Hand Arthritis Management
Initial Non-Pharmacological Foundation
- The European League Against Rheumatism (EULAR) recommends education on joint protection techniques to avoid adverse mechanical factors that accelerate joint damage, with a strength of recommendation of 59-77 1, 3
- EULAR suggests a structured exercise regimen including range of motion and strengthening exercises performed daily at home, with a moderate overall recommendation 1, 2
- Heat application (paraffin wax or hot packs) before exercise sessions is recommended to improve joint mobility, with a strength of recommendation of 59-77 1, 2
Pharmacological Treatment Algorithm
- The EULAR guidelines recommend topical NSAIDs as the first-line treatment for mild to moderate pain, due to their superior safety profile 1, 4
- Topical capsaicin is equally effective with a NNT of 3 (95% CI: 2-5) for moderate pain relief, and has a strength of recommendation of 75 (95% CI: 68-83) 4
- Acetaminophen up to 4g/day is the oral analgesic of first choice, with a strength of recommendation of 87 (95% CI: 78-96) and 92% expert consensus 1, 2, 3
- Oral NSAIDs should be used at the lowest effective dose for the shortest duration, with periodic re-evaluation, and have a strength of recommendation of 81 (95% CI: 74-88) 1, 2, 5
Adjunctive Interventions
- Splints for thumb base OA are recommended, with a strength of recommendation of 67 (95% CI: 57-77) 1, 2
- Orthoses to prevent or correct lateral angulation and flexion deformity should be provided, with a strength of recommendation of 67 (95% CI: 57-77) 1, 2
Invasive Interventions
- Intra-articular corticosteroid injection is effective for painful inflammatory flares, especially for trapeziometacarpal (thumb base) joint OA, with a strength of recommendation of 60 (95% CI: 47-74) 1, 2, 3
- Surgery (interposition arthroplasty, osteotomy, or arthrodesis) should be considered for severe thumb base OA with conservative treatment failure, with a strength of recommendation of 68 (95% CI: 56-79) 1, 2, 3