From the Guidelines
Treatment for severe wrist arthritis should prioritize a multidisciplinary approach, starting with education, exercises, and orthoses, followed by pharmacological interventions like topical NSAIDs, and considering surgery as a last resort for structural abnormalities 1. When managing severe wrist arthritis, it's essential to consider the patient's overall well-being and quality of life. The European League Against Rheumatism (EULAR) recommendations 1 suggest that education and training in ergonomic principles, pacing of activity, and use of assistive devices should be offered to every patient. Some key considerations for treatment include:
- Exercises to improve function and muscle strength, as well as to reduce pain 1
- Orthoses for symptom relief, particularly in patients with thumb base OA 1
- Topical NSAIDs as the first pharmacological topical treatment of choice 1
- Oral analgesics, such as NSAIDs, for a limited duration to relieve symptoms 1
- Chondroitin sulfate for pain relief and improvement in functioning 1
- Surgery, including trapeziectomy, arthrodesis, or arthroplasty, for patients with structural abnormalities when other treatment modalities have not been effective 1 It's crucial to weigh the benefits and risks of each treatment option, considering the patient's individual needs and preferences. Surgery should be considered for patients with structural abnormalities when other treatment modalities have not been sufficiently effective in relieving pain 1. In terms of specific treatment modalities, topical NSAIDs are preferred over systemic treatments due to safety reasons 1. Additionally, oral analgesics, particularly NSAIDs, should be considered for a limited duration for relief of symptoms 1. Ultimately, the goal of treatment is to alleviate pain, improve function, and enhance the patient's quality of life, while minimizing the risk of adverse effects. A multidisciplinary approach, incorporating education, exercises, orthoses, and pharmacological interventions, is essential for effective management of severe wrist arthritis 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 Naproxen may be used to treat osteoarthritis, which can cause severe wrist arthritis. The treatment has been shown to reduce joint pain and improve mobility. However, the FDA label does not specifically mention wrist arthritis, so the effectiveness of naproxen for this condition is not directly addressed 2.
From the Research
Treatment Options for Severe Wrist Arthritis
- The goal of treatment for osteoarthritis (OA), including severe wrist arthritis, is to alleviate symptoms such as pain and loss of function, as there are no disease-modifying treatments available 3.
- Common pharmacologic treatments for OA include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids, each with varying levels of efficacy and safety 3.
- NSAIDs are a viable option for pain management in OA, but their prescription should be adjusted according to patient features, such as age, cardiovascular disease, or impaired renal function, to minimize adverse effects 4.
- Selective COX-2 inhibitors may be associated with higher cardiovascular risk, while non-selective COX inhibitors are associated with higher gastrointestinal risk, highlighting the need for careful consideration in NSAID selection 4.
Considerations for NSAID Use
- Patients with frequent NSAID use needs, such as elderly patients and those with cardiovascular disease or impaired renal function, may benefit from NSAIDs with lower renal excretion, such as acemethacin, diclofenac, and etodolac 4.
- Polymedicated patients, elderly patients, and those with chronic alcohol abuse may be at lower risk for adverse effects with NSAIDs that undergo phase 2 liver biotransformation, such as acemethacin and diclofenac 4.
- Young patients, those dealing with acute pain, or with active and/or chronic symptomatic gastritis, may find selective COX-2 inhibitors, like celecoxib or etoricoxib, to be a better option 4.
Other Relevant Information
- There is no direct evidence from the provided studies regarding the use of neuroleptics or prolactin responses in the treatment of severe wrist arthritis 5.