Osteoarthritis

ORIGINAL RESEARCH

Efficacy and safety of non-­

pharmacological, pharmacological and
surgical treatments for hand osteoarthritis
in 2024: a systematic review
Ingvild Kjeken ‍ ‍,1,2 Daniel Huseby Bordvik ‍ ‍,1 Nina Osteras ‍ ‍,1,2
Ida K Haugen ‍ ‍,2 Kristine Aasness Fjeldstad ‍ ‍,1,2 Ingrid Skaalvik ‍ ‍,1
Margreet Kloppenburg ‍ ‍,3 Féline P B Kroon ‍ ‍,4 Anne Therese Tveter ‍ ‍,1,2
Geir Smedslund ‍ ‍1,5

To cite: Kjeken I, Bordvik DH, ABSTRACT

Osteras N, et al. Efficacy and WHAT IS ALREADY KNOWN ON THIS TOPIC
Background We aimed to update the 2018 systematic
safety of non-­pharmacological, literature review on the efficacy and safety of treatments ⇒ Hand osteoarthritis (OA) is a prevalent rheumat-
pharmacological and ic joint disease, for which there is yet no cure or
for hand osteoarthritis (OA), which was based on 126
surgical treatments for hand disease-­modifying treatment.
studies.
osteoarthritis in 2024: a
Methods We performed a systematic literature search ⇒ There is a general consensus across international
systematic review. RMD Open
2025;11:e004963. doi:10.1136/ on randomised controlled trials from June 2017 up to 31 treatment recommendations that all patients with
rmdopen-2024-004963 December 2023. Risk of bias was assessed using the hand OA should receive patient education and ex-
ercises to improve hand function, that topical or oral
RoB2 tool. Meta-­analyses of previous and new studies
► Additional supplemental non-­steroidal anti-­inflammatory medication may be
regarding the efficacy for pain, function, grip strength and
material is published online only. considered for short time use, whereas surgery may
OMERACT/OARSI responders were performed. Certainty be considered for patients with structural abnormal-
To view, please visit the journal
online (https://​doi.​org/​10.​1136/​ of evidence was judged using the GRADE (Grading ities when other treatment modalities have not been
rmdopen-​2024-​004963). of Recommendations Assessment, Development and sufficiently effective in relieving pain.
Evaluation) tool. ⇒ The treatment recommendations vary with respect
Results Sixty-­five new studies were included. For to other treatment modalities, and the evidence for
Received 6 September 2024
non-­pharmacological interventions, there was low-­ most treatments is limited.
Accepted 22 November 2024
certainty evidence for a small long-­term effect of
WHAT THIS STUDY ADDS
hand exercises and a moderate long-­term effect of
thumb orthoses for pain, and moderate-­certainty ⇒ This systematic literature review includes 65 new
evidence that assistive devices had a moderate long-­ randomised controlled trials published in the hand
OA field since June 2017, thereby providing an up-
term effect on function. Concerning pharmacological
dated overview of all current evidence on efficacy
interventions, there was low-­certainty evidence for
and safety of non-­pharmacological, pharmacologi-
a moderate short-­term effect of oral non-­steroidal
cal and surgical treatment options for hand OA.
anti-­inflammatory drugs (NSAIDs) on pain, high- and
moderate-­certainty evidence for a small short-­term HOW THIS STUDY MIGHT AFFECT RESEARCH,
effect of topical NSAIDs and oral glucocorticoids on PRACTICE OR POLICY
function, respectively, and low-­certainty evidence that ⇒ This study confirms the need for high-­quality ran-
oral glucocorticoids had a small short-­term effect on domised controlled trials including hand OA sub-
function. Further, there was low-­certainty evidence that typing to better understand the action mechanisms
methotrexate had a small long-­term effect on pain. The and allow for separate analyses with regard to OA
© Author(s) (or their heterogeneity of studies did not allow for any meta-­ phenotype and trials with low risk of bias.
employer(s)) 2025. Re-­use ⇒ It further shows that there is a need for studies that
permitted under CC BY-­NC. No
analyses on surgery.
Conclusion The results largely support current help us understand factors that may influence grip
commercial re-­use. See rights
and permissions. Published by treatment recommendations. However, there is a lack strength as a basis for developing evidence-­based
BMJ Group. of interventions that efficiently improve grip strength, interventions that efficiently improves grip strength.
For numbered affiliations see and the evidence for most current treatments is still ⇒ The results also indicate that mobile applications
end of article. limited. To better understand action mechanism of may be used to deliver interventions designed to
different treatments, future trials should include enhance self-­ management, but the efficacy and
Correspondence to hand OA subtyping and be powered for subgroup cost-­effectiveness of this delivery mode should be
Professor Ingvild Kjeken; analyses. evaluated in robust clinical trials.
​Ingvild.​Kjeken@​diakonsyk.​no

