L'arthrose du pouce est une cause fréquente de douleur de l'articulation trapézo-métacarpienne et de limitation fonctionnelle. Les recommandations cliniques actuelles convergent vers une approche pharmacologique de première ligne structurée, le choix des agents étant adapté à la tolérance individuelle du patient, aux contre-indications et au risque gastro-intestinal.
DOI: 10.1016/j.rdc.2022.03.009.
Topical NSAIDs were uniformly strongly recommended for knee OA by all guidelines and were strongly and conditionally recommended for hand OA by EULAR and ACR/AF, respectively, with the strength of recommendation influenced by practicality of using topical agents on finger joints.
Oral NSAIDs were generally recommended for all sites of OA, but strength of recommendations (conditional/weak versus strong) varied among guidelines, primarily reflecting concerns about adverse effects.
The only guidelines that provided a strong recommendation for acetaminophen were AAOS for the knee and EULAR for the hand.
Acetaminophen is no longer considered "first-line" for OA due to its relative poor efficacy, though it is still an option for those who have contraindications or intolerances to NSAIDs.
Chondroitin, on the other hand, had a conditional recommendation for its use in hand OA by both EULAR and ACR/AF on the basis of a single trial that had low risk of bias, and none of the guidelines recommended chondroitin for other sites with the exception of ESCEO which again provided a strong recommendation for its use in knee OA.
Consider adding proton pump inhibitor or misoprostol in patients at risk for upper gastrointestinal events who require treatment with NSAIDs or COX-2 inhibitors.
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