What are the management options for osteoarthritis (OA) of the hands and wrists?

From the Guidelines

Management of osteoarthritis (OA) of the hands and wrists should prioritize a multimodal approach, combining non-pharmacological and pharmacological therapies, with a focus on individualized treatment and shared decision-making, as recommended by the most recent guidelines 1.

Key Components of Management

• Non-pharmacological approaches:
  • Joint protection techniques
  • Splinting, particularly for thumb base OA
  • Heat/cold therapy
  • Hand exercises to maintain strength and range of motion
• Pharmacological approaches:
  • Topical NSAIDs, such as diclofenac gel, as first-line medication for pain relief
  • Oral analgesics, starting with acetaminophen and progressing to oral NSAIDs like ibuprofen or naproxen for short-term use
  • Intra-articular corticosteroid injections for temporary relief in cases of inadequate response

Considerations for Treatment

• Treatment should be individualized based on the patient's specific needs, including 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 comorbidities and co-medication 1.
• The use of systemic treatments should be minimized, especially for mild to moderate pain and when only a few joints are affected, with preference for local treatments like topical NSAIDs and capsaicin 1.
• Surgery, including joint fusion, arthroplasty, or joint replacement, is reserved for patients with severe pain and functional limitations who have not responded to conservative measures 1.

Importance of Recent Guidelines

The 2019 American College of Rheumatology/American College of Rheumatology guideline for the management of osteoarthritis of the hand, hip, and knee 1 provides the most up-to-date recommendations, emphasizing the importance of a comprehensive approach to managing OA, including education, exercise, weight loss for overweight patients, and the use of topical and oral NSAIDs, as well as intra-articular injections for symptom management.

Prioritizing Patient Outcomes

The primary goal of OA management is to improve patient outcomes, including reducing pain, improving function, and enhancing quality of life, while minimizing the risks associated with treatments 1.

From the Research

Management Options for Osteoarthritis (OA) of the Hands and Wrists

The management of OA of the hands and wrists involves a combination of non-pharmacological and pharmacological approaches.

• Non-pharmacological approaches include:
  • Orthoses
  • Exercise
  • Diet
  • Patient education 2
  • Educating patients about self-management
  • Provision of assistive devices
  • Application of splints for thumb base OA 3
• Pharmacological approaches include:
  • Topical and oral NSAIDs for short-term symptom alleviation of pain 3
  • Intra-articular corticosteroid injections 4
  • Other treatments such as capsaicin, tramadol, and acetaminophen, although their use is more controversial 4

Guidelines for Management

Several guidelines are available for the management of OA, including those from the European League Against Rheumatism (EULAR) and the Osteoarthritis Research Society International (OARSI) 2, 5.

• The Italian Society for Rheumatology has also developed clinical practice guidelines for the diagnosis and management of knee, hip, and hand OA 6.
• These guidelines provide evidence-based recommendations for the management of OA, including non-pharmacological and pharmacological approaches.

Treatment Considerations

When managing OA of the hands and wrists, it is essential to consider the individual patient's needs and adapt the approach accordingly 2, 3.

• The treatment plan should be tailored to the patient's specific symptoms, functional limitations, and comorbidities 4.
• Clinicians should stay up-to-date with the latest evidence and recommendations to optimize treatment plans for patients with OA 4.