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963    1

RMD Open

INTRODUCTION databases from 7 June 2017 (end date of search of orig-

Hand osteoarthritis (OA) is a common rheumatic joint inal SLR) up to 31 December 2023. Additionally, confer-
disease, leading to structural and functional impair- ence abstracts of the EULAR, ACR and OARSI annual
ment that may significantly impact body functions and conferences of 2022 and 2023 and EULAR, and reference
structures, activity performance, work ability and health-­ lists of included studies and other relevant SLRs were
related quality of life.1 2 Despite its high and increasing screened. Eligible study types were parallel randomised
prevalence, research shows that the quality of care controlled trials (RCTs), cluster-­randomised trials and
services in general is suboptimal for people with OA, and cross-­over randomised trials, published in English or
that especially those with hand OA have poor access to Scandinavian. Cochrane systematic reviews were also
treatment in primary and specialist healthcare.3 4 To opti- included as a source of relevant RCTs.
mise the care for people with hand OA, treatment recom- We included all studies of non-­pharmacological, phar-
mendations should be based on updated best evidence. macological and surgical interventions for hand OA.
In a recent systematic review, Conley et al identified the Additionally, studies also involving participants with other
following four high-­quality clinical guidelines published diagnoses were included if the results were presented
since 2019, addressing different treatments for hand separately for participants with hand OA.
OA5: The OsteoArthritis Research Society International In line with the outcomes proposed by the OMERACT
(OARSI) guidelines for the non-­surgical management core set,12 the main efficacy outcomes were as follows:
of knee, hip and polyarticular OA6; the 2019 American (1) pain (measured on Visual Analogue Scale (VAS)),
College of Rheumatology (ACR)/Arthritis Foundation Numerical Rating Scale (NRS) or a validated question-
Guideline for the Management of OA of the Hand, Hip, naire, for example, Australian/Canadian Hand OA Index
and Knee7; the Italian Society for Rheumatology clinical (AUSCAN) or Michigan Hand Outcomes Questionnaire
practice guidelines for the diagnosis and management (MHQ); (2) hand function measured by a validated ques-
of knee, hip and hand OA8; and the 2018 update of the tionnaire, for example, Functional Index for Hand OA
European Alliance of Associations for Rheumatology (FIHOA), AUSCAN or MHQ; (3) grip strength; and (4)
(EULAR) recommendations for the management of number of participants fulfilling the OMERACT-­OARSI
hand OA.9 After the review by Conley et al was published,5 responder criteria.13 Safety measures (adverse events
the National Institute for Health and Care Excellence (AEs)) were also analysed, if available.
(NICE) has also launched updated guidelines for diag-
nosis and management of OA, including hand OA.10 Study selection, data extraction, risk of bias and GRADE
There is a general consensus across the five guidelines assessment
that patient education and exercises are essential compo- Four reviewers (ATT/DHB/KAAF/IK, working in pairs)
nents of hand OA treatment, that topical non-­steroidal screened all titles and abstracts using the Rayyan tool.14
anti-­inflammatory drug (NSAID) gel/cream should be the The following hierarchy was used for exclusion:
first pharmacological choice, and that oral NSAIDs may 1. Wrong design.
be considered alongside non-­pharmacological treatment 2. Wrong population.
for short time use. Further, EULAR and ACR guidelines 3. Wrong language.
state that conventional or biological disease-­modifying 4. Wrong intervention.
anti-­rheumatic drugs (DMARDs) should not be used in 5. Wrong outcome.
hand OA. However, the treatment recommendations vary In case of doubt, the third reviewer was consulted.
with respect to other treatment modalities, such as the Thereafter, potentially relevant studies were read and
use of orthoses, assistive devices, electrotherapy, thermal evaluated in full text. For each study, two authors (DHB/
modalities, paracetamol and intra-­ articular injections. IS/IK) extracted data on study design, first author, publi-
The aim of the current study was to update the 2018 cation year, patients (hand OA definition, location and
systematic literature review (SLR) by Kroon et al11 on the subtype, proportion of women, mean age, disease dura-
efficacy and safety of non-­pharmacological, pharmaco- tion, number of participants per study arm), interven-
logical and surgical treatments for hand OA. tion (including frequency, duration and dose), primary
outcome, other outcomes and AEs. The data extraction
sheets were subsequently compared to ensure accuracy.
METHODS Risk of bias (RoB) was assessed in pairs by three authors
Search strategy (DHB, IS and IK) using the RoB2 tool,15 including bias
The study protocol for this review have been published arising from the randomisation process, deviations
in the International Prospective Register of Systematic from the intended interventions, missing outcome
Reviews, PROSPERO (#CRD42022288691). A systematic data, measurement of the outcome and selection of the
literature search was conducted by two of the authors reported results. Each item was judged as low (green
(ATT and IK) in close collaboration with an experienced colour), high (red) or some concerns (yellow). Finally,
librarian. We used the same search strategy as Kroon et we did an ‘overall assessment’ for each study based on the
al (see online supplemental material) and searched the judgements of all RoB2 items. Although not described
PubMed/MEDLINE, Embase and Cochrane CENTRAL in the protocol, we decided to also use the Grading of

2 Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963

 Osteoarthritis

Recommendations Assessment, Development and Evalu- in 10 studies. Additionally, one study with three arms
ation (GRADE) tool to assess the certainty of the effect compared a non-­pharmacological and a pharmacolog-
estimates of all interventions and outcomes for which we ical intervention to a control group receiving no inter-
conducted a meta-­analysis.16 One author (GS) performed vention25 and is listed both as a non-­pharmacological and
a first assessment, which was thereafter checked by two a pharmacological intervention. We did not identify any
other authors (DHB, IK). GRADE considers the risk of new relevant Cochrane reviews. The characteristics and
bias, consistency and directness of estimates, precision overall RoB of all new studies are presented in tables 1–3.
of results, risk of publication bias, size of effect, dose-­ The detailed RoB of all new studies are provided in online
response, and possible confounding to produce a grading supplemental material (pp 10–26), as are characteristics
into one of four categories: high-, moderate-, low- or very and overall RoB of previous studies included in our meta-­
low-­certainty of the estimates of the efficacy. In section analyses (pp 27–36), GRADE assessments of the meta-­
6 in the online supplemental material, we show GRADE analyses with reasons for why an analysis was downgraded
summary of findings tables for each outcome. Whenever (pp 37–52) and the meta-­analyses (pp 53–89). The main
we have downgraded the certainty, the reasons for this results of the GRADE assessments are also included in
downgrading are provided in the footnote. figures 1–3. The reporting of results mainly focuses on
findings new to this review, meta-­analyses where results
Data analysis are graded with moderate or high-­certainty, and on effi-
We extracted outcome data from each study and, as in cacy and safety of interventions recommended for or
the original review,11 categorised these by short-­term (<3 against in one or more of the five hand OA guidelines.6–9
months) and long-­term (≥3 months) follow-­up. Contin-
uous outcomes were summarised as standardised mean Non-pharmacological interventions
differences (SMDs) with 95% CIs. We used random-­ We identified 34 new studies assessing the efficacy of
effects models for conducting meta-­analyses of studies exercises (n=11), orthoses (n=6), assistive devices (n=1),
assessing efficacy of the same intervention and pooled kinesiology tape (n=2), thermal modalities (heat appli-
data if there was adequate clinical and methodological cation) (n=7), ultrasound/laser therapy (n=1), low-­dose
homogeneity. Heterogeneity was assessed with the I² radiation therapy (n=1, results reported in two arti-
statistic and tested with Cochran’s Q test. However, we cles), gloves (n=1), acupuncture (n=1) or programmes
only pooled data from studies where the intervention combining two or more non-­pharmacological interven-
of interest was compared with a control group receiving tions (n=3) (table 1). The studies varied with regard
placebo or no intervention, or, if study groups received to number of participants (11–347; 11 studies with ≥80
a combination of interventions, the only difference participants), type and duration of interventions (range
between groups in terms of treatment was the interven- 1–24 weeks, the majority ≤8 weeks), outcomes included
tion of interest. We also included results from relevant and follow-­up period (4–52 weeks). None of the studies
studies in the SLR by Kroon et al11 in the meta-­analyses specifically included participants with signs of inflam-
(hereafter termed previous studies), but used data from matory OA. All but two studies26 27 were parallel RCTs,
full-­text articles of conference abstracts included in this and all but one study on low-­dose radiation therapy28
SLR, if available.17–23 were judged to have high RoB or some concerns, most
We applied the commonly used categorisation by often related to lack of blinding of participants and ther-
Cohen, and regarded the effect as small, moderate or apists delivering the interventions (online supplemental
large if the SMD was 0.2–0.5, ≥0.5–0.8 and ≥0.8, respec- material, pp 10–18). Whereas the studies on ultrasound/
tively.24 Finally, we conducted meta-­analyses comparing laser, radiation, acupuncture and one study of thumb
the pooled effect of each non-­ pharmacological and orthoses29 used placebo as comparator, the control group
pharmacological intervention on the four main efficacy in the other studies either received no intervention, an
outcomes. The Stata Statistical Software: Release V.18 was information leaflet, the same intervention as the inter-
used for meta-­analyses. vention group except for the intervention of interest, or
another intervention (see also descriptions in table 1).
All the results from our meta-­analyses were graded with
RESULTS very low or low certainty, except for one on long-­term
After removal of duplicates, the SLR yielded a total of effect of assistive devices on function and one on short-­
4162 records, of which 65 studies (hereafter termed term effect of ultrasound/laser on grip strength, which
new studies) reported in 66 publications were included both were graded as moderate certainty.
(see flow chart in the online supplemental material, p
6). Thirty-­three studies (reported in 34 articles) assessed Hand exercises
benefits and harms of different non-­ pharmacological Six of 11 new exercise studies evaluated the effect of
therapies, 17 investigated pharmacological interventions hand exercises (see table 1 for details on interven-
against each other or placebo, 4 studies compared phar- tions).26 30–34 The exercise programmes varied in content,
macological and non-­ pharmacological interventions, length and intensity and were often combined with other
whereas different surgical interventions were compared non-­pharmacological interventions. Meta-­ analyses of

