From the Guidelines
Osteoarthritis of the thumb should be managed with a combination of education, exercises, and orthoses as first-line treatment, with topical NSAIDs as the preferred pharmacological treatment, as recommended by the most recent and highest quality study 1.
Treatment Overview
The management of osteoarthritis of the thumb involves a multifaceted approach to reduce pain, improve function, and enhance quality of life. Key components include:
- Education and training in ergonomic principles, pacing of activity, and use of assistive devices to reduce strain on the thumb joint 1
- Exercises to improve function and muscle strength, as well as to reduce pain, such as gentle thumb stretches and opposition exercises 1
- Orthoses, such as a thumb splint, to provide support and reduce pain, especially in patients with thumb base OA 1
Pharmacological Treatment
When pharmacological treatment is necessary, topical NSAIDs are the first-line treatment due to their safety profile and efficacy in reducing pain and inflammation 1. Oral analgesics, particularly NSAIDs, may be considered for a limited duration for relief of symptoms, but their use should be cautious due to potential side effects 1.
Advanced Treatment
In cases where conservative treatments fail to provide adequate relief, surgical intervention may be considered, especially for patients with structural abnormalities and severe symptoms 1. Trapeziectomy is a recommended surgical option for patients with thumb base OA 1.
Key Recommendations
- Education and exercises should be offered to every patient as a first-line treatment 1
- Topical NSAIDs are the preferred pharmacological treatment due to their safety and efficacy 1
- Orthoses, such as a thumb splint, should be considered for symptom relief in patients with thumb base OA 1
- Surgery should be considered for patients with structural abnormalities when other treatment modalities have not been sufficiently effective in relieving pain 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 The answer to the question about osteoarthritis of the thumb is that naproxen has been shown to be effective in reducing joint pain or tenderness and improving range of motion in patients with osteoarthritis 2.
- Key benefits of naproxen in osteoarthritis include:
- Reduction in joint pain or tenderness
- Increase in range of motion
- Improved mobility
- Improvement in capacity to perform daily activities
From the Research
Osteoarthritis of the Thumb
- Osteoarthritis of the thumb joints can be managed through various treatment options, including surgical and non-surgical approaches 3.
- The carpometacarpal joint is a common site for osteoarthritis in the thumb, and numerous options exist for its surgical treatment, whereas fewer options are available for metacarpophalangeal joint arthritis 3.
- For interphalangeal arthritis, surgical treatment mainly involves arthrodesis 3.
Pharmacological Treatment
- Joint pain due to osteoarthritis can be severe and disabling, and various pharmacological treatment approaches are available, including topical, oral, and intraarticular treatments 4.
- Topical nonsteroidal anti-inflammatory drugs (NSAIDs) can be recommended for patients with mild osteoarthritis, while oral NSAIDs are suggested for those with moderate to severe osteoarthritis at the lowest effective dose for the shortest possible duration 4.
- Topical capsaicin can be used when other treatments are ineffective or contraindicated, and it has been found to have a good safety profile and efficacy in reducing osteoarthritis pain 4, 5.
Conservative Treatment
- Conservative treatment of thumb base osteoarthritis includes hand therapy, intra-articular injections, and the use of orthoses 6.
- Hand therapy may possibly reduce pain, but the evidence is limited due to the lack of good-quality randomized controlled trials 6.
- Intra-articular injections of hyaluronate or steroid can provide pain relief, with hyaluronate being more effective, and orthoses can reduce pain without affecting function, strength, or dexterity 6.
- A systematic review and network meta-analysis found that a long thermoplastic splint is the best choice for pain relief, and a short thermoplastic CMC splint is the best treatment to increase function in patients with thumb osteoarthritis 7.