PARIS _ During their lifetime, one in two women and one in four men will suffer from osteoarthritis of the hand, a disabling disease which can result in pain, joint stiffness, functional and sometimes aesthetic discomfort.
Therapeutic options are rare but the idea that “there is nothing that can be done is a misconception,” stressed Françoise Alliot Launoispresident of theFrench Antirheumatic Association (AFLAR) in a recent press release.
In this context, new recommendations on the non-pharmacological and pharmacological management of hand osteoarthritis have been developed by the French Society of Rheumatology (SFR) in partnership with the French Society of Physical Medicine and Rehabilitation (SOFMER) et l’AFLAR.
They were presented during a session of the congress of the French Society of Rheumatology (SFR) by the Dre Alice Courtiesproject manager (APHP, Saint-Antoine hospital, Paris) but also during an ISBA Pharma press conference in the presence of Pr Jeremy Sellam (APHP, Saint-Antoine hospital, Paris), coordinator of recommendations with the Pre Christelle Nguyen (APHP, Cochin hospital, Paris) and Pr Yves-Marie Pers (Montpellier).
General principles
As a preamble, the recommendations stipulate that the objective of treatments is to improve symptoms, quality of life, function and to limit dependence and disability. They also emphasize the fact that osteoarthritis is a heterogeneous disease whose management must be individualized taking into account the location of the attack (base of the thumb or long fingers), its severity, the presence of an inflammatory and/or painful outbreak, comorbidities and patient expectations.
Information must be provided to the patient about the disease, its progression and the therapeutic methods available in order to allow an optimal shared decision between the patient and the doctor.
There are pharmacological and non-pharmacological treatments and if medical treatments fail, surgical advice should be considered.
Four “non-pharmacological” recommendations
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Exercises (joint mobilization, muscle strengthening, grip, proprioception) must be offered to all patients (evidence level 1A). The benefit/risk balance is very favorable. The effect does not persist over time.
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Ergonomic advice and technical aids can be offered. The benefit/risk balance is very favorable (2B).
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Rest orthoses must be offered in rhizarthrosis and may be offered in osteoarthritis of the fingers. The benefit/risk balance is very favorable (1A).
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In complementary approaches, local application of heat could be considered for a short-term analgesic effect. Electromagnetic waves, laser, acupuncture or adhesive compression tapes should not be offered (2B).
Six pharmacological recommendations
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Topical NSAIDs may be offered (1B).
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Oral NSAIDs can be offered, particularly in the event of a painful flare-up and for the shortest possible duration, at the lowest possible dose. It is essential to pay attention to cardiovascular, renal and gastrointestinal comorbidities (1B).
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Oral corticosteroids can be considered in polyarticular inflammatory flare-ups, for a limited duration (shortest possible duration at the lowest possible dose) (1B).
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Paracetamol can be considered for a limited duration. Weak opioids (including tramadol) should generally not be used (5).
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A new development is that chondroitin sulfate 800 mg/day (IBSA Pharma), a slow-acting symptomatic anti-arthritic, can perhaps be considered for symptomatic purposes and without expecting a structural effect because it has been shown in an academic trial that it improves pain and function vs placebo (1B).
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Intra-articular infiltrations should not be offered apart from corticosteroid infiltrations in the interphalangeal joints during an inflammatory flare-up. This recommendation is based on a positive clinical trial published in 2015. The trials in rhizarthrosis are negative. (1B).
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In view of current data, colchicine, hydroxychloroquine, methotrexate and anti-cytokine treatments should not be offered (1B).
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