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963 3

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Table 1 Characteristics of 34 new studies of non-­pharmacological interventions published between 7 June 2017 and 31 December 2023
Duration, frequency, Measurement OA location, Age in years
RoB Study Design Intervention instructions timepoints N definition Women (%) (SD) Primary outcome (PO)

Hand exercises
RMD Open

Kang et al 2019#30 RCT parallel A: Combination of A: 6 exercises, 10 to 15 Short term 15 Hand, ACR NR 46.7 (4.6) Grip strength (dynamometer) at
conservative treatment reps, 30 min, 5 times/ 14 47.9 (4.0) 8 weeks. Also measured pain and
(paraffin therapy+physio week for 8 weeks. function (AUSCAN subscales)
supervised exercise A and B: Paraffin bath
programme 5 times/week) therapy: Once a day,
B: Paraffin bath therapy 5 times/week for 8 weeks
Leonard et al 2021#31 RCT parallel A: Educational pamphlet A: Knitting 20 min/day for Short term 19 Hand, ACR, 100 64.6 (6.4) Morning stiffness (VAS) at
Pilot study about HOA+exercise— 8 weeks Long term 8 pain >3 months 100 70.5 (7.0) 8 weeks. Also measured pain
knitting programme (VAS) and function (AUSCAN) and
B: Educational pamphlet grip strength (JAMAR)
about HOA
Magni et al# 202232 RCT parallel A: Advice and blood flow A and B: Exercising Short term 19 Hand, ACR, 84 67.9 (8.6) Exercise-­induced pain (NRS)
Feasibility restriction training 3 times per week for 20 KL≥1, NRS pain 95 72.7 (9.0) 1 week post-­intervention. Also
study B: Advice and traditional 6 weeks 20 >3 months and 70 75.6 (12.0) measured grip strength, function
(three groups) high intensity training pain ≥3 last (FIHOA) and OMERACT-­OARSI
C: Advice only week responders
McVeigh et al 202133 RCT parallel A: Standard conservative A: Exercises with 10 Short term 42 CMC, clinical 85 70.6 Pain (NRS) at 6 weeks. Also
therapy (SCT); heat repetitions, 3 times/day, 42 and Rx 90 84.8 measured function (qDASH) and
application, joint protection, 7 days/week for 6 weeks diagnosis grip strength
assistive devices, ADL
modifications, thumb
orthosis, with the addition
of 3 dynamic stabilisation
exercises
B: SCT
Pedersini et al 202134 RCT parallel A: Neurodynamic A: Mobilisation in Short term 36 Hand, clinical 71 58 NR. Measured pain (NRS) and
mobilisation 3 minutes × 3/session, Long term 36 diagnosis and 69 52 grip strength (dynamometer) after
B: Robotic-­assisted passive 3 sessions/week for KL 3 to 4 on Rx 3 months
movement 4 weeks
B: Passive movement,
3 sessions/week for
4 weeks
Pisano et al# 202226 RCT A: SCT: heat application, B: Exercising 2 to Long term 96 CMC, clinical 80 60 (8.8) NR. Measured pain at rest (NRS),
crossover joint protection, assistive 3 times/day, 7 days/week 94 diagnosis by 78 61 (9.6) grip strength (JAMAR) and
devices, ADL modifications, for 6 months surgeons and/ function (DASH)
thumb orthosis. or physician
B: SCT+stabilisation and/or assistant
stretching and/or stabilising
thumb exercises
Proprioceptive exercises
Cantero-­Tellez et al# RCT parallel A: Standard treatment plus A: Exercises 2 to 3×8–10 Long term 6 CMC, E-­L stage NR 67.2 NR. Measured pain intensity
202339 Pilot study a proprioceptive training repetitions, 2 times/day 6 I-­II, NRS pain 65.3 during activity (NRS)
programme for 12 weeks >4 in ADL
B: Standard treatment
Cantero-­Téllez et al# RCT parallel A: Standard treatment plus A: Exercises 3×10 Short term 26 CMC, E-­L stage 100 63.5 (6.6) Proprioception measured as joint
202240 a proprioceptive training repetitions daily for Long term 26 I-­III, NRS pain 100 62.7 (8.0) position sense. Also measured
programme 12 weeks >4 in ADL pain (NRS) and hand function
B: Standard treatment (qDASH)

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Continued
 Table 1 Continued
Duration, frequency, Measurement OA location, Age in years
RoB Study Design Intervention instructions timepoints N definition Women (%) (SD) Primary outcome (PO)

Cantero-­Téllez et al# RCT parallel A: A conservative exercise A and B: Daily exercises Short-­term 23 CMC, E-­L stage 100 63 (7) Proprioception measured as joint
202241 program+a proprioceptive with 3×10 repetitions for Long-­term 22 I-­III, NRS pain 100 62 (7) position sense. Also measured
training programme. B: 4 weeks >4 in ADL pain (NRS) and hand function
A conservative exercise (qDASH)
programme
Campos-­Villegas et al RCT parallel A: Strength exercising A and B: Both Short-­term 21 CMC-­OA, 100 59.1 (8.1) Function measured with qDASH.
202242 programme (SEP) programmes with 3 21 clinical 100 61.0 (6.1) Also measured pain (VAS) and
B: SEP+proprioceptive sessions of 30 to 45 min/ diagnosis and grip strength
neuromuscular facilitation week, 3×10 repetitions E-­L stage ≤3
programme of each exercise/session
for 4 weeks
Cruz-­Gambero et al RCT parallel A: Orthosis, exercises+a NR Long-­term 29 CMC, E-­L NR 58 (8) 62 (6) NR. Measured
2023#43 proprioceptive training 28 grade I-­III pain (NRS) and Occupational
programme for 4 weeks. performance (COPM)
B: Orthosis and exercises for
4 weeks.
Orthoses vs no orthoses or placebo
Adams et al# 202129 RCT parallel A: Self-­management A and B: Exercises at Short term 116 CMC, pain 64 (9.4) 78 Pain (AUSCAN) at week 8. Also
(three groups) programme: Booklet and least 3 days/week for Long term 116 >5 and function 62.1 (9.1) 78 measured function (AUSCAN)

