What are the management options for osteoarthritis (OA) of the hands?

From the Guidelines

Management of osteoarthritis (OA) of the hands should prioritize a multimodal approach, including non-pharmacological and pharmacological treatments, with a focus on symptom management and functional preservation, as recommended by the 2019 update of the EULAR recommendations 1.

Key Components of Management

• Education about joint protection techniques, activity modification, and regular exercise to maintain hand strength and range of motion
• Use of assistive devices, such as splints, to stabilize painful joints, particularly the thumb base
• Topical NSAIDs, like diclofenac gel, as the initial pharmacological treatment due to their effectiveness and minimal systemic side effects 1
• Oral analgesics, such as acetaminophen, and oral NSAIDs, like ibuprofen or naproxen, for short periods, if topical treatments are insufficient
• Consideration of intra-articular corticosteroid injections for temporary relief of inflamed joints, particularly at the thumb base
• Hand therapy with a trained therapist to teach joint protection strategies and customized exercises

Additional Considerations

• The 2020 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee also supports the use of topical NSAIDs, oral NSAIDs, and intra-articular glucocorticoid injections for knee OA, but notes that evidence for hand OA is less robust 1
• Surgical options, such as joint fusion or arthroplasty, may be considered for severe OA unresponsive to conservative measures
• A patient-centered approach, considering individual preferences and needs, is essential for effective management of hand OA

Prioritization of Treatments

• Topical NSAIDs are recommended as the first-line pharmacological treatment for hand OA, due to their favorable risk-benefit profile 1
• Oral analgesics and NSAIDs should be used judiciously, considering potential side effects and interactions
• Intra-articular corticosteroid injections should be reserved for patients with significant inflammation and pain, and used under careful consideration of potential risks and benefits

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 management of osteoarthritis (OA), specifically OA of the hands, may involve the use of naproxen to reduce joint pain and improve mobility. However, the provided drug labels do not specifically address the management of OA of the hands.

• Key considerations for the use of naproxen in OA include:
  • Reduction of joint pain and tenderness
  • Improvement in range of motion and mobility
  • Enhancement of activities of daily living However, no conclusion can be drawn regarding the specific management of OA of the hands using naproxen, as the FDA label does not explicitly and directly address this question 2.

From the Research

Management of OA Hands

• The management of hand osteoarthritis (OA) involves a combination of non-pharmacological and pharmacological treatments, with the goal of achieving symptom relief and optimizing hand function 3.
• Non-pharmacological treatments, such as hand exercise and prolonged thumb base splinting, have been shown to be beneficial in managing hand OA 4.
• Pharmacological treatments, including topical and oral non-steroidal anti-inflammatory drugs (NSAIDs), have also been found to be effective in reducing pain and improving function in hand OA patients 4, 5.
• However, the use of acetaminophen, a commonly used pharmacological treatment for OA, has been found to be less effective than NSAIDs in reducing pain and improving global assessments, although it has similar efficacy in improving functional status 5.
• The choice of treatment for hand OA should take into account the patient's preferences and concerns, as well as the potential risks and benefits of each treatment option 6.
• A patient-centric approach to managing hand OA is essential, and healthcare professionals should work with patients to develop a treatment plan that meets their individual needs and goals 6.
• The use of assistive devices, joint protection, and other non-pharmacological interventions can also be beneficial in managing hand OA, and should be considered as part of a comprehensive treatment plan 4.