Arthritis Osteoarthritis Treatment Treatment Recommendations for Hand Osteoarthritis By Carol Eustice facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Carol Eustice Medically reviewed by Medically reviewed by David Ozeri, MD on October 12, 2020 linkedin David Ozeri, MD, is a board-certified rheumatologist from Tel Aviv, Israel specializing in arthritis, autoimmune diseases, and biologic therapies. Learn about our Medical Review Board David Ozeri, MD on October 12, 2020 Print 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, released guidelines in 2006 for the treatment of hand osteoarthritis. BSIP / UIG / Getty Images 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. These recommendations ranged from strongly recommended to weakly recommended depending on the level of evidence. 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. 11 Recommendations for Treatment of Hand Osteoarthritis The EULAR task force has presented these recommendations for managing and treating hand osteoarthritis: A combination of pharmacologic (drug) and non-pharmacologic (non-drug) 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 co-medication should all be considered along with the patient's wishes.Patients should be educated about joint protection and given an exercise regimen.Heat application (e.g. hot pack, heating pad, paraffin wax) and ultrasound are helpful for management of osteoarthritis of the hand.For the base of the thumb, splinting is recommended. Orthotics are recommended to prevent certain other deformities.For mild to moderate pain and when not many joints are affected, local or topical treatments (e.g. topical NSAIDs, capsaicin) are better than systemic treatments.Acetaminophen (e.g., Tylenol) is the recommended oral analgesic. Up to 4 g/day is considered safe and effective.For patients who get an unsatisfactory response from 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 gastrointestinal risk and cardiovascular risk.Glucosamine and chondroitin, avocado soybean unsaponifiables, diacerein, and viscosupplementation are all slow-acting treatments for osteoarthritis. They may offer relief with low toxicity.Intra-articular corticosteroid injections are effective, especially during bouts of painful osteoarthritis.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 exerciseNSAIDsCOX-2 inhibitorstopical NSAIDstopical capsaicinchondroitin sulfate ACR Recommendations for Hand Osteoarthritis (2012) In 2012, the American College of Rheumatology updated recommendations for treating hand osteoarthritis. They conditionally recommended that doctors do the following for non-drug treatments: Evaluate the ability to perform activities of daily living (ADLs)Instruct in joint protection techniquesProvide assistive devices, as needed, to help patients perform ADLsInstruct in use of thermal modalitiesProvide splints for patients with trapeziometacarpal joint osteoarthritis Conditional pharmacologic recommendations included the following (use one or more of the following): Topical capsaicinTopical NSAIDs, including trolamine salicylateOral NSAIDs, including COX-2 selective inhibitorsTramadol ACR conditionally recommended that health professionals not use the following: Intra-articular therapiesOpioid analgesics Also, patients who are 75 years old should use topical rather than oral NSAIDs. Was this page helpful? Thanks for your feedback! Learn tips for managing arthrits pain, medications, and daily challenges. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee. Hochberg M. et al. Arthritis Care & Research Vol. 64, No. 4, April 2012. Eular evidence based recommendations for the management of hand osteoarthritis. Zhang, W. Annals of the Rheumatic Diseases. Published online. October 17, 2006.