What are the treatment options for hand osteoarthritis?

From the Guidelines

The most effective treatment approach for hand osteoarthritis involves a combination of non-pharmacological and pharmacological methods, with a focus on topical treatments and individualized care, as recommended by the 2019 EULAR guidelines 1.

Treatment Options

Treatment options for hand osteoarthritis include:

• Non-pharmacological treatments such as hand exercises, splinting, heat or cold therapy, and activity modifications to reduce joint stress
• Pharmacological treatments, with topical non-steroidal anti-inflammatory drugs (NSAIDs) being the first-line choice for pain relief, as they have been shown to be effective and safe for hand OA, with a level of evidence of Ia and a strength of recommendation of 75 (68 to 83) 1
• Oral analgesics, such as acetaminophen or NSAIDs, can be used for symptom relief, but should be used at the lowest effective dose for the shortest duration due to potential side effects
• Intra-articular glucocorticoids may be considered for painful interphalangeal OA, but are generally not recommended
• Surgical options, such as joint fusion or joint replacement, may be considered in advanced cases unresponsive to conservative treatment

Key Recommendations

• Topical NSAIDs, such as diclofenac gel, should be used as the first-line pharmacological treatment for hand OA, due to their efficacy and safety profile, as demonstrated by a systematic review of topical NSAIDs in hand OA, which showed a significant reduction in pain with minimal gastrointestinal side effects 1
• Non-pharmacological treatments should be tried first and used in conjunction with pharmacological treatments
• Treatment should be individualized and based on the specific needs and circumstances of each patient, as emphasized by the 2019 EULAR guidelines, which recommend a multidisciplinary and multimodal approach to treatment 1
• Regular follow-up and monitoring of treatment effectiveness and potential side effects is essential to ensure optimal management of hand OA, as recommended by the 2012 American College of Rheumatology guidelines 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 treatment option for hand osteoarthritis is naproxen, which has been shown to reduce joint pain or tenderness and improve mobility.

• Key benefits of naproxen for hand osteoarthritis 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 Hand Osteoarthritis

The treatment options for hand osteoarthritis include:

• Non-pharmacological approaches, such as orthoses, exercise, diet, and patient education, which are recommended as the first line of treatment 3
• Rehabilitation interventions, including exercise, splints, laser, heat, massage, and acupuncture, which have been shown to have varying degrees of effectiveness in improving hand pain, function, and physical impairments 4
• Conservative treatments, such as splints, resistance training, and physical exercise, which have been found to be effective in reducing pain and improving function in hand osteoarthritis 5
• Exercise programs, which have been shown to reduce hand pain, improve hand function, and reduce finger joint stiffness, although the evidence is of low quality and the effect sizes are small 6

Non-Pharmacological Interventions

Non-pharmacological interventions, such as:

• Splints, which have been shown to reduce pain and improve function in hand osteoarthritis 4, 5
• Exercise, which has been found to reduce hand pain, improve hand function, and reduce finger joint stiffness 4, 6
• Patient education, which is an important component of non-pharmacological treatment for hand osteoarthritis 3

Future Research Directions

Future research is needed to:

• Identify subgroups of patients with hand osteoarthritis who benefit most from different non-surgical and non-pharmacological treatments 7
• Investigate the effects of rehabilitation interventions on specific treatment goals for hand osteoarthritis 4
• Develop more effective and targeted treatment approaches for hand osteoarthritis 5, 6