# Current and future advances in practice: practical management of hand osteoarthritis

## TL;DR

This paper discusses the best ways to manage hand osteoarthritis, focusing on non-drug treatments and when to consider surgery.

## Contribution

The paper provides updated clinical guidance and practical strategies for managing hand osteoarthritis based on recent insights and guidelines.

## Key findings

- Non-drug interventions like education, hand exercises, and splinting should be prioritized in hand OA management.
- Topical NSAIDs are recommended before oral medications or steroid injections for symptom relief.
- Surgical options like joint fusion or arthroplasty are considered when conservative treatments fail.

## Abstract

The high-quality management of hand osteoarthritis (OA) is crucial for improving the daily lives of people with the condition. The 2022 National Institute for Health and Care Excellence (NICE) guidelines for OA management emphasize education, weight advice and physical activity as foundational management strategies, although hand OA requires specific, tailored approaches. While there can be a focus on pharmacological treatments, non-drug interventions such as education, hand exercises, splinting, joint protection and ‘offloading’ should be prioritized. Pharmacological options including topical NSAIDs are recommended before considering oral medications or intra-articular steroid injections. Although no disease-modifying therapies exist, many symptom management strategies are available. In cases where conservative treatments fail, surgical interventions such as joint fusion, trapeziectomy or arthroplasty are options. The latest insights into OA management based on collective clinical expertise as well as research are outlined. This is underpinned by a current view of pathogenesis, with the hope of enabling a positive consultation incorporating current, accurate information about hand OA. Addressing concerns, myth-busting and using non-negative language are important for activation and empowerment.