Hand Osteoarthritis: An Update on Therapy

Abstract

Objectives:This literature review aims to summarize and discuss the most novel clinical studies relevant to the treatment of hand osteoarthritis. Materials and methods: A comprehensive search using Medline and PubMed was performed. Results were restricted to the period between January 2008 and May 2014, and included randomized controlled trials and reviews. The bibliographies of articles retrieved through this search were searched manually for additional relevant references. Results: The latest methods of nerve mobilization, splinting, exercise, and other diverse nonpharmacological treatments have led to significant functional and symptomatic improvements. Topical nonsteroidal antiinflammatory drugs' clinical beneficence was reinforced and corticosteroid injections were shown to be superior to hyaluronic acid injections. Other pharmacological therapies, such as Hylan injections and synergistic drugs, also showed promise. Antitumor necrosis factor was suggested to play role as a potential disease-modifying agent. Surgical procedures such as arthroscopic debridement, synovectomy of the trapeziometacarpal joint, and early tendon arthroplasty were promising with long-term benefits when used as early interventions. Conclusion: Recent studies show that emerging therapies may play role in the clinical setting as an upgrade over current practices, and that earlier surgical interventions should be considered in the management process.

Differentiating Bilateral Symptomatic Hand Osteoarthritis From Rheumatoid Arthritis Using Sonography When Clinical and Radiographic Features Are Nonspecific: A Case Report

“…In RA, especially if identified early, prompt referral to a rheumatologist to receive disease-modifying antirheumatic drugs results in optimal outcomes. 5,18…”

“…4 Clinical features include pain with activity, morning stiffness, swelling, joint hypertrophy, and functional impairment. 5 These features are nonspecific, and when present bilaterally, hand OA may be difficult to differentiate from inflammatory arthritis, especially rheumatoid arthritis (RA). Laboratory analysis and diagnostic imaging may be needed in these scenarios.…”

Peri-articular Methylprednisolone Acetate Injection for the Treatment of Primary Osteoarthritis of the Distal Interphalangeal Joints

“…Pain at the DIPJ could be acute or chronic and treatment includes non-steroidal anti-inflammatory tablets or ointments, simple analgesics, paraffin baths, local intra-articular corticosteroid injections or even alternative treatments [7,8]. The utility of these treatments could be limited, and an attempting a local intra-articular injection at the tiny DIPJ, is usually not an easy task, and could be associated with a lot of pain.…”

The Effect of Periarticular Injection of Methylprednisolone Acetate in Patients with Primary Osteoarthritis of the Proximal Interphalangeal Joints: A Case Controlled Study

“…Pain can be approached by different modalities of treatment including topical and/or systemic nonsteroidal anti-inflammatory drugs (NSAID), simple analgesics, warm paraffin paths, physical therapy, surgery, alternative therapy, and/or local corticosteroid injection [ 13 , 14 ] The local steroid injection is usually directed intra-articularly. Due to the small size of the PIPJ, attempting an intra-articular approach there could be very painful and intolerable by the patients.…”