Hand osteoarthritis (OAH) is a common disease, however, the number of clinical trials on OAH is limited, and therefore recommendations for the management of patients with OAH are based more on expert opinion than on evidence. However, this «forgotten» disease in the past has attracted increasing attention; a number of high-quality clinical trials have been performed or are continuing over the past few years. EULAR experts conducted a systematic review of the literature published to date on the OAH, collected evidence on non-pharmacological, pharmacological and surgical treatment options for OAH and released updated recommendations in 2018. Five basic principles and 10 recommendations are proposed. The basic principles cover treatment objectives, information provision, individualized treatment, cooperative decision making and the necessity to consider interdisciplinary and multimodal treatment approaches. The 1-3th guideline recommendations cover various non-pharmacological treatment options (training, assistive rehabilitation devices, exercises and orthoses).
The 4-8th recommendations describe the role of various pharmacological treatments, including topical treatment, which is preferable to systemic, topical nonsteroidal anti-inflammatory drugs (NSAIDs), being first-line drug of choice, oral analgesics (especially NSAIDs, which should be prescribed to relieve symptoms for a limited period of time), chondroitin sulfate (to relieve symptoms), intra-articular glucocorticoids (usually not recommended, but may be considered to reduce the pain of interphalangeal OA), synthetic and biological disease modifying antirheumatic drugs are not recommended. Principles of surgical treatment are described in 9th recommendations. The last 10th recommendation characterizes clinical follow-up of patients with OAH. The presented EULAR recommendations provide up-to-date guidance for the management of patients with OAH, based on expert opinion and research data. Further qualitative studies are needed on the role of anti-inflammatory drugs, such as corticosteroids, symptomatic slow-acting drugs and biological agents, since at present the data on their effectiveness are controversial, and further studies are underway to evaluate osteoarthritis modifying drugs.
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