EULAR Recommendations on Hand Osteoarthritis: A Quiz

Question 1. According to the 2018 EULAR recommendations, every patient with hand osteoarthritis should be offered:

ANSWER: The 2018 EULAR guidelines state that every patient with hand osteoarthritis should be offered education and training in ergonomics, activity pacing, and assistive devices. EULAR considers ergonomics and activity pacing to be “important aspects[s]” of management. Research supports the efficacy of assistive devices, which can improve patient self-management.

Question 2. Which of the following is the first drug of choice in the treatment of hand osteoarthritis?

ANSWER: The 2018 EULAR guidelines recommend topical NSAIDs as first-line drug therapy for hand osteoarthritis because they have a more favorable safety profile than oral NSAIDs. Research suggests that use of topical NSAIDs may result in similar pain relief as oral NSAIDs. Systemic medication may be considered when a large number of joints are affected. Systemic NSAIDs should be used at the lowest possible dose for the shortest duration, and preferably on demand. Intra-articular glucocorticoid injections should generally not be considered, except in patients with painful interphalangeal joints.

Question 3. Which of the following should not be advocated as having disease-modifying properties in hand osteoarthritis?

ANSWER: While the 2018 EULAR recommendations state that chondroitin sulfate may be used to treat hand osteoarthritis, evidence does not support the use of other nutraceuticals. These include diacerhein, intra-articular hyaluronan, glucosamine, and avocado/soybean unsaponifiables. EULAR further states that no drugs have been found to have disease-modifying properties in hand osteoarthritis and should not be advocated for this reason.

Question 4. According to the 2018 EULAR recommendations, biologic DMARDs may be effective in the treatment of hand osteoarthritis.

ANSWER: The 2018 EULAR guidelines do not recommend conventional or biologic DMARDs in the treatment of hand osteoarthritis. This is a new recommendation, based on insufficient evidence or evidence suggesting lack of efficacy. Studies investigating tumor necrosis factor inhibitors, hydroxychloroquine, and anti-interleukin-1 have failed to demonstrate efficacy in hand osteoarthritis. To date, no trials of methotrexate, sulfasalazine, and colchicine have been conducted in this setting, while studies of low-dose oral glucocorticoids have had conflicting results.

Question 5. Which of the following surgical techniques is not recommended in hand osteoarthritis?