What is the initial management for bilateral hand osteoarthritis?

From the Guidelines

The initial management for bilateral hand osteoarthritis should prioritize a combination of non-pharmacological and pharmacological approaches, starting with patient education, regular hand exercises, and topical NSAIDs, as recommended by the 2019 update of the EULAR recommendations for the management of hand osteoarthritis 1.

Key Recommendations

• Patient education about joint protection techniques and activity modification to reduce strain on affected joints
• Regular hand exercises to maintain range of motion and strengthen supporting muscles
• Topical NSAIDs, such as diclofenac gel (1% applied 4 times daily), as the first pharmacological treatment of choice for pain relief
• Acetaminophen (up to 3000mg daily in divided doses) for pain control
• Oral NSAIDs, like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily), for short-term use in patients with inadequate response to topical NSAIDs, while considering their cardiovascular and gastrointestinal risk profiles

Rationale

The 2019 EULAR recommendations 1 provide a comprehensive framework for managing hand osteoarthritis, emphasizing the importance of a multimodal approach that incorporates non-pharmacological and pharmacological interventions. By prioritizing patient education, regular exercises, and topical NSAIDs, healthcare providers can help patients manage symptoms, reduce pain, and maintain hand function while minimizing medication side effects. The American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee (2020) also supports the use of oral NSAIDs as a mainstay of pharmacologic management 1.

Additional Considerations

• Splinting of affected joints, particularly at night, can help reduce pain and improve function
• Heat and cold therapy can provide symptomatic relief
• Chondroitin sulfate may be used for pain relief and improvement in functioning, as suggested by the 2019 EULAR recommendations 1
• Intra-articular injections of glucocorticoids may be considered in patients with painful interphalangeal joints, although their use is not generally recommended for hand OA 1

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 initial management for bilateral hand osteoarthritis may include the use of NSAIDs such as naproxen to reduce joint pain and tenderness, and improve mobility.

• The recommended dosage and administration of naproxen should be followed as indicated in the drug label 2.
• Alternatively, topical capsaicin may be considered for localized pain relief, applied 3 to 4 times daily to the affected area 3.
• It is essential to consult a healthcare professional for proper evaluation and guidance on the management of bilateral hand osteoarthritis.

From the Research

Initial Management for Bilateral Hand Osteoarthritis

The initial management for bilateral hand osteoarthritis involves a combination of non-pharmacologic and pharmacologic measures.

• Non-pharmacologic measures include patient education, weight loss, and exercise 4, 5.
• Pharmacologic measures include the use of simple oral analgesics such as acetaminophen, topical therapy, oral nonsteroidal anti-inflammatory drugs (NSAIDs), and intra-articular injections of hyaluronic acid-like products or corticosteroids 4, 6, 7.

Treatment Options

Treatment options for osteoarthritis can be categorized into:

• Conservative management: includes non-pharmacologic measures, acetaminophen, NSAIDs, and intra-articular injections 4, 5, 6, 7.
• Surgical management: may be considered for patients with advanced disease who have not responded to conservative management 5.

Considerations for Treatment

When considering treatment options, it is essential to take into account the patient's individual needs, medical history, and potential risks and benefits of each treatment option 4, 5, 6, 7.

• The use of cyclooxygenase-2 (COX-2)-selective inhibitors may be considered for patients who do not respond to or cannot tolerate acetaminophen or traditional NSAIDs 6.
• Intra-articular corticosteroid injections may provide short-term pain relief in disease flares 4.