What is the first-line treatment of thumb osteoarthritis?

Thumb osteoarthritis affects the first carpometacarpal (CMC) joint and is a common cause of hand pain and reduced grip function. First-line management is guided by major rheumatology organisations and encompasses both non-pharmacological modalities and targeted local joint interventions.

Treatment approach

First-line options span mind-body therapies, physical modalities, and procedures directed at the first CMC joint—reflecting a multi-modal approach endorsed across ACR, OARSI, and EULAR guidelines.

Complete regimen details, option sequencing, and clinical considerations are in the full protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.rdc.2022.03.009.

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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