What treatment is recommended for hand pain with osteoarthrosis and erosive changes on the radial aspect of the third middle phalanx?

Treatment for Hand Osteoarthritis with Erosive Changes

For hand pain with osteoarthritis and erosive changes on the radial aspect of the third middle phalanx, topical NSAIDs should be used as first-line treatment, followed by oral NSAIDs at the lowest effective dose if needed, with intra-articular corticosteroid injections considered only for acute painful flares with inflammation. 1, 2

Understanding Your X-ray Results

Your x-ray shows:

• No fracture and proper alignment of bones
• Erosion of the radial aspect of the third middle phalanx
• Mild to moderate first metacarpophalangeal joint osteoarthritis with osteophyte formation and subchondral cystic change
• Scattered mild degenerative changes in other joints
• Possible old injuries (tiny fragment at thumb base, absent ulnar styloid)
• Soft tissue prominence of the third finger

These findings indicate osteoarthritis affecting multiple joints in your hand, with more significant erosive changes in the third finger, which is likely contributing to your pain.

Treatment Algorithm

First-line Treatment

• Topical NSAIDs (such as diclofenac gel)
  • Apply to painful joints 3-4 times daily
  • Provides localized pain relief with minimal systemic side effects 1, 2
  • Particularly effective for superficial joints like those in the hand

Second-line Treatment

• Oral acetaminophen (paracetamol)
  • Up to 4g/day divided into doses
  • Take with food to minimize stomach irritation 2

Third-line Treatment

• Oral NSAIDs (such as ibuprofen)
  • Start with 400mg 3-4 times daily as needed 3
  • Use the lowest effective dose for the shortest duration
  • Take with food to reduce gastrointestinal side effects
  • Not recommended for long-term use due to potential cardiovascular and gastrointestinal risks 1, 2

For Acute Painful Flares

• Intra-articular corticosteroid injections
  • May be considered specifically for painful interphalangeal joints with clear signs of inflammation 1, 2
  • Not generally recommended for routine use or for thumb base OA 1, 2
  • Limited to 2-3 injections per joint to avoid cartilage damage 2

Non-Pharmacological Approaches (Essential Components)

• Hand exercises

  • Range-of-motion and strengthening exercises
  • Perform daily to maintain function and reduce stiffness 1

• Joint protection techniques

  • Avoid activities that aggravate symptoms
  • Use larger joints for heavy tasks when possible 1

• Orthoses/splints

  • Consider night splinting for pain relief
  • Daytime splinting during activities that worsen symptoms 1

• Heat/cold therapy

  • Apply warm paraffin wax or heating pads for stiffness
  • Use cold packs for acute pain and inflammation 2

When to Consider Surgery

Surgery should only be considered if:

• You have severe pain that significantly impacts quality of life
• Conservative treatments have failed after adequate trials
• Functional limitations severely affect daily activities 1

For erosive osteoarthritis of interphalangeal joints, surgical options are limited and should be carefully considered, as outcomes may be unpredictable 1.

Important Considerations

• Erosive osteoarthritis is considered a more aggressive form of hand OA, often causing more pain and functional limitations than non-erosive OA 4, 5
• Research shows that joints with erosive changes are significantly more likely to be tender and painful than non-erosive joints 6, 7
• The presence of erosions strongly predicts future joint tenderness and functional limitations 6, 8
• Clinical symptoms and radiographic progression don't always correlate - you may have periods of improvement in symptoms even if x-rays show progression 8

Follow-up Recommendations

Follow-up should be based on your symptoms and response to treatment. More frequent monitoring may be needed initially to assess treatment effectiveness, with less frequent follow-up once symptoms are stable 1.