Hand Osteoarthritis Management

Non-Pharmacological Interventions

The American College of Rheumatology strongly recommends thumb splinting/orthoses for first carpometacarpal (CMC) joint osteoarthritis, with both neoprene and rigid orthoses being effective 1
The European League Against Rheumatism recommends using splinting/orthoses, particularly effective for thumb base OA and to prevent/correct deformities, with optimal effectiveness when used for at least 3 months 2
Local heat application, such as paraffin wax or hot packs before exercise, provides temporary pain relief with strong evidence (77% recommendation) 2
Range of motion exercises, strengthening exercises for hand muscles, and techniques to minimize stress on affected joints are recommended by the European League Against Rheumatism, including local application of heat for temporary pain relief 2, 3, 4
Exercise therapy, including active finger motion exercises, range of motion exercises, and strengthening exercises, is an essential component of conservative management, with supervised exercise being more effective 3, 4
Patient education should include information about the condition and its management, joint protection techniques, ergonomic principles, and pacing of activities, with evaluation for ability to perform activities of daily living and provision of adaptive equipment as needed 5, 6, 7

Topical NSAIDs are preferred over systemic treatments for mild to moderate pain, according to the European League Against Rheumatism, with a strength of evidence (ES) = 0.77 (95% CI 0.32 to 1.22), and are strongly recommended for hand OA, with a safer profile than oral NSAIDs, especially in older adults 2, 5
Oral paracetamol is recommended as the first oral analgesic for mild to moderate pain, and oral NSAIDs may be considered if topical NSAIDs and paracetamol are ineffective, but should be used at the lowest effective dose for the shortest duration, with monitoring for side effects, especially in older adults 8, 5
Chondroitin sulfate may be considered for osteoarthritis, though evidence for hand OA is limited, with a moderate strength of evidence, as suggested by the European League Against Rheumatism 7
The following treatment algorithm is recommended:

Intra-articular corticosteroid injections are effective for painful flares, especially in trapeziometacarpal joint OA, with one uncontrolled trial showing significant pain reduction at one month 2
Intra-articular hyaluronan may be useful in treating trapeziometacarpal OA, with one active controlled RCT suggesting it is as effective as corticosteroid for pain relief with potentially more prolonged benefit 2

Surgical options, including interposition arthroplasty, osteotomy, or arthrodesis, should be considered only when conservative treatments have failed and there is marked pain and/or disability 2
For DIP joints specifically, arthrodesis (joint fusion) is the recommended surgical approach, and consider surgery (e.g., interposition arthroplasty, osteotomy, arthrodesis) for severe osteoarthritis when conservative treatments have failed 7, 2
Single surgical procedures (e.g., trapeziectomy alone) may be as effective as combined procedures with fewer complications 7, 2

Approximately 80% of patients recover fully within 3-6 months with appropriate treatment 9
Follow-up in 4-6 weeks to evaluate response to treatment is recommended, with monitoring for medication side effects, particularly with oral NSAIDs, and evaluation of the ability to perform activities of daily living, providing assistive devices as needed to help with daily activities 9, 1, 7, 6
Early intervention with conservative management leads to better outcomes, and short-term use (less than 3 months) of splinting may not provide significant benefit 7
Relying solely on oral NSAIDs without addressing mechanical factors is a treatment pitfall, as noted by the European League Against Rheumatism 2

CMC joint OA is more common in postmenopausal women, and in patients older than 75 years, thumb CMC osteoarthritis has a radiographic prevalence of 25% in men and 40% in women 3