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963

exercise programme at least 20 min/day for 117 >9 on AUSCAN 61.7 (10.1) 79 and OMERACT-­OARSI
B: Self-­management 12 weeks responders
program+an orthosis for the B: Orthosis should be
CMC, MCP+ (for some) the used minimum
IP joint 6 hours/day for 12 weeks
C: Self-­management
programme+placebo
orthosis for the CMC, MCP
and the IP joint**
Can et al 2020#7 RCT parallel A: Prefabricated orthosis A: Orthosis should Short term 40 Stage one or 2 56.1 (7.5) 91.7 NR. Measured pain and function
immobilising the wrist and be used as much as 40 CMC-­OA 56.6 (9.2) 89.3 (AUSCAN and qDASH) and grip
CMC and MCP joint of the possible for the first strength (JAMAR) at 6 weeks
thumb. 3 weeks and then only
B: Oral information only during painful activities
for the next 3 weeks
Silva et al 2020128 RCT parallel A: Custom-­made nighttime A: Orthosis should be Short term 26 PIP and/or DIP 64.1 (8.4) 100 Pain (NRS). Also measured
neutral positioning orthosis used every night for 6 Long term 26 ACR, pain 3 to 63.5 (7.8) 100 function (AUSCAN) and grip
in the DIP or PIP joint of months 8 on NRS strength
the 2 or 3 finger (or both) of A and B: Patient
the dominant hand+patient education, three 40 min
education sessions
B: Patient education
Thumb orthoses immobilising the CMC-­joint only against thumb orthoses also immobilising the wrist and/or one or more additional thumb joints
Cantero-­Téllez# 201852 RCT parallel A: Thumb orthosis (CMC and A and B: Orthosis should Short term 33 CMC, E-­L 63.8 (8.9) 84.8 NR. Measured pain (VAS) and
MCP joint immobilised) be used at night and 33 stage II-­III and 63.7 (10.3) 81.8 function
B: Thumb orthosis (only during daytime ADL for 3 NRS pain >4 in (qDASH) at 1 week
CMC joint immobilised) to 4 hours/day in 1 week ADL

Continued
Osteoarthritis

5
6
Table 1 Continued
Duration, frequency, Measurement OA location, Age in years
RoB Study Design Intervention instructions timepoints N definition Women (%) (SD) Primary outcome (PO)
RMD Open

Cantero-­Téllez# 201851 RCT parallel A: Thumb orthosis (CMC and A and B: Orthosis should Long term 44 CMC, Rx 59.7 (9.6) 93.2 NR. Measured pain (VAS) and
MCP joint immobilised) be used at night and 40 diagnosis and 60.5 (9.8) 90.0 function
B: Thumb orthosis (only during daytime ADL for NRS pain >4 in (DASH) at 3 months
CMC joint immobilised) 3 to 4 hours/day in 3 ADL
months
Eyiis et al# 202327 RCT A: 3-­D customised thumb A and B: Use of orthosis Short term 24 CMC, KL I-­III, 65 (11) 66.6 Patient satisfaction at 4 weeks.
crossover orthosis (only CMC for 4 weeks 25 positive shear 61 (11) 84.0 Also measured pain (VAS) and
immobilised) and grind tests function (QuickDASH)
B: Plaster customised thumb
orthosis (CMC and MCP
immobilised)
Assistive devices
Amaral et al# 201856 RCT parallel A: Assistive devices+group A: 12 week treatment Short term 19 Hand, ACR and 59.0 (9.0) 100 Occupational performance
education period in which use of Long term 20 ADL problems 60.2 (6.2) 100 (COPM) and hand function
B: Information leaflet devices should become (SACRAH) at 30 days. Also
part of each individual’s measured pain (VAS)
routine
Kinesiology tape
Farhadian et al 2019129 RCT parallel A: Kinesiology tape (wrist Kinesiotape was used for Short term 19 Hand, NR 69.5 (4.0) 84 NR. Measured pain (VAS), grip
Pilot study and thumb)+exercise 2 months but changed 19 68.5 (3.9) 84 strength (dynamometer) and
B: Exercise after 3 days or when it function (DASH)
was necessary, with a 1-­
day rest before applying
new tape. Exercise
dosage not described
Wade et al 2018130 RCT parallel A: Supportive/analgesic A and B: Used tape for Short term 6 Hand, clinical 62.4 (8.4) 83.3 Pain (VAS). Also measured
Pilot study kinesiology tape (PIP) 1 week 5 and Rx (sample) 40.0 function (qDASH)
B: Placebo kinesiology tape diagnosis
(PIP)
Thermal modalities
Aksanyar et al 202258 RCT parallel A: Hot paraffin+exercise Paraffin or mud: One Short term 40 Hand, ACR, 55.2 (8.3) 100 NR. Measured pain (NRS), grip
B: Hot peloid mud+exercise 20 min session 5 days/ 40 VAS-­pain score 57.7 (7.0) 100 strength (JAMAR) and function
week for 3 weeks, 47°C ≥4 (AUSCAN)
Exercises: 2 daily
sessions with 10 repeats
of each exercise for
3 weeks
Benini et al 202161 RCT parallel A: Hot mud+bath therapy A and B: 15 min/day for Short term 26 Hand, ACR, KL 67.3 (6.8) 92.3 Pain and/or function (AUSCAN) at
Pilot study (balneotherapy) 12 days intercepted by 2 Long term 26 II or III 64.3 (9.4) 90.5 12 months
B: Bath therapy rest days, 47 to 50°C
(balneotherapy)
Azevedo et al# 2023 RCT parallel A: Paraffin baths A: 3 times/week for 4 Short term 34 HOA acc. to 59 (10) 32 (94) Pain (VAS) after 4 weeks
Abstract62 B: Leaflet with information weeks 33 ACR criteria 60 (9) 31 (94)
on joint protection (control) B: Delivered once

Continued

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 Table 1 Continued
Duration, frequency, Measurement OA location, Age in years
RoB Study Design Intervention instructions timepoints N definition Women (%) (SD) Primary outcome (PO)

