Italian Society for Rheumatology recommendations for the management of hand osteoarthritis

Abstract

Hand osteoarthritis (OA) is a common and potentially disabling disease, with different features from hip and knee OA so that a specific therapeutic approach is required. Evidence based recommendations for the management of hand OA were developed by the European League Against Rheumatism (EULAR) in 2006. The Italian Society for Rheumatology (SIR) aimed to update, adapt to national contest and disseminate the EULAR recommendations for the management of hand OA. The multidisciplinary group of experts included specialists involved in the management of patients with hand OA. In order to maintain consistency with EULAR recommendations, a similar methodology was utilized by the Italian group. The original propositions were reformulated in terms of a search query and for every recommendation a systematic search was conducted updating EULAR recommendations' review. The propositions were translated in Italian and reformulated basing on collected evidences and expert opinion. The strength of recommendation was measured for each proposition with the EULAR ordinal and visual analogue scales. The original 11 propositions of EULAR recommendations were translated and adapted to Italian context. Further evidences were collected about non-pharmacological therapies, local treatments, intra-articular injection with SYSADOA and corticosteroids, and surgery. The SIR has developed updated recommendations for the management of hand OA adapted to the Italian healthcare system. Their implementation in clinical practice is expected to improve the management of patients with hand OA.

Viscosupplementation in prevention and treatment of the degenerative joint disease

“…According to the reports of experts from the Italian Society of Rheumatology, in prospective studies it was possible to observe the decrease of pain and improvement of functionality in MCP joints after application of HA specimens in comparison to the pre-treatment period. The experts indicate, however, that there is no evidence that the application of HA specimens has a greater significance than the use of placebo [63]. In agreement with Fuchs et al [64], the use of injections with sodium derivatives of HA was effective in terms of reducing pain and improving functionality in the MCP joint.…”

Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management

“…Injecting drugs such as glucocortiocoids directly into the joints provide local symptomatic relief and offers another option in addition to core treatment. Interest in the use of intra-articular injection therapy in hand OA continues 193,152,194,195,196,197 , as this approach is preferable to surgical approaches in elderly patients with comorbidities 197 .…”

“…The benefits and harms of intra-articular therapies were assessed in a systematic literature review and meta-analysis; this analysis included trials that investigated the efficacy or safety of any intra-articular therapy in first CMCJ and IPJ OA compared with placebo or other treatments for which pain was the main outcome 197 . A total of 13 trials (including 864 patients with hand OA; 11 trials of patients with OA of the first CMCJ and 2 trials of patients with OA of the IPJs) were included.…”

Non-Pharmacological Management of Hand Osteoarthritis: From A Perspective of Psychiatry

“…Joint protection education (JPE) is recommended by international guidelines, as the first line management of hand OA [7,8,10]. According to the systematic review of Valdes et al, there is moderate evidence to support JPE and provision of adaptive equipment for improvement in pain and hand function [11].…”