I was hesitant to take it after she said I have to take the medicine for six months, and my liver should be tested every month.

That scared me. Please give me your opinion regarding this. — C.G.

The prescription medication efinaconazole (Jublia) is specifically designed to treat nail fungus, and is applied to the toenails. Trials show it has 15% to 20% effectiveness. Unfortunately, it is very expensive: A bottle (which lasts about a week) costs about $600 at goodrx.com, and treatment is intended to last 48 weeks.

Oral medications, such as terbinafine (Lamisil) and itraconazole (Sporanox), are more effective than any topical treatment. However, they do have the rare potential to cause liver damage, sometimes permanently, even fatally. Because of this, I recommend against it.

Even if a treatment is effective, recurrence is common.