From the Guidelines
The initial management for degenerative joint changes in the right hand should involve a combination of non-pharmacological and pharmacological approaches, starting with education on joint protection and exercise, as well as consideration of topical NSAIDs or capsaicin for pain management, as recommended by the most recent guidelines 1. The management plan should be individualized according to the localization of OA, risk factors, type of OA, presence of inflammation, severity of structural change, level of pain, disability, and restriction of quality of life, as well as comorbidity and co-medication 1. Key components of the management plan include:
- Education concerning joint protection and an exercise regimen involving range of motion and strengthening exercises 1
- Local application of heat or ultrasound, especially before exercise 1
- Use of splints for thumb base OA and orthoses to prevent or correct lateral angulation and flexion deformity 1
- Topical NSAIDs or capsaicin for pain management, as conditionally recommended by the American College of Rheumatology 1
- Oral NSAIDs, including COX-2 selective inhibitors, or tramadol, may be considered for patients who do not respond to topical treatments, although their use should be carefully weighed against potential risks, particularly in patients over 75 years old 1
- Paracetamol (up to 4 g/day) is recommended as the oral analgesic of first choice, due to its efficacy and safety 1 It is essential to periodically re-evaluate the patient's requirements and response to treatment, adjusting the management plan as needed to optimize outcomes and minimize adverse effects 1.
From the Research
Initial Management for Degenerative Joint Changes
The initial management for degenerative joint changes in the right hand involves a combination of conservative treatments.
- The goal of treatment is to alleviate pain, maintain joint mobility, and prevent further degeneration 2.
- Conservative treatments may include medication, physical therapy, and orthotics 3.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and limited activity may be recommended as initial treatments 4.
- Gradual range-of-motion exercises and continuation of daily NSAIDs use may be recommended if pain improves 4.
- Treatment should vary depending on the severity of disease and patient's expectations and level of activity 3.
Conservative Treatment Options
Conservative treatment options for degenerative joint changes in the hand include:
- Analgesic and anti-inflammatory drugs 3
- Physical therapy and exercises to maintain muscle strength, joint stability, and mobility 3
- Orthotics and cartilage therapeutics 2
- Acupuncture, joint mobilizations, and palliative adhesive taping of the affected joint 5
Duration of Conservative Treatment
The duration of conservative treatment for degenerative joint changes in the hand may vary.