Kasapoğlu Aksoy et RCT parallel A: Hot paraffin A: Paraffin: 52°C, Short term 31 Hand, Rx-­ 57.2 (10.6) 90.3 NR. Measured pain (VAS) and
al# 201859 therapy+home-­based 20 min/5 days weekly for 30 based (KL) 61.3 (8.4) 89.3 grip strength (JAMAR)
exercise programme 2 weeks diagnosis
B: Home-­based exercise A and B: Exercises:
programme alone 15 min x 2 per day,
5 days/week for 2 weeks
Savas et al# 2019 RCT parallel A: Flaxseed poultice hot A and B: The hot Short term 33 Primary IP, ACR 62 (6.8) 93.9 NR. Measured pain (VAS) and
(NB also listed as a (three groups) compress** compress was applied 29 64.9 (8.3) 96.6 function (AUSCAN)
herbal intervention)25 B: Hot compress for 20 min once a day for 20 65.5 (9.2) 85
C: No intervention 7 days, 40 to 45°C
Ustun and Çağlar RCT parallel A: Paraffin wax 52°C A: Daily 20 min 5 days/ Short term 23 Hand OA 60.43 (7.36) 100 NR. Measured pain (NRS),
2023131 B: Prolotherapy injection week for 2 weeks Long term 23 59.52 (6.92) 100 function (DHI) and grip strength
0.25 to 0.50 mL 15% B: 1 injection into the (JAMAR)
dextrose solution periarticular ligaments
of the symptomatic PIP,
DIP and CMC joints
Öncel et al 202160 RCT parallel A: Hot paraffin therapy A and B: Received Short term 41 Hand, ACR 61.9 (10.3) 80.6 NR. Measured pain (VAS) and
B: Fluid therapy (dry heat 20 min therapy daily 41 64.2 (10.3) 97.6 function (DHI)
therapy) 53°C for 14 days
Laser therapy

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963

Cantero-­Téllez et al# RCT parallel A: High-­intensity laser A: 75 J/session, spot Short term Long 22 CMC, Rx stage 63.1 (7.5) 100 NR. Measured pain (VAS)
202067 therapy size 5 cm2, 3 days/week term 21 1–2 and NRS 64.3 (8.6) 100
B: Laser placebo for 4 weeks pain >4 in ADL
B: 1 session, 3 days/
week for 4 weeks
Low-­dose radiation
Minten et al# 2018132 RCT parallel A: Low-­dose radiation A: 1 Grey × 3 per week Long term 28 Hand, ACR, 67 (1.2) 86 OMERACT-­OARSI responders
B: Sham radiation for 2 weeks 28 NRS pain ≥5 for 63 (1.2) 71 at 3 months. Also measured pain
B: Sham therapy × 3 per min 15 of last (NRS) and function (AUSCAN)
week for 2 weeks 30 days
Van den Ende et al RCT parallel A: Low-­dose radiation A: 1 Grey × 3 per week Long term 28 Hand, ACR, 67 (1.2) 86 OMERACT-­OARSI responders at
2020 B: Sham radiation for 2 weeks 28 NRS pain ≥5 for 63 (1.2) 71 3 months. Also measured pain
(NB Report 6- and B: Sham therapy × 3 per min 15 of last (NRS) and function (AUSCAN)
12 months results from week for 2 weeks 30 days
the study by Minten
et al)28
Gloves
Jamison et al 2018133 RCT parallel A: Vibrating gloves A: Gloves used minimum Short term Long 34 Hand, 100 (sample) 63.0 (7.8) NR. Measured pressure pain
B: Treatment as usual 20 min per day for term 35 OA- related (sample) (Pain Disability Inventory)
3 months pain
Acupuncture
Barnard et al 2020134 RCT parallel A: Acupuncture A and B: Both groups Short term 36 CMC, Rx Not described Not described Pain (VAS) after 4 weeks. Also
B: Sham acupuncture received two sessions/ 37 or clinical measured grip strength (JAMAR)
week for 3 weeks diagnosis and hand function (Nelson score)
Combination programmes

Continued
Osteoarthritis

7
8
RMD Open

Table 1 Continued
Duration, frequency, Measurement OA location, Age in years
RoB Study Design Intervention instructions timepoints N definition Women (%) (SD) Primary outcome (PO)

Rodriguez Sanchez-­ RCT parallel A: Combination of A: 12 weeks of self-­ Long term 66 Symptoms. 73 62.2 (8.8) AUSCAN function at 3+6 months.
Lauhlè et al 202369 conservative treatments management hands Hand OA, 62 64.3 (7.7) Also measured pain (AUSCAN)
delivered in mobile app recommendations, 78 ACR and grip strength (Saehan
B: Exercises only joint protection hands SH5001)
(description) material, general
information about the
disease, videos with
demonstrations, and a
‘follow-­up diary’ with
graphical representations
of
the exercises performed
every session. Exercises
4 times per week. Phone
call once/month
B: Phone call once/
month, exercises
4 times per week, usual
consultations
Stoffer-­Marx et al# RCT parallel A: Combination of A: One therapy Short term 74 Hand, ACR or 60.1 (10.9) 79.7 Grip strength (Martin vigorimeter)
201870 conservative treatments session+one telephone-­ 77 bony swelling 59.6 (10.6) 88.3 at 8 weeks. Also measured pain
(information, assistive follow up after 4 weeks of min 1 IP or (NRS) and function (AUSCAN)
devices, instructions on pain B: Use a massage ball CMC joint
management and exercises) on the hands
B: Routine care+placebo (a
massage ball)
Tveter et al# 202271 RCT parallel A: Patient education, A: One session with Long term 90 Referred 62.8 (7.5) 81 Number of patients receiving
assistive devices, hand education+follow up 90 to surgical 63.3 (7.8) 77 CMC surgery during the 2-­year
exercises, thumb o session after 2 weeks. consultation follow-­up period. Also measured
B: Leaflet with written Told to do hand due to CMC-­ pain (NRS), grip strength (Grippit)
information exercises three sessions/ OA an function (qDash).
week for 3 weeks

Studies marked with # are included in meta-­analyses, whereas intervention groups from these studies marked with ** are excluded from meta-­analyses.
*Available as abstract only to the 2018 review of Kroon et al (paragraph)—full-­text manuscript evaluated for the update. **Not included in meta-­analyses. Colours denote RoB (green: low, yellow: some concern, red: high). (A) indicates conference
abstract.
ACR, American College of Rheumatology; ADLs, activities of daily living; AUSCAN, Australian/Canadian Hand Osteoarthritis Index; CMC, first carpometacarpal joint; CO, cross-­over trial; COPM, Canadian Occupational Performance Measure;
OMERACT-­OARSI criteria, Outcome Measures in Rheumatology-­Osteoarthritis Research Society International responder criteria; DASH, Disabilities of the Arm, Shoulder and Hand; DHI, Duruöz Hand Index; DIP, distal interphalangeal joint; E-­L,
Eaton-­Litter; FIHOA, Functional Index for Hand OsteoArthritis; IP, interphalangeal joint; MCP, metacarpophalangeal; MHQ, Michigan Hand Questionnaire; N, number; NR, not reported; NRS, Numerical Rating Scale; OA, osteoarthritis; PO, primary
outcome; qDASH, quick DASH; RCT, randomised controlled trial; RoB, risk of bias; Rx, radiography; SLR, systematic literature review; VAS, Visual Analogue Scale; WA, wash-­out period.

