Hand Osteoarthritis Management

Treatment Options

• For hand pain with osteoarthritis and erosive changes, the American College of Rheumatology recommends using topical NSAIDs as first-line treatment, followed by oral NSAIDs at the lowest effective dose if needed, with intra-articular corticosteroid injections considered only for acute painful flares with inflammation 1, 2
• Topical NSAIDs, such as diclofenac gel, provide localized pain relief with minimal systemic side effects and are particularly effective for superficial joints like those in the hand 1
• Oral NSAIDs, such as ibuprofen, should be used at the lowest effective dose for the shortest duration to minimize gastrointestinal and cardiovascular risks 1
• Intra-articular corticosteroid injections may be considered for painful interphalangeal joints with clear signs of inflammation, but are not generally recommended for routine use or for thumb base OA 2, 3, 1

Non-Pharmacological Interventions

• Hand exercises, including range-of-motion and strengthening exercises, should be performed daily to maintain function and reduce stiffness 1
• Joint protection techniques, such as avoiding activities that aggravate symptoms and using larger joints for heavy tasks, can help reduce pain and improve function 1
• Orthoses/splints, such as night splinting for pain relief and daytime splinting during activities that worsen symptoms, can be considered 1

Surgery and Follow-up

• Surgery should only be considered if there is severe pain that significantly impacts quality of life, conservative treatments have failed after adequate trials, and functional limitations severely affect daily activities 1
• For erosive osteoarthritis of interphalangeal joints, surgical options are limited and should be carefully considered, as outcomes may be unpredictable 1
• Follow-up should be based on symptoms and response to treatment, with more frequent monitoring initially to assess treatment effectiveness and less frequent follow-up once symptoms are stable 2

Management of Hand Contractures

• First determine the underlying cause of hand contractures, which can include osteoarthritis, Dupuytren's disease, or other capsular contractures 4
• For OA-related contractures, the European League Against Rheumatism recommends first-line treatment with topical NSAIDs, such as diclofenic gel, and the American College of Rheumatology recommends second-line treatment with oral paracetamol up to 4g/day, and third-line treatment with oral NSAIDs at the lowest effective dose for the shortest duration 4, 3, 4
• Consider steroid injection only for painful interphalangeal joints with inflammation, as suggested by the American College of Rheumatology, using a small needle (25-27 gauge) and a dose of 5-10mg triamcinolone acetonide per joint, with ultrasound guidance not required for hand joints, and limiting the frequency of injections to avoid potential cartilage damage 2, 3, 4
• Reassess after the initial injection series, evaluating pain relief and functional improvement for OA, and monitoring nodule size for Dupuytren's disease, and consider alternative treatments if there is an inadequate response after 2-3 injections 4
• Steroid injections should be part of a comprehensive approach that includes orthoses, exercises, and joint protection techniques for optimal management of hand contractures, as recommended by the American College of Rheumatology, noting that the effects of steroid injections may be temporary, especially in OA, highlighting the importance of ongoing management and follow-up 4, 2, 1