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  • Review Article
  • Published:

Hand osteoarthritis—nonpharmacological and pharmacological treatments

Nature Reviews Rheumatology volume 10, pages 242–251 (2014)Cite this article

Subjects

Key Points

  • Evidence from high-quality clinical trials for the management of hand OA is limited and, therefore, recommendations are mostly based on expert opinion and medication is often prescribed off-label

  • Education for self-management is effective for pain and disability; however, because the stand-alone result of education is small, it should be combined with other management strategies

  • High-quality clinical trials now show that splints are effective in pain alleviation for thumb base OA, but the optimum splint type and instruction for use has not been defined

  • Inflammation is frequently observed in hand OA, although anti-inflammatory drugs show ambiguous results and more research into the role of inflammation in hand OA is required

  • Evidence for the efficacy of symptomatic slow acting drugs for OA is currently lacking—ongoing trials will contribute to our knowledge in the coming years

  • Disease modifying activity is seldom investigated for hand OA; more long-term studies are needed to investigate disease modifying drug activity across hand OA subsets

Abstract

Hand osteoarthritis (OA) is a prevalent disease with a high clinical burden. The number of clinical trials in hand OA is limited and, therefore, recommendations for the management of hand OA are mostly expert-based instead of evidence-based, and medication is often prescribed off-label. However, in the past 5 years, this 'forgotten' disease has attracted increasing attention and a number of high-quality clinical trials have now been performed, or are ongoing. The results from studies conducted to assess nonpharmacological treatment modalities indicate that educating patients about self-management, the provision of assistive devices and the application of splints for thumb base OA, are effective for pain and disability. For pharmacological management, more high-quality trials are needed, although evidence is available for short-term symptom alleviation of pain by topical and oral NSAIDs. The role of anti-inflammatory medication, such as corticosteroids and biologic agents, is controversial, and the same holds true for the efficacy of symptomatic slow acting drugs for OA. Disease modifying OA drugs (DMOADs) for hand OA are currently not available. The results from the ongoing pharmacological trials will increase our knowledge for evidence-based management of hand OA in the near future.

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  1. Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Centre, P. O. Box 9600, Leiden, 2300 RC, Netherlands

    Margreet Kloppenburg

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Correspondence to Margreet Kloppenburg.

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Competing interests

The author received lecture/consultancy fees from Pfizer, Servier, Abbott, UCB, and BMS, and research grants from the Dutch Arthritis Foundation, Pfizer and TI Pharma.

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Kloppenburg, M. Hand osteoarthritis—nonpharmacological and pharmacological treatments. Nat Rev Rheumatol 10, 242–251 (2014). https://doi.org/10.1038/nrrheum.2013.214

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