Management of Hand Osteoarthritis : EULAR 2018 Recommendations

Updated guidelines for the management of hand osteoarthritis (OA), published in Annals of the Rheumatic Diseases was issued by the European League Against Rheumatism (EULAR). The previous EULAR recommendations for the management of hand OA were released in 2007. Since then, new evidence has emerged, and the task force sought to update recommendations based on the new evidence.

Based on the evidence and expert opinion from an international task force of 19 physicians, healthcare professionals and patients from 10 European countries a consensus reached on five overarching principles and 10 recommendations. The overarching principles cover treatment goals, information provision, individualization of treatment, shared decision-making and the need to consider multidisciplinary and multimodal (non-pharmacological, pharmacological, surgical) treatment approaches.

The 5 overarching principles of managing hand OA are:

• Clinicians should offer patients information regarding the nature and course of hand osteoarthritis as well as education on self-management principles and treatment options.


• The primary goal is to control symptoms and optimize hand function so that patients can maximize activity, participation, and quality of life.


• The optimal management of hand osteoarthritis usually requires a multidisciplinary approach; clinicians should consider non-pharmacologic, pharmacologic, and surgical treatment options.


• Clinicians should individualize the management of hand OA after taking localization, severity, and comorbidities into account.


• Clinicians should base the management of hand OA on a shared decision by the patient and clinician.

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The 10 recommendations are:

• Clinicians should consider exercises to improve function, improve muscle strength, and reduce pain


• Topical treatments should be used over systemic treatments due to safety reasons. The first choice of pharmacologic topical treatment is topical nonsteroidal anti-inflammatory drugs (NSAIDs).


• Clinicians should adopt the long-term follow-up of patients with OA based on individual patient needs.


• Clinicians should offer education and training in ergonomic principles, pacing of activity, and the use of assistive devices.


• Clinicians should consider orthoses for symptom relief in patients with thumb base OA. Long-term orthoses use is recommended.


• Clinicians should consider a limited duration of oral analgesics, especially NSAIDs, for the relief of symptoms.


• Clinicians should not use conventional or biologic disease-modifying antirheumatic drugs for the treatment of hand OA.


• Clinicians should consider chondroitin sulfate for pain relief and improvement in functioning in patients with hand OA.


• Generally, intra-articular injections of glucocorticoids should not be used in patients with hand OA. However, they may be considered in patients with painful interphalangeal joints.


• Clinicians should consider surgery in patients with structural abnormalities if other treatment methods have not been sufficiently effective in relieving pain. Consider trapeziectomy in patients with thumb base OA and consider arthrodesis or arthroplasty in patients with interphalangeal OA.

For reference log on to https://ard.bmj.com/content/early/2018/08/27/annrheumdis-2018-213826