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Hand osteoarthritis

Key sources
The following summarized guidelines for the management of hand osteoarthritis are prepared by our editorial team based on guidelines from the American College of Rheumatology (ACR 2020) and the European League Against Rheumatism (EULAR 2019).
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Guidelines

1.Medical management

General principles: set controlling symptoms as the primary goal for the management of patients with hand OA, such as pain and stiffness, and to optimize hand function, in order to maximize activity, participation and QoL.
B
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  • Non-opioid analgesics

  • Opioids

  • Duloxetine

  • Chondroitin sulfate

  • Agents with no evidence for benefit

2.Nonpharmacologic interventions

Self-management programs: advise participating in self-efficacy and self-management programs in patients with hand OA.
A

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  • Physical therapy

  • Orthoses

  • CBT

  • Alternative and complementary therapies

3.Therapeutic procedures

Intra-articular corticosteroids
As per ACR 2020 guidelines:
Consider administering intra-articular corticosteroid injections in patients with hand OA.
C
Consider preferring intra-articular corticosteroids over other injections in patients with hand OA.
C

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  • Other intra-articular injections

4.Surgical interventions

Indications for surgery: consider performing surgery in patients with structural abnormalities when other treatment modalities have not been sufficiently effective in relieving pain.
C
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5.Patient education

Patient education: educate all patients with hand OA on the following:
nature and course of the disease
B
self-management principles
B
treatment options
B
ergonomic principles
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pacing of activity
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use of assistive devices.
B

6.Follow-up and surveillance

Follow-up: ensure a long-term follow-up in patients with hand OA adapted to the patient's individual needs.
B