Management of Bilateral Hand Degenerative Changes

Diagnosis and Clinical Assessment

The radiographic findings of degenerative changes in the distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints, and carpometacarpal (CMC) joint of the thumb are consistent with hand osteoarthritis (HOA), which commonly affects both hands in a symmetrical pattern 1, 2, 3
The involvement of characteristic target joints (DIPJs, PIPJs, thumb base) is a clinical hallmark of HOA 1
HOA typically presents with pain on usage and only mild morning or inactivity stiffness affecting one or a few joints at a time, with symptoms often intermittent and targeting characteristic sites (DIPJs, PIPJs, thumb base, index and middle MCPJs) 2
Functional impairment in HOA may be as severe as in rheumatoid arthritis and should be carefully assessed, looking for clinical hallmarks such as Heberden and Bouchard nodes and/or bony enlargement with or without deformity 3, 4

Patients with polyarticular HOA are at increased risk of knee OA, hip OA, and OA at other common target sites (generalized OA) and should be assessed accordingly 5
Different subsets of HOA (IPJ OA with/without nodes, thumb base OA, erosive OA) may require different management approaches 6
Blood tests are not required for diagnosis of HOA but may be needed to exclude coexistent inflammatory disease if marked inflammatory symptoms/signs are present 7
Regular assessment of pain, function, and quality of life using validated outcome measures is necessary, with monitoring for disease progression and development of OA at other sites 4, 5

Underestimating the functional impact of HOA, which can be as severe as rheumatoid arthritis, is a common pitfall to avoid 4
Failing to recognize different HOA subsets (nodal, erosive, thumb base) that may require specific management approaches is another pitfall to avoid 6
Overlooking the need to assess for OA at other sites in patients with polyarticular HOA is also a common mistake 5
When erosive changes are present, referral should be considered, as these may indicate a more aggressive disease course 8