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Hand Osteoarthritis - EULAR Treatment Guidelines

Impact of Hand Osteoarthritis on Disability Is Significant

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Updated January 29, 2014

EULAR Task Force Assesses Hand Osteoarthritis

Symptomatic hand osteoarthritis affects 20 percent of people over 55 years of age. A EULAR (The European League Against Rheumatism) task force which previously released recommendations for the treatment of hip and knee osteoarthritis, has released guidelines for the treatment of hand osteoarthritis.

The EULAR task force, comprised of 21 experts including several rheumatologists, an orthopedic surgeon, and a physiatrist among other health professionals, analyzed evidence-based research and came to a consensus that 11 recommendations based on 17 treatment modalities was most appropriate for the treatment of hand osteoarthitis. It was noted that only 6 of the 17 treatment modalities were based on research evidence. Other recommendations were based on clinical expertise or data derived from osteoarthritis studies of joints other than the hand.

Eleven Recommendations for Treatment of Hand Osteoarthritis

The EULAR task force has presented these recommendations for managing and treating hand osteoarthritis:

  • A combination of pharmacologic and non-pharmacologic treatments, individualized for the hand osteoarthritis patient, is recommended.
  • Therapy for hand osteoarthritis should be individualized for the patient. Risk factors, type of osteoarthritis, level of inflammation, pain level, severity, disability, quality of life, comorbidity, and comedication should all be considered along with the patient's wishes.
  • For the base of the thumb, splinting is recommended. Orthotics are recommended to prevent certain other deformities.
  • Tylenol or (acetaminophen) is the recommended analgesic. Up to 4 g/day is considered safe and effective.
  • For patients who get an unsatisfactory response from Tylenol, or acetaminophen, the next choice is oral NSAIDs (nonsteroidal anti-inflammatory drugs) at the lowest effective dose, for the shortest duration possible. The choice of NSAID for each individual patient must take into account gastointestinal risk and cardiovascular risk.
  • Surgery (e.g. arthroplasty, arthrodesis, or osteotomy) can be considered for patients who had no luck with more conservative treatments. Surgery is recommended for patients with severe pain and disability from hand osteoarthritis.

Why Joint-Specific Recommendations Were Needed

Osteoarthritis impacts hands, hips, and knees differently. The joints are different in terms of anatomy and function, and patients are different in terms of appropriateness of treatment and response to treatment.

Six of the 11 recommendations, in the report which appeared in the Annals of the Rheumatic Diseases, were supported by study data:

  • education and exercise
  • NSAIDs
  • COX-2 inhibitors
  • topical NSAIDs
  • topical capsaicin
  • chondroitin sulfate

Sources:

Eular evidence based recommendations for the management of hand osteoarthritis. Zhang, W. Annals of the Rheumatic Diseases. October 17, 2006.

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