See more at : keele . ac . uk / mskmatters
MUSCULOSKELETAL MATTERS – BULLETIN 14
Individuals with hand OA experience frustration because of their hand problems and acknowledging this can be helpful . The number of adaptations an individual makes because of their hand problem corresponds with the level of functional difficulties they experience . The inability to make a full fist with all fingers tucked into the palm of their hand and their thumb fully ‘ opposed ’ across the digits is an indication of functional difficulties .
Management for hand OA
Trials have been conducted to evaluate the effectiveness of treatment for hand OA , and in clinical practice painful hand OA may be managed with :
• y information provision ( from health professionals )
• y weight management ( where relevant )
• y education on joint health
• y hand exercises
• yanalgesics ( e . g . topical NSAIDs , capsaicin )
• y joint injection for thumb base OA
• ythumb splinting
NICE recommends referral to an occupational therapist for more specialist advice and assessment . We showed that individuals with hand OA in primary care who attended occupational therapy classes on joint protection education are twice as likely to respond to treatment at six months than if they had not received the classes . We found hand exercises to be cost-effective at twelve months .
KEY MESSAGES For Patients
Seek advice if hand symptoms are troublesome or disabling : there are effective treatments
Read our Hand OA Leaflet ( https :// tinyurl . com / ycb8o4um )
Look at the Osteoarthritis Guidebook ( www . keele . ac . uk / media / keeleuniversity / ri / primarycare / pdfs / OA _ Guidebook . pdf )
For Clinicians
Consideration should be given to referral to occupational therapy for people with reduced hand function
Advice on weight loss ( where relevant )
Joint protection techniques such as those recommended by Arthritis Research UK https :// goo . gl / R8brLZ
Hand exercises such as those recommended by Arthritis Research UK https :// goo . gl / faMNTG
For Healthcare Service Commissioners
Hand OA is a common problem , causing a lot of potentially preventable disability in the community , and it may be under-treated
Adequate access to occupational therapy is needed for those with functional impairment
See more at : keele . ac . uk / mskmatters
References Dziedzic K , Nicholls E , Hill S , Hammond A , Handy J , Thomas E , Hay E . Self-management approaches for osteoarthritis in the hand : a 2 × 2 factorial randomised trial . Ann Rheum Dis . 2015 ; 74 ( 1 ): 108-18 . DOI : 10.1136 / annrheumdis-2013-203938 . Oppong R , Jowett S , Nicholls E , Whitehurst DG , Hill S , Hammond A , Hay EM , Dziedzic K . Joint protection and hand exercises for hand osteoarthritis : an economic evaluation comparing methods for the analysis of factorial trials . Rheumatology ( Oxford ). 2015 ; 54 ( 5 ): 876-83 . DOI : 10.1093 / rheumatology / keu389 . O ’ Reilly S , Johnson S , Doherty S , Muir K , Doherty M . Screening for hand osteoarthritis ( OA ) using a postal survey . Osteoarthritis Cartilage . 1999 ; 7 ( 5 ): 461-5 . DOI : 10.1053 / joca . 1999.0240 Hill S , Dziedzic KS , Nio Ong B . Patients ’ perceptions of the treatment and management of hand osteoarthritis : a focus group enquiry . Disabil Rehabil . 2011 ; 33 ( 19-20 ): 1866-72 . DOI : 10.3109 / 09638288.2010.550381 . Marshall M , Peat G , Nicholls E , van der Windt D , Myers H , Dziedzic K . Subsets of symptomatic hand osteoarthritis in community-dwelling older adults in the United Kingdom : prevalence , inter-relationships , risk factor profiles and clinical characteristics at baseline and 3-years . Osteoarthritis Cartilage . 2013 ; 21 ( 11 ): 1674- 84 . DOI : 10.1016 / j . joca . 2013.08.004 . Marshall M , Nicholls E , Kwok WY , Peat G , Kloppenburg M , van der Windt D , Myers H , Dziedzic K . Erosive osteoarthritis : a more severe form of radiographic hand osteoarthritis rather than a distinct entity ? Ann Rheum Dis . 2015 ; 74 ( 1 ): 136-41 . DOI : 10.1136 / annrheumdis-2013-203948 . National Institute for Health and Clinical Excellence . NICE guideline on osteoarthritis : The care and management of osteoarthritis in adults , NICE clinical guideline 177 , 2014 . http :// guidance . nice . org . uk / CG177 . National Institute for Health and Clinical Excellence . Quality standard for osteoarthritis ( QS87 ), 2015 . https :// www . nice . org . uk / guidance / qs87 Funding The Clinical Assessment Study of the Hand was supported by programme grants awarded by the Medical Research Council ( G9900220 ) and Arthritis Research UK ( 18174 ) and service support through West Midlands North CLRN . Thanks to Arthritis Research UK for funding the SMoOtH study .
This bulletin presents independent research funded by the National Institute for Health Research ( NIHR ) under its Research for Patient Benefit ( RfPB ) programme ( Grant Reference Number PB-PG-1207-15240 ). The views expressed are those of the author ( s ) and not necessarily those of the NHS , the NIHR or the Department of Health . For more information on these bulletins please visit : keele . ac . uk / pchs / disseminatingourresearch / newslettersandresources / bulletins