EULAR recently updated its recommendations on hand osteoarthritis. See if you know what’s new.
EULAR recently updated its guidelines for the management of hand osteoarthritis. Take the quiz to find out what’s new.
1. Kloppenburg M, Kroon FP, Blanco FJ, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis. 2018 Aug 28. pii: annrheumdis-2018-213826. doi: 10.1136/annrheumdis-2018-213826
Recently, the European League Against Rheumatism (EULAR) updated its guidelines for the management of hand osteoarthritis (OA).1 See if you know what’s new.
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.
ANSWER: According to the 2018 EULAR recommendations, surgery can be considered in patients with structural abnormalities who have not had adequate pain relief from other treatments. Trapeziectomy is recommended in thumb base osteoarthritis. Arthrodesis or arthroplasty (usually with silicon implants) is recommended in interphalangeal osteoarthritis. Osteotomy is not recommended and is considered obsolete.
For more information, please see 10 Recommendations for Management of Hand Osteoarthritis: EULAR 2018.