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 Table 2 Characteristics of 22 new studies of pharmacological interventions published between 7 June 2017 and 31 December 2023
Frequency, Age,
duration Measurement OA location, years Women
RoB Study Design Intervention (instructions) timepoints N definition (SD) (%) Primary outcome
Herbal treatment
Kim et al 202177 RCT A: Red ginseng (RG) A: 3 g/day Long term 26 Hand, Rx 60.2 (9.5) 100 NR. Measured pain
parallel capsules of RG for 26 diagnosis 60.6 (7.9) 100 (VAS) and function
B: Placebo capsules 12 weeks (DASH) at 12 weeks
B: Daily
placebo for
12 weeks
Liu et al 202178 RCT A: Combination of A: Combination Long term 52 Hand, ACR, 65.1 (6.9) 85 Pain (VAS) at
parallel three herbs of Boswellin 54 VAS pain 40–90, 66.2 78 12 weeks. Also
B: Placebo Super 250 mg/ FIHOA ≥6 and (7.6) measured function
day, Fenoprolic KL ≥2 in ≥1 (FIHOA) and
70 Organic painful joint OMERACT-­OARSI

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963

100 mg/day and responders
MSM 1500 mg/
day (capsule 1)
and curcumin
(Flexofytol)
168 mg/day
(capsule 2). 7
capsules/day
for 12 weeks
B: Placebo
capsules, 7
capsules/day
for 12 weeks
Savaş et al 2019 RCT A: Flaxseed poultice A and B: The Short term 33 Primary IP, ACR 62 (6.8) 93.9 NR. Measured pain
(NB also listed under parallel hot compress hot compress 29 64.9 (8.3) 96.6 (VAS) and function
non-­pharmacological (three B: Hot compress was applied for 20 65.5 (9.2) 85 (AUSCAN)
interventions)25 groups) C: No intervention 20 min once a
day for 7 days,
40–45°C
Topical corticosteroids
Continued
Osteoarthritis

9
10
Table 2 Continued
Frequency, Age,
duration Measurement OA location, years Women
RMD Open

RoB Study Design Intervention (instructions) timepoints N definition (SD) (%) Primary outcome
79
Wang et al 2023 RCT A: Topical A and B: Self-­ Short term 54 Symptomatic 85.2 63.0 (6.8) Pain VAS at 6 weeks.
parallel betamethasone apply a thin 52 HOA, VAS pain 86.5 64.5 (7.9) Also measured
dipropionate layer ointment ≥40, KL ≥2 in ≥1 function (AUSCAN)
B: Placebo on painful hand joint
joints three
times per day
for 6 weeks
Oral glucocorticoids
Kroon et al# 201980 RCT A: Prednisolone 10 mg A and B: Daily Short term 46 Hand, ACR, 62.2 (8.8) 83 Pain (VAS) at
parallel (oral solution) for 8 weeks 46 signs of 65.6 (8.5) 76 6 weeks. Also
B: Placebo inflammation in measured pain and
DIP/PIP joints function (AUSCAN
subscales), grip
strength and
OMERACT-­OARSI
responders
IA hyaluronic acid
Wang et al 202376 RCT A: IA hyaluronic acid A: 1 mL of AAM Long term 8 CMC OA, 75 59.5 Pain (VAS) at
parallel (ArtiAid-­Mini) (10 mg/mL) 8 symptomatic 37.5 (10.5) 12 weeks. Also
B: IA hyaluronic acid B: 1 mL or OM and radiological 59.9 (9.0) measured grip
(Ostenil-­Mini) (10 mg/mL) strength.
A and B:
A second
injection given
after 1 week
Biological disease-­modifying anti-­rheumatic drugs (bDMARDs)/TNF inhibitors
Kloppenburg et al# RCT A: Lutikizumab 200 mg A and B: Short term 64 Hand, ACR, ≥1 66 (8) 83 Pain (AUSCAN)
201981 parallel subcutaneously Injection every Long term 67 erosive and ≥3 66 (7) 87 after 16 weeks. Also
B: Placebo injections 2 weeks for tender and/or measured function
24 weeks swollen joints (AUSCAN)
Richette et al 202182 RCT A: Intravenous A and B: Short term 42 Hand, VAS pain 64.1 (8.9) 81 Pain (VAS) at
parallel infusions of Intravenous Long term 41 ≥40, ≥3 painful 64.7 (8.6) 83 6 weeks. Also
tocilizumab 8 mg/kg infusion in joints, KL ≥2 measured function
B: Intravenous weeks 0 and 4 (FIHOA)
infusions of placebo
Continued

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 Table 2 Continued
Frequency, Age,
duration Measurement OA location, years Women
RoB Study Design Intervention (instructions) timepoints N definition (SD) (%) Primary outcome
Schett et al 202083 RCT A: Otilimab 180 mg A and B: Short term 22 Inflammatory 60.9 (6.3) 91 Pain (NRS) at
parallel subcutaneously Weekly from Long term 22 OA, ≥2 56.7 (6.8) 91 6 weeks. Also
B: Placebo week 0 to week swollen and measured function
subcutaneously 4, every other w tender joints, (AUSCAN)
from week 5 to inflammation on
week 10 MR, pain NRS
≥5 past 7 days
Synthetic DMARDs anti-­rheumatic drugs (hydroxychloroquine)
Kedor et al# 202184 RCT A: Hydroxychloroquine A and B: Once Long term 75 Hand, 52.4 (8.1) 90.7 Pain and function
parallel oral 200–400 mg per day for 1 78 inflammatory 50.2 (6.6) 76.9 (AUSCAN) after 1
B: Placebo year and erosive OA year
Synthetic DMARDs anti-­rheumatic drugs (methotrexate)

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Ferrero et al# 202185 RCT A: Methotrexate oral A and B: Once Long term 32 Hand, ACR, ≥1 64.9 (7.0) 97 Pain (VAS) at
parallel 10 mg per week for 1 32 joint with Rx 67.5 (8.0) 91 3 months. Also
B: Placebo oral year erosion in both measured function
hands (FIHOA)
Wang et al# 2023b86 RCT A: Methotrexate oral A and B: Once Long term 50 Hand OA and 61.4 (6.1) 68 Pain (VAS) at
parallel 20 mg per week for 47 synovitis, 61.5 (7.3) 72 6 months. Also
B: Placebo oral 6 months ACR, VAS measured function
pain ≥40 past (AUSCAN and
7 days, KL ≥2 in FIHOA) and grip
min one joint, strength.
synovitis grade
≥1 on MRI in
min one joint
Colchicine
Davis et al# 202188 RCT A: Colchicine oral A and B: Short term Long 32 Hand, ACR, 66.0 (8.0) 84 Pain (VAS) at
parallel 0.5 mg 2×0.5 mg/day term 32 pain for min 66.0 (7.0) 84 12 weeks. Also
B: Placebo for 12 week 15 of last 30 measured function
days, VAS (MHQ) and grip
pain ≥40 past strength (JAMAR)
48 hours
Continued
Osteoarthritis

11
12
Table 2 Continued
Frequency, Age,
duration Measurement OA location, years Women
RoB Study Design Intervention (instructions) timepoints N definition (SD) (%) Primary outcome
RMD Open

