Management of hand osteoarthritis: from an US evidence-based medicine guideline to a European patient-centric approach

Abstract

Hand osteoarthritis is the most common joint condition and is associated with significant morbidity. It is of paramount importance that patients are thoroughly assessed and examined when complaining of hand stiffness, pain, deformity or disability and that the patient’s concerns and expectations are addressed by the healthcare professional. In 2019 the American College of Rheumatology and Arthritis Foundation (ACR/AF) produced guidelines which included recommendations for the treatment of hand osteoarthritis. An ESCEO expert working group (including patients) was convened and composed this paper with the aim to assess whether these guidelines were appropriate for the treatment of hand osteoarthritis therapy in Europe and whether they met with the ESCEO patient-centered approach. Indeed, patients are the key stakeholders in healthcare and eliciting the patient’s preference is vital in the context of an individual consultation but also for informing research and policy-making. The patients involved in this working group emphasised the often-neglected area of aesthetic changes in hand osteoarthritis, importance of developing pharmacological therapies which can alleviate pain and disability and the need of the freedom to choose which approach (out of pharmacological, surgical or non-pharmacological) they wished to pursue. Following robust appraisal, it was recommended that the ACR/AF guidelines were suitable for a European context (as described within the body of the manuscript) and it was emphasised that patient preferences are key to the success of individual consultations, future research and future policy-making.

An update on the use of conventional and biological disease-modifying anti-rheumatic drugs in hand osteoarthritis

“…several side effects for the oral formulations. [5][6][7] Some positive, but preliminary results in improving pain and functionality were derived from the use in non-EHOA and EHOA of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs), such as prescription-grade glucosamine sulfate (pGS) or prescription-grade chondroitin sulfate (pCS). [8][9][10][11] Conversely, no disease-modifying OA drugs (DMOADs) that prevent or retard disease progression are actually available, although several clinical trials are currently ongoing.…”

“…2,3 This heterogeneity in the presentation and the variety of the resulted symptoms and signs makes HOA very complex to study. 4,5 Indeed, its pathogenetic mechanisms still remain unclear.…”

“…The therapeutic options are limited and almost exclusively addressed to symptom management, mainly consisting of topical and oral non-steroidal anti-inflammatory drugs (NSAIDs) that have only small to modest analgesic benefits and several side effects for the oral formulations. 5–7 Some positive, but preliminary results in improving pain and functionality were derived from the use in non-EHOA and EHOA of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs), such as prescription-grade glucosamine sulfate (pGS) or prescription-grade chondroitin sulfate (pCS). 8–11 Conversely, no disease-modifying OA drugs (DMOADs) that prevent or retard disease progression are actually available, although several clinical trials are currently ongoing.…”

Osteoarthritis of hand joints: prevalence, risk factors, phenotypes, diagnosis, treatment

“…После публикации клинических рекомендаций ACR для ОАК была созвана рабочая группа экспертов ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases), включавшая и пациентов, которая должна была оценить, подходят ли эти рекомендации для лечения ОАК в Европе и соответствуют ли они подходу ESCEO, ориентированному на пациента [18].…”

Experiences of people with hand osteoarthritis and perceptions of clinicians and carers on quality of life and treatment services: A qualitative synthesis

“…Treatment for HOA includes oral non-steroidal antiinflammatory drugs, patient education, exercise, selfmanagement, and splints. [11][12][13][14][15] Surgery is considered for severe joint instability and deformity. 16,17 Many qualitative studies have explored the experiences of people living with HOA.…”