Article Text
PDF
Abstract
To update the evidence on efficacy and safety of non-pharmacological, pharmacological and surgical interventions for hand osteoarthritis (OA), a systematic literature review was performed up to June 2017, including (randomised) controlled trials or Cochrane systematic reviews. Main efficacy outcomes were pain, function and hand strength. Risk of bias was assessed. Meta-analysis was performed when advisable. Of 7036 records, 127 references were included, of which 50 studies concerned non-pharmacological, 64 pharmacological and 12 surgical interventions. Many studies had high risk of bias, mainly due to inadequate randomisation or blinding. Beneficial non-pharmacological treatments included hand exercise and prolonged thumb base splinting, while single trials showed positive results for joint protection and using assistive devices. Topical and oral non-steroidal anti-inflammatory drugs (NSAIDs) proved equally effective, while topical NSAIDs led to less adverse events. Single trials demonstrated positive results for chondroitin sulfate and intra-articular glucocorticoid injections in interphalangeal joints. Pharmacological treatments for which no clear beneficial effect was shown include paracetamol, intra-articular thumb base injections of glucocorticoids or hyaluronic acid, low-dose oral glucocorticoids, hydroxychloroquine and anti-tumour necrosis factor. No trials compared surgery to sham or non-operative treatment. No surgical intervention for thumb base OA appeared more effective than another, although in general more complex procedures led to more complications. No interventions slowed radiographic progression. In conclusion, an overview of the evidence on efficacy and safety of treatment options for hand OA was presented and informed the task force for the updated European League Against Rheumatism management recommendations for hand OA.
- hand osteoarthritis
- treatment
- osteoarthritis
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0
Statistics from Altmetric.com
Footnotes
Contributors FPBK, LC, and MK contributed to development of the protocol, study selection, interpretation of the data and writing of the manuscript. FPBK contributed to data extraction and management. JWS devised the search strategy and executed the search for the review. All authors approved the final version of the manuscript.
Competing interests MK has received consultancy fees/fee as local investigator of industry driven trials from Abbvie, GlaxoSmithKline, Merck, Levicept (all through institution), and has received research funding (through the institution) from Pfizer and APPROACH-IMI. LC has received research funding (through the institution) from Pharmaceutical laboratories (AbbVie Spain, Bristol Myers & Squibb, Celgene, Eisai Farmacéutica, Gebro Pharma, Grünenthal Pharma, LEO Pharma, Merck Sharp & Dohme España, Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, UCB Pharma), Scientific societies (Academia de Dermatología y Venereología, Asociación Emeritense de Reumatología, Eular, Italian Society of Rheumatology, Sociedad Castellano-Manchega, SORCOM, SEDISA, SEIO, Sociedad Española de Neumología y Cirugía Torácica, SERPE, Societat Catalana de Reumatología), Contract Research organisations (Scientia Salus, Continuing Medical Communication, Mediaevents AA, Congresos Eventos y Azafatas, Meed Comunicación, Proyectos Incentivos y Congresos), Research groups and Foundations (AIRE-MB, FISABIO, Fundació Parc Taulí, Fundación Asturcor , Fundación Clínic, Fundación de Investigación Sanitaria Illes Balears, Fundación Española de Reumatología, Fundación para la Investigación Biomédica del Hospital Universitario de La Princesa, Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud, Hospital Universitario Fundación Alcorcón, Reumacare), Individual researchers (Dr Ramón Mazzuchelli, Dr Xavier Juanola, Dra Afnan Abdelkader), and is director of Instituto de Salud Musculoesquelética.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available.