What are the treatment options for osteoarthritis in fingers?

Treatment Options for Osteoarthritis in Fingers

The optimal management of finger osteoarthritis requires a combination of non-pharmacological and pharmacological treatment modalities individualized to the patient's specific needs, with education and training in ergonomic principles, pacing of activity, and use of assistive devices being first-line recommendations for all patients. 1

Non-Pharmacological Treatments

• Evaluation of the patient's ability to perform activities of daily living should be conducted by a health professional (primary care provider, occupational or physical therapist) to identify functional limitations 1

• Education about joint protection techniques and ergonomic principles should be provided to help patients avoid adverse mechanical factors that may worsen symptoms 1

• Assistive devices should be provided as needed to help patients perform activities of daily living with less pain and greater efficiency 1

• Thermal modalities (heat application such as paraffin wax or hot packs) can provide symptomatic relief, especially when applied before exercise 1

• Exercise regimens involving both range of motion and strengthening exercises are recommended to maintain finger mobility and function 1

• Splints should be provided for patients with trapeziometacarpal joint osteoarthritis (base of the thumb), as they may benefit from this device 1

Pharmacological Treatments

• Topical NSAIDs are recommended as first-line pharmacological treatment due to their efficacy and favorable safety profile, especially when only a few finger joints are affected 1, 2

• Oral analgesics such as acetaminophen (up to 3-4g/day) can be considered for pain relief, though evidence suggests limited efficacy in hand OA 1

• Oral NSAIDs should be used at the lowest effective dose and for the shortest duration in patients who respond inadequately to acetaminophen and topical treatments 1, 2

• In patients with increased gastrointestinal risk, non-selective NSAIDs plus a gastroprotective agent or a selective COX-2 inhibitor should be considered 1, 2

• In patients with increased cardiovascular risk, COX-2 inhibitors are contraindicated and non-selective NSAIDs should be used with caution 1, 2

• Intra-articular corticosteroid injections are generally not recommended for interphalangeal joints but may be considered for painful flares, particularly for trapeziometacarpal joint involvement 1

Surgical Options

• Surgical interventions should be considered when conservative treatments have failed and the patient has marked pain and/or disability 1

• Options include joint fusion (arthrodesis) or joint replacement (arthroplasty) depending on the specific joint involved and patient factors 3

Treatment Algorithm

1. Initial Approach: Begin with education, joint protection techniques, assistive devices, and thermal modalities 1

2. Add Exercise: Implement range of motion and strengthening exercises to maintain function 1

3. Consider Splinting: Particularly for trapeziometacarpal joint involvement 1

4. Pharmacological Step 1: Try topical NSAIDs for localized pain 1, 2

5. Pharmacological Step 2: If inadequate response, consider oral acetaminophen or short-term oral NSAIDs at lowest effective dose 1, 2

6. Pharmacological Step 3: For persistent pain, consider intra-articular corticosteroid injections, particularly for trapeziometacarpal joint 1

7. Surgical Consultation: Consider when conservative measures fail to provide adequate pain relief or functional improvement 1, 3

Common Pitfalls and Caveats

• Overreliance on oral NSAIDs can lead to gastrointestinal, cardiovascular, and renal complications, especially with long-term use 2

• Neglecting non-pharmacological approaches may lead to unnecessary medication use and poorer outcomes 4, 5

• Failure to provide splinting for trapeziometacarpal joint OA misses an opportunity for significant symptom relief 1

• Expecting complete pain resolution may lead to treatment dissatisfaction; managing expectations about the chronic nature of OA is important 1, 5

• Delayed implementation of a multidisciplinary approach may lead to unnecessary functional decline and reduced quality of life 5