What are the treatment options for osteoarthritis (OA) in bilateral hands?

From the Guidelines

Treatment of osteoarthritis in bilateral hands should prioritize non-pharmacological approaches, including hand exercises, splinting, and activity modification, with topical NSAIDs being the first-line pharmacological treatment due to their localized relief and fewer systemic side effects, as recommended by the 2019 update of the EULAR recommendations for the management of hand osteoarthritis 1.

Non-Pharmacological Treatments

• Hand exercises to maintain strength and range of motion
• Splinting to support painful joints
• Heat or cold therapy for pain relief
• Activity modification to reduce joint stress

Pharmacological Treatments

• Topical NSAIDs, such as diclofenac gel (1% applied to affected joints 4 times daily), as the first-line treatment for their localized relief and fewer systemic side effects 1
• Acetaminophen (500-1000mg every 6-8 hours, not exceeding 3000mg daily) as a alternative option due to its safety profile
• Oral NSAIDs, such as ibuprofen (400-800mg three times daily with food) or naproxen (250-500mg twice daily), can be used for inflammation and pain, but should be used cautiously due to gastrointestinal and cardiovascular risks, especially in older adults
• Intra-articular corticosteroid injections can provide temporary relief for particularly painful joints

Surgical Options

• Joint fusion or arthroplasty might be considered in advanced cases unresponsive to conservative treatment The 2019 update of the EULAR recommendations for the management of hand osteoarthritis 1 and the 2020 American College of Rheumatology guideline for the management of osteoarthritis of the hand, hip, and knee 1 provide the most recent and highest quality evidence for the treatment of osteoarthritis in bilateral hands.

From the FDA Drug Label

In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease

The treatment option for osteoarthritis (OA) in bilateral hands is naproxen, which has been shown to reduce joint pain or tenderness and improve mobility.

• Key benefits of naproxen for OA treatment include:
  • Reduction in joint pain or tenderness
  • Increase in range of motion
  • Improved mobility
  • Improvement in capacity to perform activities of daily living impaired by the disease 2

From the Research

Treatment Options for Osteoarthritis in Bilateral Hands

• Non-pharmacological interventions, such as functional consultation and exercises, have been shown to improve grip strength in patients with osteoarthritis of the hand 3.
• A combined, interdisciplinary intervention, including detailed information on functioning, activities of daily living, physical activity, nutrition, assistive devices, instructions on pain management, and exercises, can significantly improve grip strength and self-reported satisfaction with treatment in patients with hand OA 3.
• Topical nonsteroidal anti-inflammatory drugs (NSAIDs) can be recommended for patients with mild OA, while oral NSAIDs are suggested for patients with moderate to severe OA at the lowest effective dose for the shortest possible duration to control symptoms 4.
• Duloxetine can be considered for patients with multiple-joint OA and high risk of NSAID-induced adverse events 4.
• Intraarticular injections with glucocorticoids can be suggested to achieve short-term pain relief in patients suffering from severe OA-related pain 4.

Non-Pharmacological and Non-Surgical Approaches

• Education, advice, or information about the etiology, progression, prognosis, and treatment options of OA are recommended to be an ongoing and integral part of care 5.
• Exercise is a key core treatment in knee, hip, and hand OA and should be considered regardless of age, structural disease severity, functional status, pain levels, or the presence of comorbidities 5.
• Walking aids/devices and orthoses are recommended for patients with hip, knee, and carpometacarpal (CMC) joint OA 5.
• Hand exercise and prolonged thumb base splinting have been shown to be beneficial non-pharmacological treatments for hand OA 6.

Pharmaceutical Treatment

• Oral and topical NSAIDs, including COX-2 inhibitors, are strongly recommended first-line treatments for osteoarthritis due to their ability to improve pain and function 7.
• Intra-articular corticosteroid injections are generally recommended for osteoarthritis management and have relatively minor adverse effects 7.
• Other treatments, such as capsaicin, tramadol, and acetaminophen, are more controversial, and many updated guidelines offer differing recommendations 7.