From the Guidelines
Treatment for moderate thumb carpometacarpal (CMC) osteoarthritis should prioritize conservative approaches, including education, exercises, orthoses, and topical treatments, before considering surgical options, as recommended by the most recent and highest quality study 1.
Conservative Management
- Education and training in ergonomic principles, pacing of activity, and use of assistive devices should be offered to every patient, as it is highly recommended with a level of evidence 1b and grade of recommendation A 1.
- Exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient, with a level of evidence 1a and grade of recommendation A 1.
- Orthoses, such as a custom or prefabricated thumb spica splint, can provide significant relief by immobilizing and supporting the joint, and are recommended with a level of evidence 1b and grade of recommendation A 1.
Pharmacological Management
- Topical NSAIDs are the first pharmacological topical treatment of choice, preferred over systemic treatments due to safety reasons, with a level of evidence 1b and grade of recommendation A 1.
- Oral analgesics, particularly NSAIDs, should be considered for a limited duration for relief of symptoms, with a level of evidence 1a and grade of recommendation A 1.
- Chondroitin sulfate may be used in patients with hand OA for pain relief and improvement in functioning, with a level of evidence 1b and grade of recommendation A 1.
Injections and Surgery
- Intra-articular injections of glucocorticoids should not generally be used in patients with hand OA, but may be considered in patients with painful interphalangeal joints, with a level of evidence 1a-1b and grade of recommendation A 1.
- Surgery should be considered for patients with structural abnormalities when other treatment modalities have not been sufficiently effective in relieving pain, with a level of evidence 5 and grade of recommendation D 1.
Overall Management
- Treatment should be individualized according to the patient's requirements, including the localization of OA, risk factors, type of OA, presence of inflammation, severity of structural change, level of pain, disability, and restriction of quality of life, as well as comorbidity and co-medication 1.
- The patient's wishes and expectations should also be taken into account when developing a treatment plan, as recommended by the EULAR 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
Treatment for moderate thumb CMC osteoarthritis may include naproxen, as it has been shown to reduce joint pain and improve mobility in patients with osteoarthritis. However, the specific use of naproxen for thumb CMC osteoarthritis is not directly addressed in the label. 2
From the Research
Treatment Options for Moderate Thumb CMC Osteoarthritis
- Nonoperative management is often the first line of treatment for thumb CMC osteoarthritis, including activity modification, orthotic use, anti-inflammatory medications, and intra-articular injections 3.
- A systematic review and network meta-analysis found that multimodal treatment and hand exercises can reduce short-term pain and improve grip strength, while a rigid CMC-MCP splint can enhance medium-term function 4.
- The use of image-guided corticosteroid injections has been studied, but the clinical benefits are unclear, and the average cost of performing non-image-guided injections was found to be $203 less than using ultrasound 5.
Nonoperative Interventions
- A study found that the following nonoperative interventions can be effective for thumb CMC osteoarthritis:
- The American Society of Hand Therapists has established a consensus on the assessment and treatment of nonsurgical thumb CMC osteoarthritis, including the use of orthoses, dynamic stability programs, patient education, and functional-based interventions 6.
Surgical Treatment
- Surgical treatment options for thumb CMC osteoarthritis are available, but are typically considered after nonoperative management has failed 7, 5.
- A study found that image-guided thumb CMC injections do not result in significant increases in time between injections and do not lead to a meaningful delay to surgery 5.