Absent specific treatment recommendations for erosive hand OA, Dr. Ramonda directed rheumatologists to the 2018 update of the European League Against Rheumatism (EULAR) recommendations for the management of hand OA. Overall, the recommendations emphasize the importance of controlling symptoms and reducing pain. Patients should be educated and trained in ergonomic principles and pacing of activity. Moreover, patients should be offered assistive devices. The recommendations also suggest patients be given exercises to improve function and muscle strength, as well as to reduce pain. Patients with thumb OA should be offered orthoses for thumb relief and their use should be considered long term. All of these interventions should be done in partnership with the patient.
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EULAR recommends the use of topical treatments over systemic treatment for hand OA for safety reasons and suggests topical non-steroidal anti-inflammatory drugs (NSAIDs) be considered the first pharmacological topical treatment of choice. When oral analgesics, such as NSAIDs, are used, EULAR suggests they be prescribed for a limited duration for symptom relief. Chondroitin sulfate (CS) may also be used in patients with hand OA for pain relief and functional improvement. Dr. Ramonda also reported from a few studies that CS is partially effective in erosive hand OA.1-3
Although EULAR states that intra-articular injections of glucocorticoids should not generally be used in patients with hand OA, it noted they may be considered in patients with painful interphalangeal joints. Such pain is characteristic of erosive hand OA, and Dr. Ramonda presented the results of studies indicating this treatment could be effective and safe in select patients with erosive hand OA.4,5 EULAR also recommends patients with hand OA not be treated with conventional or biological disease-modifying anti-rheumatic drugs (DMARDs). This recommendation applies to patients with erosive hand OA as well, because randomized clinical trials treating erosive hand OA with DMARDs (e.g., hydroxychloroquine, anakinra and adalimumab) indicated they were ineffective in reducing erosions.
In contrast, a recent study of etanercept in patients with erosive hand OA and inflamed joints found pain was significantly reduced after one year and radiographic scores were significantly improved.6 Another pilot trial found intramuscular clodronate was effective and safe in reducing pain and swelling and improving functionality.7 However, none of the currently available drugs has been shown to change the disease course.
Lara C. Pullen, PhD, is a medical writer based in the Chicago area.
- Rovetta G, Monteforte P, Molfetta G, Balestra V. Chondroitin sulfate in erosive osteoarthritis of the hands. Int J Tissue React. 2002;24(1):29–32.
- Rovetta G, Monteforte P, Molfetta G, Balestra V. A two-year study of chondroitin sulfate in erosive osteoarthritis of the hands: Behavior of erosions, osteophytes, pain and hand dysfunction. Drugs Exp Clin Res. 2004;30(1):11–16.
- Scarpellini M, Lurati A, Vignati G, et al. Biomarkers, type II collagen, glucosamine and chondroitin sulfate in osteoarthritis follow-up: The ‘Magenta osteoarthritis study.’ Orthop Traumatol. 2008 Jun;9(2):81–87.
- Utsinger PD, Resnick D, Shapiro RF, Wiesner KB. Roentgenologic, immunologic, and therapeutic study of erosive (inflammatory) osteoarthritis. Arch Intern Med. 1978 May;138(5):693–697.
- Favero M, Ramonda R, Rossato M. Efficacy of intra-articular corticosteroid injection in erosive hand osteoarthritis: Infrared thermal imaging. Rheumatology (Oxford). 2017 Jan;56(1):86.
- Kloppenburg M, Ramonda R, Bobacz K, et al. Etanercept in patients with inflammatory hand osteoarthritis (EHOA): A multicentre, randomised, double-blind, placebo-controlled trial. Ann Rheum Dis. 2018 Dec;77(12):1757–1764.
- Saviola G, Abdi-Ali L, Povino MR, et al. Intramuscular clodronate in erosive osteoarthritis of the hand is effective on pain and reduces serum COMP: A randomized pilot trial—The ER.O.D.E. study (ERosive Osteoarthritis and Disodium-clodronate Evaluation). Clin Rheumatol. 2017 Oct;36(10):2343–2350.