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osteoarthritis of the hand

Epidemiology: - 1st carpometacarpal joint osteoarthritis - more common in women - occurs 10 years earlier in women - peak incidence 70-74 years (women) - overall incidence = 4.3% of women, 1.7% of men - radiographic prevalence of hand osteoarthritis in adults 45-79 years is 41%; symptomatic prevalence is 12% [8] - prevalence of hand osteoarthritis - increases with age - more commmon in women - more common in patients with knee osteoarthritis [8] Clinical manifestations: - usually involves the distal interphalangeal joints (Heberden nodes) & proximal interphalangeal joints (Bouchard nodes) - flares of synovitis may occur - pain usually resolves in 1 to 2 years - first carpometacarpal joint - often remains chronically painful with exacerbations - decreased function over time [2] - pain with palpation of involved joints - clinical exam more sensitive than radiology [1] Laboratory: - no specific laboratory findings - erythrocyte sedimentation rate: normal to minimally elevated - serology for autoantibodies not necessary to confirm clinical diagnosis [1] Radiology: - radiograph of hands - joint space narrowing - osteophytes in distal interphalangeal joints & proximal interphalangeal joints - subchondral cysts in distal interphalangeal joints - not necessary to confirm clinical diagnosis [1] - clinical symptoms do not necessarily correlate with radiographic changes - see osteoarthritis Differential diagnosis: - pseudogout: wrist or knee more likely involved - polyarticular gout: joints other than distal interphalangeal joints (DIP) & proximal interphalangeal joints (PIP) more likely involved - psoriatic arthritis: prolonged morning stiffness, nail pitting - rheumatoid arthritis: - prolonged morning stiffness, metacarpophalangeal joint involvement Management: - see osteoarthritis - topical diclofenac safe & effective - consider prior to oral NSAID [1] - hand exercise therapy associated with less pain, better function & greater grip strength in women [1,3] - multimodal occupational therapy of benefit for patients with osteoarthritis involving the carpometacarpal joint [8] - hydroxychloroquine of no benefit for hand osteoarthritis [5] - prednisolone 10 mg QD for 6 weeks, followed by a 2-week taper dimninishes pain before taper but at follow-up 6 weeks after tapering, pain reverts to baseline for most [7]

Related

hand

Specific

carpometacarpal arthritis; carpometacarpal osteoarthritis

General

osteoarthritis (OA) hand disorder

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2022
  2. Wolf JM, Turkiewicz A, Atroshi I, Englund M. Prevalence of doctor-diagnosed thumb carpometacarpal joint osteoarthritis: An analysis of Swedish health care. Arthritis Care Res (Hoboken) 2014 Jun; 66:961 PMID: 24339432 http://onlinelibrary.wiley.com/doi/10.1002/acr.22250/abstract
  3. Hennig T, Haehre L, Hornburg VT et al. Effect of home-based hand exercises in women with hand osteoarthritis: A randomised controlled trial. Ann Rheum Dis 2015 Aug; 74:1501 PMID: 24667900
  4. Valdes K, Marik T. A systematic review of conservative interventions for osteoarthritis of the hand. J Hand Ther. 2010;23:334-350 PMID: 20615662
  5. Kingsbury SR, Tharmanathan P, Keding A et al Hydroxychloroquine Effectiveness in Reducing Symptoms of Hand Osteoarthritis: A Randomized Trial. Ann Intern Med. 2018. Feb 20. http://annals.org/aim/article-abstract/2672940/hydroxychloroquine-effectiveness-reducing-symptoms-hand-osteoarthritis-randomized-trial
  6. Kloppenburg M, Kwok WY. Hand osteoarthritis--a heterogeneous disorder. Nat Rev Rheumatol. 2011 Nov 22;8(1):22-31. Review. PMID: 22105244
  7. Kroon FPB, Kortekaas MC, Boonen A et al. Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE): A double-blind, randomised, placebo-controlled trial. Lancet 2019 Nov 30; 394:1993-2001. PMID: 31727410 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32489-4/fulltext
  8. Eaton CB et al. Prevalence, incidence, and progression of radiographic and symptomatic hand osteoarthritis: The Osteoarthritis Initiative. Arthritis Rheumatol 2022 Jun; 74:992. PMID: 35077023 https://onlinelibrary.wiley.com/doi/10.1002/art.42076 - Tveter AT et al. Short-term effects of occupational therapy on hand function and pain in patients with carpometacarpal osteoarthritis: Secondary analyses from a randomized controlled trial. Arthritis Care Res (Hoboken) 2022 Jun; 74:955 PMID: 33338325 https://onlinelibrary.wiley.com/doi/10.1002/acr.24543
  9. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72:220-233. PMID: 31908163