Management of Carpometacarpal Joint Degenerative Joint Disease

Initial Conservative Management

The American College of Rheumatology recommends a hand orthosis as the first-line treatment approach for patients with carpometacarpal joint degenerative joint disease (DJD) 1, 2, 3
First carpometacarpal (CMC) joint orthoses are strongly recommended for symptom relief in patients with thumb base osteoarthritis, with custom-made orthoses being preferable to improve patient compliance 4, 3, 5
Long-term use of orthoses is advocated as studies show beneficial effects on pain and function when used for at least 3 months, with a strong recommendation for use 4
Hand exercises should be implemented to improve joint mobility, muscle strength, and thumb base stability, with exercises specifically aimed at the first carpometacarpal joint differing from those for interphalangeal joints 4
Exercise regimens should be supervised for better outcomes and should include strengthening exercises, with a conditional recommendation for supervised exercise 2
Patient education about osteoarthritis, its management options, and ergonomic principles is strongly recommended, with training in joint protection techniques and pacing activities also recommended 1, 4

Oral NSAIDs are strongly recommended for short-term use unless contraindicated, with a recommendation to prescribe at low doses for short periods and discontinue if not effective, while monitoring for side effects 1
Acetaminophen may be considered as an alternative, though it has limited efficacy, with a conditional recommendation for use 6
Topical NSAIDs are conditionally recommended for hand OA, including CMC joint involvement, with practical considerations limiting their effectiveness 6, 3

Intra-articular glucocorticoid injections are conditionally recommended for hand OA, including CMC joint involvement, and can provide temporary relief during acute pain flares 7, 3
Surgery should be considered when there is radiographic evidence of OA, marked disability, reduced quality of life, and other treatment modalities have been unsuccessful in relieving pain, with a strong recommendation for surgical consultation 1

A treatment algorithm is recommended, with first-line treatment consisting of a hand orthosis, exercise therapy, and education, followed by second-line treatment with topical NSAIDs, third-line treatment with oral NSAIDs, fourth-line treatment with intra-articular glucocorticoid injections, and fifth-line treatment with surgical consultation 1, 4, 3, 6