Hand osteoarthritis involves degenerative changes in the small joints of the hand, leading to pain and functional limitation. A structured first-line protocol exists to guide management in this clinical scenario.
This first-line protocol draws on a combination of non-pharmacological and, where appropriate, procedural interventions for hand OA — the complete evidence-graded regimen, including the full range of options and their clinical basis, is available below.
Acupuncture was conditionally recommended for patients with knee, hip, and/or hand OA in the ACR/AF guidelines despite limited evidence, given the positive effect of acupuncture for analgesia and low risk of harm.
Thermal modalities were strongly recommended for hip OA by OARSI (conditionally not recommended for knee and polyarticular OA) and conditionally recommended by ACR/AF for knee, hip, and/or hand OA.
Cognitive behavioral therapy (CBT) was conditionally recommended for patients with knee, hip, and/or hand OA by ACR/AF on the basis of data regarding chronic pain management, although further study is needed to better assess the benefit of CBT in OA directly.
EULAR made a strong recommendation against IACS for hand OA though commented on its potential use in the case of "clear joint inflammation", whereas ACR provided a conditional recommendation for its use.
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