Hand Osteoarthritis Assessment and Management

Hand osteoarthritis is a degenerative joint disorder characterised by cartilage degradation, subchondral bone remodelling and synovial inflammation. It most commonly affects the distal and proximal interphalangeal joints and the thumb base, leading to pain, stiffness and reduced grip strength. Assessment combines clinical examination with patient‐reported outcomes for pain and function, supported by imaging modalities such as conventional radiography, ultrasonography and magnetic resonance imaging to evaluate osteophytes, joint space narrowing and synovitis. Management follows a stepped approach. First‐line care emphasises education, self‐management and non-pharmacological interventions including splinting, hand exercises and thermal therapies. Analgesics and topical non-steroidal anti-inflammatory drugs are used for symptom relief. Emerging treatments aim to modify structural progression or target inflammation. In advanced cases with persistent pain or functional impairment, surgical options such as joint arthroplasty or fusion may be considered. A multidisciplinary strategy involving rheumatology, occupational therapy and physiotherapy is essential to optimise outcomes and quality of life.

Research from Nature Portfolio

Recent clinical trials have demonstrated that inhibition of the receptor activator of nuclear factor-κB ligand pathway can slow erosive progression in hand osteoarthritis. In a randomised, placebo-controlled study, patients receiving a monoclonal antibody against this ligand showed significant reductions in new erosive lesions and improved radiographic scores over 48 weeks. These findings suggest a potential disease-modifying approach beyond symptom control and open avenues for targeted biological therapies in erosive subtypes of hand osteoarthritis.

Hand Osteoarthritis Assessment and Management publication trend

The graph below shows the total number of articles in hand osteoarthritis assessment and management across all publications each year (not limited to Nature Index journals).

Technical terms

RANKL: A signalling protein that stimulates osteoclast formation and bone resorption.

Denosumab: A monoclonal antibody that inhibits RANKL to reduce bone erosion.

Ghent University Scoring System (GUSS): A radiographic index for quantifying erosive changes in hand joints.

Osteophyte: A bony outgrowth at the margin of a joint associated with osteoarthritis.

Joint space narrowing: Radiographic reduction in space between bones, indicating cartilage loss.

Power Doppler ultrasound: An imaging technique to visualise blood flow within the inflamed synovium.

References

1. RANKL blockade for erosive hand osteoarthritis: a randomized placebo-controlled phase 2a trial. Nature Medicine (2024).
2. OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for hand osteoarthritis. Osteoarthritis and Cartilage (2015).
3. Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review. Arthritis Research & Therapy (2011).
4. The prevalence of radiographic thumb base osteoarthritis: a meta-analysis. Osteoarthritis and Cartilage (2021).
5. Imaging modalities in hand osteoarthritis - status and perspectives of conventional radiography, magnetic resonance imaging, and ultrasonography. Arthritis Research & Therapy (2011).