What is the recommended management for osteoarthritis (OA) nodules on hands?

Management of Osteoarthritis Nodules on Hands

The optimal management of hand osteoarthritis (OA) nodules requires a multidisciplinary approach combining non-pharmacological and pharmacological treatments tailored to the individual's specific symptoms and functional limitations. 1

Non-Pharmacological Interventions

Education and Exercise

• Education about joint protection techniques and ergonomic principles should be offered to all patients with hand OA nodules 1
• Regular hand exercises focusing on both range of motion and strengthening should be prescribed to improve function, muscle strength, and reduce pain 1
• A combination of education and exercise has shown significant clinical benefit with a number needed to treat (NNT) of 2 for improvement in patient global function 1

Assistive Devices and Orthoses

• Provision of assistive devices should be considered to help maintain function and independence 1
• Orthoses/splints should be considered for symptom relief, particularly for thumb base OA 1
• Long-term use of orthoses is recommended with evidence showing moderate effect size (0.64) for functional improvement 1
• Splinting has demonstrated an NNT of 4 for symptomatic improvement 1

Thermal Modalities

• Local application of heat or cold can provide temporary symptomatic relief 1
• These modalities are safe, inexpensive, and can be easily self-administered 2, 3

Pharmacological Management

Topical Treatments

• Topical treatments are preferred over systemic treatments due to safety considerations 1
• Topical NSAIDs should be the first-line pharmacological treatment choice for hand OA nodules 1
• Topical NSAIDs have shown good efficacy with an effect size of 0.77 for function 1
• Topical capsaicin may be considered as an alternative with an NNT of 3 for pain relief 1

Oral Analgesics

• Oral NSAIDs should be considered for limited duration when topical treatments provide inadequate relief 1
• NSAIDs have demonstrated an effect size of 0.40 for functional improvement and an NNT of 3 for pain relief 1
• Acetaminophen (paracetamol) may be considered for mild pain, though evidence suggests NSAIDs are more effective for moderate-severe pain 1, 4
• Tramadol can be considered when other analgesics are insufficient or contraindicated 1

Other Pharmacological Options

• Chondroitin sulfate may be used for symptom relief in hand OA 1
• Intra-articular glucocorticoid injections are generally not recommended for hand OA but may be considered in patients with painful interphalangeal joints 1
• Conventional or biological disease-modifying antirheumatic drugs (DMARDs) should not be used for hand OA 1

Surgical Considerations

• Surgery should be considered only when other treatment modalities have not been sufficiently effective in relieving pain 1
• For thumb base OA, trapeziectomy should be considered 1
• For interphalangeal OA, arthrodesis or arthroplasty may be appropriate 1

Follow-up and Monitoring

• Long-term follow-up should be adapted to the patient's individual needs 1
• Regular reassessment of symptoms, function, and treatment response is important 1

Common Pitfalls and Caveats

• Overreliance on pharmacological treatments without implementing non-pharmacological approaches 1, 3
• Prolonged use of oral NSAIDs increases risk of gastrointestinal, cardiovascular, and renal adverse effects 1, 4
• Delaying implementation of orthoses/splints, which can provide significant symptom relief 1
• Failure to address psychological aspects of chronic pain associated with hand OA 1, 2
• Not recognizing when surgical intervention may be beneficial for patients with structural abnormalities unresponsive to conservative management 1