Døssing et al# 2023 RCT A: Colchicine oral A and B: Long term 50 Symptomatic NA NA Hand/finger pain
(abstract)89 parallel 0.5 mg 2×0.5 mg two 50 HOA and VAS (VAS) at 12 weeks.
B: Placebo times per day pain ≥40 Also measured
for 12 weeks function (AUSCAN),
grip strength and
OMERACT-­OARSI
responders
Platelet-­rich plasma
Abdelfattah et al RCT A: Platelet-­rich plasma A, B and C: Short term 15 CMC, NR 52.5 (8.3) 86.4 (total NR. Measured pain
2020135 parallel IA injection 1 mL One injection Long term 15 (total sample) (VAS), function
B: Hydraulic acid IA 15 sample) (AUSCAN) and grip
injection 1 mL strength
C: Corticosteroid
(betamethasone) IA
injection 0.25 mL
Malahias 202175 RCT A: Platelet-­rich plasma A and B: First Long term 16 CMC, clinical 62.8 81 NR. Measured pain
parallel IA injection (dose injection at day 16 and Rx, ACR (10.6) 81 (VAS) and qDASH
NR) B: Corticosteroid 1 and second at diagnosis, E-­L 63.0
(methylprednisolone) day 15 I-­III (11.8)
IA injection
125 mg/2 mL
Winter et al 2023136 RCT A: Platelet-­rich plasma A, B, C and Short term 24 CMC, NA 79 Pain (NRS). Also
parallel IA injection 1 mL D: 1.5 mL was Long term 25 E-­L stage I-­IV 88 measured function
B: Fat IA injection 1 mL prepared in a 25 88 (qDASH) and grip
C: Fat and Platelet-­rich 2 mL Luerlock 21 77 strength
plasma IA injection syringe (one
0.25 mL injection)
D: Placebo (saline
0.9%)
Oestrogen
Williams et al 202290 RCT A: Oral conjugated A and B: Once Short term 14 Hand, ACR, 58.3 (3.4) 100 Feasibility outcomes.
parallel
oestrogens (dose per day for Long term 14 NRS pain ≥4 in 58.9 (3.4) 100 Also measured pain
feasibility
not described) + 24 weeks ≥2 hand joints (NRS), function
bazedoxifene acetate (FIHOA) and grip
(20 mg) strength.
B: Oral placebo
Studies comparing combinations of pharmacological and non-­pharmacological interventions
Continued

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 Table 2 Continued
Frequency, Age,
duration Measurement OA location, years Women
RoB Study Design Intervention (instructions) timepoints N definition (SD) (%) Primary outcome
91
Deveza et al 2021 RCT A: Education, A and B: 1 Short term 102 CMC, Rx KL ≥2, 66.0 (7.8) 85.3 Pain (VAS) and
parallel exercises, orthosis, individual Long term 102 pain for min 15 65.2 (8.5) 66.7 function (FIHOA)
Diclofenac gel 1% 30 min of last 30 days, at 6 weeks. Also
B: Education treatment VAS pain ≥40, measured grip
session at FIHOA ≥6, strength and
baseline and 1 OMERACT-­OARSI
(15 min) in week responders
2, thereafter
told to continue
with treatment
for 3 months
Ioppolo et al 201892 RCT A: Extracorporeal A: One session Short term 28 CMC, ACR 68.0 (9.0) 57 Pain (VAS) and
parallel shock wave therapy, per week for Long term 30 66.7 (8.1) 60 function (DHI)
2400 consecutive 3 weeks at 6 months. Also

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963

pulses/session, B: One IA measured grip
frequency of 4 Hz per week for strength
energy flux density of 3 weeks
0.09 mJ/mm2
B: Hyaluronic acid IA
0.5 cm3
Metin Ökmen et al RCT A: Nerve block A: One injection Short term 25 Hand, 58.8 (5.5) 100 NR. Measured Pain
201893 parallel injection (bupivacaine A+B: 9 25 ACR, KL ≥2 59,2 (4,8) 100 (VAS), function
and 1 mL methyl-­ exercises with (DASH) and grip
prednisolone acetate) 10 repetitions, strength (JAMAR)
subcutaneously performed
around the superficial once a day for
branch of the radial 4 weeks
nerve+exercises
B: Exercises
Nguyen et al 202294 RCT A: Botulinum toxin A IA A and B: One Long term 30 CMC, 65.2 (8.2) 83 Pain (NRS) at
parallel injection, (50 Allergan single injection 30 ACR, CMC Rx 64.6 73 3 months. Also
units) + orthosis OA evidence, (10.4) measured function
B: Placebo: Saline IA CMC pain (Cochin and scale)
injection+orthosis and OMERACT-­
OARSI responders
Continued
Osteoarthritis

13
RMD Open

four new26 30–32 and five previous studies21 35–38 showed

that, compared with no exercises, there is low-­certainty

osteoarthritis; PO, primary outcome; qDASH, quick DASH; RCT, randomised controlled trial; RoB, risk of bias; Rx, radiography; TNF, Tumor Necrosis Factor; VAS, Visual Analogue Scale; WA,
Primary outcome

*Available as abstract only to the 2018 review of Kroon et al (paragraph)—full-­text manuscript evaluated for the update. Colours denote RoB (green: low, yellow: some concern, red: high). (A)

articular; IP, interphalangeal joint; KL, Kellgren-­Lawrence; MCP, metacarpophalangeal; MHQ, Michigan Hand Questionnaire; N, number; NR, not reported; NRS, Numerical Rating Scale; OA,
evidence of a significant small long-­term effect of exer-

ACR, American College of Rheumatology; ADLs, activities of daily living; AUSCAN, Australian/Canadian Hand Osteoarthritis Index; CMC, first carpometacarpal joint; CO, cross-­over trial;
DASH, Disabilities of the Arm, Shoulder and Hand; DHI, Duruöz Hand Index; DIP, distal interphalangeal joint; E-­L, Eaton-­Litter; FIHOA, Functional Index for Hand OsteoArthritis; IA, intra-­
cises on pain (SMD=−0.34 (–0.58, –0.09)). For the
other outcomes (function, grip strength and number of
OMERACT/OARSI responders), the certainty of results
from meta-­analyses was very low (online supplemental
material, pp 37, 53–56). New to this SLR, we also identi-
fied five studies assessing the effect of adding propriocep-
Women

tive exercises to other hand exercise programmes.39–43 We

(%)

pooled four of these studies,39–41 43 but again the certainty

of results from meta-­analyses was very low (online supple-
mental material, pp 38, 57–58). None of the new exercise
Studies marked with # are included in meta-­analyses, whereas intervention groups from these studies marked with ** are excluded from meta-­analyses.
years

studies reported on AEs, whereas Kroon et al11 reported

Age,

(SD)

few and non-­severe AEs in participants undergoing exer-

cise therapy.
OA location,

Orthoses
definition

We identified six new studies on orthoses. One was a trial

with high RoB showing that a custom-­made night-­time
orthosis for the distal (DIP) and proximal interphalan-
geal (PIP) joint of the second or third finger of the domi-
N

nant hand had no effect on pain or function compared

with no orthosis.44 Two studies investigated the effect of
Measurement

a thumb orthosis against a placebo orthosis29 or informa-

timepoints

tion only.45 When pooling these two with five previous

studies,46–50 the results from meta-­analyses showed that
there is low-­certainty evidence that, compared with no
orthoses, thumb orthoses has a significant and moderate
long-­term effect on pain (SMD = –0.77 (– 1.20, –0.34))
(instructions)

(online supplemental material, pp 39, 59–62). The last

Frequency,

three new studies compared thumb orthoses immobi-

duration

lising the first carpometacarpal (CMC-­1) joint against

thumb orthoses additionally immobilising the wrist
and/or one or more thumb joints.27 51 52 The certainty
of results from meta-­analyses of these and four previous
studies22 53–55 was very low for all outcomes (pain and
function) (online supplemental material, pp 40, 63–64).
One new29 and two previous22 50 studies reported on AEs,
Intervention

which were few and none serious.

