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.
Overarching principles
- The
primary goal of management is to control symptoms (pain and stiffness) and
to optimise hand function (to maximize activity, participation and quality
of life).
- All
patients should be offered information on the nature and course of the
disease including education on self-management principles and treatment
options.
- Management
should be individualized depending on its localization, severity and
comorbidities.
- Management
should be based on a shared decision making between the patient and the
doctor.
- A
multidisciplinary approach is required for optimal care Nonpharmacological, pharmacological options and surgery.
Recommendations
- Every
patient should be educated and trained in ergonomic principles, pacing of
activity, and use of assistive devices.
- Exercises
to improve function and muscle strength, as well as to reduce pain, should
be considered for every patient.
- Consider
orthoses for symptomatic relief in patients with thumb base OA. Long term
use is advocated.
- Topical
therapy is preferred over systemic therapy. The 1st pharmacological
topical treatment of choice is a topical NSAID.
- Oral
analgesics, particularly NSAIDs, should be considered for a limited
duration for symptomatic relief.
- Chondroitin
sulphate may be used for pain relief and functional improvement.
- Intra-articular
steroid may be considered in patients with painful interphalangeal joints,
but should generally be avoided.
- Avoid
DMARDs, conventional or biological.
- Surgery
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
interphalangeal OA.
- Long-term
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
