medwireNews: EULAR has issued updated recommendations for the management of hand osteoarthritis (OA) based on current evidence and expert opinion.
“For a long time, hand OA was a ‘forgotten disease’, resulting in a paucity of clinical trials to guide recommendations, and therefore many of the propositions of previous recommendations were based mainly on expert opinion,” say Margreet Kloppenburg (Leiden University Medical Center, the Netherlands) and fellow guideline authors.
However, “new data have become available on several pharmacological and non-pharmacological treatments” in the past decade, meaning it was timely to update the 2007 EULAR recommendations, they add.
The taskforce of 19 experts – comprising rheumatologists, other healthcare professionals, and patients – carried out a systematic review to collate data on treatment options for hand OA, and produced five overarching principles, which were not included in the 2007 guidelines, and 10 specific recommendations.
The overarching principles specify that the primary goal of hand OA treatment should be to control symptoms and optimize function, and that education on the disease and self-management should be offered to all patients.
They also advise that disease management should be multidisciplinary, individualized, and based on shared decision-making between patients and healthcare professionals.
Three of the 10 specific recommendations cover non-pharmacologic treatments for hand OA, advocating education and training in ergonomic principles, pacing of activity, exercises to improve muscle strength and function, and orthoses for symptom relief.
Kloppenburg and colleagues also recommend a range of different pharmacologic treatments, with topical treatments favored over systemic options for safety reasons. They state that topical nonsteroidal anti-inflammatory drugs should be the first pharmacologic treatment option, while oral analgesics “should be considered for a limited duration for relief of symptoms,” and chondroitin sulfate may also be used to relieve pain and improve functioning.
The authors caution against the use of conventional or biologic DMARDs in patients with hand OA in light of several studies demonstrating a lack of efficacy. They say that intra-articular glucocorticoid injections “should not generally be used” in these patients, but such treatment “may be considered” in those with painful interphalangeal joints.
One recommendation covers surgical treatment, proposing that surgery should be considered for patients with structural abnormalities who have not experienced sufficient pain relief with other treatment options.
Finally, the team recommends that long-term follow-up should be tailored to the needs of individual patients. All recommendations were based on consistent level 1 evidence, with the exception of the two points covering surgery and long-term follow-up, which were based only on expert opinion.
“These recommendations are targeted at all health professionals who care for patients with hand OA,” including rheumatologists, primary care providers, surgeons, and physical therapists, write Kloppenburg et al in the Annals of the Rheumatic Diseases.
And they conclude that “[t]he next update should be undertaken when sufficient new data are available, either on the current treatment options, or on new therapies.”
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