The European League Against Rheumatism (EULAR) has published updated guidelines for the management of hand osteoarthritis (OA).
The guidelines, published in January 2019 issue of Annals of the Rheumatic Diseases give emphasis to shared decision-making and multidisciplinary and multimodal treatment. They also advise against using disease-modifying antirheumatic drugs (DMARDs) given their lack of efficacy in hand OA.
The guidelines include five overarching principles and 10 recommendations.
primary goal of management is to control symptoms (pain and stiffness) and
to optimise hand function (to maximize activity, participation and quality
patients should be offered information on the nature and course of the
disease including education on self-management principles and treatment
should be individualized depending on its localization, severity and
should be based on a shared decision making between the patient and the
multidisciplinary approach is required for optimal care Nonpharmacological, pharmacological options and surgery.
patient should be educated and trained in ergonomic principles, pacing of
activity, and use of assistive devices.
to improve function and muscle strength, as well as to reduce pain, should
be considered for every patient.
orthoses for symptomatic relief in patients with thumb base OA. Long term
use is advocated.
therapy is preferred over systemic therapy. The 1st pharmacological
topical treatment of choice is a topical NSAID.
analgesics, particularly NSAIDs, should be considered for a limited
duration for symptomatic relief.
sulphate may be used for pain relief and functional improvement.
steroid may be considered in patients with painful interphalangeal joints,
but should generally be avoided.
DMARDs, conventional or biological.
is indicated in patients with structural abnormalities when other treatment
modalities have failed to relieve pain; tapeziectomy in patients with
thumb base OA and arthrodesis or arthroplasty in patients with
follow-up should be as per the individual needs of the patient.
(EULAR Press Release)
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA