Hand osteoarthritis (OA) is a common musculoskeletal disease associated with hand pain, stiffness, functional limitation, decreased grip strength and reduced quality of life. The European League Against Rheumatism (EULAR) has published recommendations for the management of hand OA based off the latest evidence.
Recommendations for the management of hand OA with support from systematic reviews include:
- Exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient
- Oral analgesics, particularly NSAIDs, should be considered for a limited duration for symptom relief
- Intra-articular injections of glucocorticoids should not generally be used in patients with hand OA
- Patients with hand OA should not be treated with conventional of biological disease-modifying anti-rheumatic drugs
Recommendations with support from individual RCTs:
- Education and training in ergonomic principles, pacing of activity and use of assistive devices should be offered to every patient
- Orthoses should be considered for symptom relief in patients with thumb base OA, long term use is advocated
- Topical treatments are preferred over systemic treatments due to safety reasons
- Chondroitin sulfate may be used in patients with hand OA for pain relief and improvement in functioning
Expert opinion also recommends surgery for patients with structural abnormalities when other treatment modalities have not been effective, and that long-term follow up of patients with hand OA should be adapted to patient’s individual needs.
The evidence supporting exercises had wide variability in exercise type, frequency and repetitions, therefore using clinical judgement and tailoring exercises towards a patient’s goals and needs is recommended. This variability was also true for orthoses used in the RCTs, and the same recommendation of tailoring towards patient’s goals and needs is also recommended.
Kloppenburg, M., Kroon, F. P., Blanco, F. J., Doherty, M., Dziedzic, K. S., Greibrokk, E., ... & Maheu, E. (2018). 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Annals of the rheumatic diseases, annrheumdis-2018.