Management of Hand Osteoarthritis

Diagnostic Approach

The European League Against Rheumatism recommends determining the location of the non-tender red bump on the thumb joint, as it critically matters for diagnosis and treatment, with different implications for the interphalangeal (IP) joint, metacarpophalangeal (MCP) joint, or thumb base (carpometacarpal joint) 2
Heberden nodes (distal IP joint) and Bouchard nodes (proximal IP joint) are hallmark clinical features of hand osteoarthritis, presenting as bony enlargements that may appear red during inflammatory phases, according to the European League Against Rheumatism 2
Hand OA typically affects adults over 40, with female sex and menopausal status being significant risk factors, as stated by the European League Against Rheumatism 2

The American College of Rheumatology recommends topical NSAIDs as the first pharmacological topical treatment of choice for hand OA, which is safer than oral NSAIDs, particularly in older patients with comorbidities, with Level 1a evidence 1
The European League Against Rheumatism suggests considering orthoses for thumb base involvement for symptom relief, with long-term use advocated 1
The American College of Rheumatology advises exercises to improve function and muscle strength while reducing pain, which should be offered to every patient, with Level 1a evidence 1
The European League Against Rheumatism recommends training in ergonomic principles, pacing of activity, and use of assistive devices, which should be offered to every patient 1

The American Academy of Orthopaedic Surgeons states that surgery is reserved for severe cases of hand OA, considering when structural abnormalities exist and other treatments have failed, with trapeziectomy being the procedure of choice for thumb base OA 1
The American Academy of Orthopaedic Surgeons suggests that simple trapeziectomy alone is as effective as combined procedures but with fewer complications, for thumb base OA 7, 6