What are the guideline sources, guidelines and references for Hand osteoarthritis ?
Guideline 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). 1 2 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 quality of life. B Show 3 more Non-opioid analgesics: As per ACR 2020 guidelines: Offer NSAIDs (topical and oral) in patients with hand OA. A Consider offering acetaminophen in patients with hand OA. C As per EULAR 2019 guidelines: https://web.pathway.md/diseases/recGJNpIVxhQ21thW 1/4 6/24/23, 12:31 PM Hand osteoarthritis Pathway Prefer topical over systemic treatments because of safety reasons. Offer topical NSAIDs as first-choice topical treatment in patients with hand OA. B Consider offering oral analgesics, particularly NSAIDs, for a limited duration for relief of symptoms. B Opioids: Consider offering tramadol in patients with hand OA. C Avoid using non-tramadol opioids in patients with hand OA. Consider offering non-tramadol opioid in certain circumstances, particularly when alternatives have been exhausted. D Duloxetine: consider offering duloxetine in patients with hand OA. C Chondroitin sulfate: As per ACR 2020 guidelines, consider offering chondroitin sulfate in patients with hand OA. B As per EULAR 2019 guidelines, consider offering chondroitin sulfate for pain relief and function improvement in patients with hand OA. B Agents with no evidence for benefit: As per ACR 2020 guidelines: Avoid using the following agents in patients with hand OA: colchicine vitamin D. D Do not use the following agents in patients with hand OA: bisphosphonates glucosamine hydroxychloroquine methotrexate. D As per EULAR 2019 guidelines, do not use conventional or biological DMARDs in patients with hand OA. D 2. Nonpharmacologic interventions Self-management programs: advise participating in self-efficacy and self-management programs in patients with hand OA. A Physical therapy: As per ACR 2020 guidelines, advise exercising in patients with hand OA. A As per EULAR 2019 guidelines, consider advising exercising to improve function and muscle strength and to reduce pain in all patients with hand OA. B Orthoses: As per ACR 2020 guidelines: Offer hand orthoses in patients with first CMC joint OA. A https://web.pathway.md/diseases/recGJNpIVxhQ21thW 2/4 6/24/23, 12:31 PM Hand osteoarthritis Pathway Consider offering hand orthoses in patients with OA in other joints of hand. C As per EULAR 2019 guidelines, consider offering orthoses for symptom relief in patients with thumb base OA. Encourage their long-term use. B Cognitive behavioral therapy: consider offering CBT in patients with hand OA. C Alternative and complementary therapies: consider offering kinesotaping in patients with first CMC joint OA. C Show 3 more 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 As per EULAR 2019 guidelines, do not administer intra-articular corticosteroid injections in patients with hand OA, but consider administering in patients with painful interphalangeal joints. D Other intra-articular injections: Avoid administering intra-articular hyaluronic acid in patients with first CMC joint OA. D Do not administer intra-articular TNF inhibitors or IL-1 receptor antagonists in patients with hand OA. D 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 Show 2 more 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 B pacing of activity B use of assistive devices. B https://web.pathway.md/diseases/recGJNpIVxhQ21thW 3/4 6/24/23, 12:31 PM Hand osteoarthritis Pathway 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 References 1. Sharon L Kolasinski, Tuhina Neogi, Marc C Hochberg et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res Hoboken). 2020 Feb;72 2 149 162. Open 2. Margreet Kloppenburg, F line Pb Kroon, Francisco J Blanco et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis. 2019 Jan;78 1 16 24. Open https://web.pathway.md/diseases/recGJNpIVxhQ21thW 4/4