Assistive devices
We identified one new study on the effect of assistive
devices,56 and pooled this with one previous study.57
Design

Compared with no assistive devices, the results showed

evidence of moderate certainty for a moderate long-­term
effect of assistive devices on hand function (SMD −0.55,
CI (−0.94 to –0.16)) (online supplemental material, pp
41, 65–66).
indicates conference abstract.

Thermal modalities
Continued

Five new studies evaluated the effect of heat applica-

tion. The interventions comprised hot paraffin,58–60
wash-­out period.
Study

hot mud,58 61 hot compress25 and/or dry heat therapy60

against each other or placebo. The results of meta-­
analyses of three new25 59 62 and five previous studies20 63–66
Table 2

RoB

showed that, compared with no heat application, there is

evidence for a large, significant short-­term and long-­term

14 Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963

 Table 3 Characteristics of 10 new studies surgical interventions (published between 7 June 2017 and 31 December 2023)
Measurement
Postoperative timepoints OA location, Women Primary outcome
RoB Study Design Intervention (POM) management analysed N definition Age, years (SD) (%) (primary or NR)

Studies comparing surgical interventions including joint replacement

de Jong 2023 et RCT A: Total joint replacement A and B: Patients Long term 31 CMC 59 (6.5) 61 (8.5) 100 MHQ total score at
al109 parallel (Maia prosthesis) immobilised in plaster 31 Eaton and Glickel 100 12 months. Also measured
B: Trapeziectomy bandage for 1 week and grade II or III pain (MHQ subscale) and
in a circular forearm and grip strength
thumb plaster cast for
another 3 weeks, thereafter
supervised rehabilitation
1/week in weeks 5–8 and
once every 2 weeks in
4 weeks.
Guzzini 2023 et RCT A: Touch TMC joint dual A: Immobilised with cast Short term 71 (75 CMC 66.8 (8.2) 81.7 NR. Measured pain (VAS),
al110 parallel mobility press-­fit prosthesis or brace for 3 weeks, Long term hands) Eaton and Glickel 68.2 (9.8) 79.4 function (DASH) and grip
B: Trapeziectomy with tendon thereafter followed a 65 (72 grade II or III strength after 1, 3, 6, 12
interposition (abductor pollicis rehabilitation protocol hands) Thumb base pain and 24 months
longus) arthroplasty B: Immobilised with a at rest or affecting
spica splint for 1 week, ADL activities
followed by active
thumb mobilisation with

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963

intermittent brace use for
1 week
Klim et al 2023111 RCT A: The double mobility TCMC A and B: The first ray Short term 82 CMC 56 (53–62) 84 Pain (VAS) at 6 weeks. Also
parallel prosthesis immobilised with orthosis Long term 86 Eaton and Glickel 60 (55–68) 78 measured function (DASH)
B: Trapeziectomy with for 6 weeks, thereafter grade II or III
resection-­interposition 8 weeks of physical therapy
(flexor carpi radialis (FCR))
arthroplasty
Thorkildsen et al RCT A: Hydroxyapatite-­coated A: Postoperative treatment Long term 20 Symptomatic 64 (range 55–72) 61 (range 70 Function (qDASH). Also
2019 parallel ElektraTM total joint NR B: Thumb immobilised 20 idiopathic 36–77) 70 measured grip strength
112
replacement for 6 weeks CMC-­OA
B: Trapeziectomy with LRTI
(FCR)
Studies comparing different surgical techniques
Brennan et al RCT A: Trapeziectomy alone A and B: Patients Long term (17 28 (43%) CMC 76 (total sample) 79 (total NR. Measured pain (VAS),
2021118 parallel B: immobilised in Bennett’s years) of original Eaton and Glickel sample) function (qDASH) and grip
Trapeziectomy+combinations type cast for 4 weeks, then 65 grade III or IV strength (JAMAR) after 17
(LRTI) mobilised for further 4 to years
6 weeks
Marks et al RCT A: Trapeziectomy with A and B: Patients wore Short term 29 CMC 64 (8) 90 Function (MHQ) at
2017113 parallel suspension-­interposition a removable orthosis for Long term 31 Eaton stage II or 65 (8) 81 12 months. Also measured
arthroplasty 6 weeks. Active mobilisation more pain (MHQ subscale) and
B: Trapeziectomy with a started 3 weeks after grip strength
human dermal collagen surgery, strengthening
template (allograft). exercises started 8 weeks
after surgery

Continued
Osteoarthritis

15
16
RMD Open

Table 3 Continued
Measurement
Postoperative timepoints OA location, Women Primary outcome
RoB Study Design Intervention (POM) management analysed N definition Age, years (SD) (%) (primary or NR)

Morais et al RCT A: Trapeziectomy with LRTI A: Thumb immobilised Long term 39 CMC 61.1 (7.4) 94.8 NR. Measured pain (VAS),
2022114 parallel B: Trapeziectomy with suture-­ for 2 weeks, thereafter 37 Eaton classification 61.8 (7.8) 89.2 function (qDASH) and grip
button suspensionplasty physiotherapy for 4 weeks strength (JAMAR) after
B: Thumb immobilised for 40 months
6 weeks, physiotherapy
from week 0
Sánchez-­Flò et al RCT A: Partial trapeziectomy with A and B: Thumb Long term 17 Isolated CMC OA 60.5 (9.8) 76.5 Key-­pinch strength (kg) at
2020115 parallel suspension and interposition immobilised for 3 weeks 17 grade II to III (E-­Li) 61.0 (8.9) 88.2 12 months. Also measured
arthroplasty based on Weilby with a thumb spica with pain and loss pain (VAS), function
technique orthosis, followed by of function (qDASH) and grip strength,
B: Total trapeziectomy with 3 months of physiotherapy
suspension and interposition until stabilisation.
arthroplasty based on Weilby
technique
van Laarhoven et RCT A: Arthroscopic distal A: Thumb immobilised for Long term 45 (45 CMC OA grade II 58.8 (9.6) 64.4 Pain and function
al 2023116 parallel hemitrapeziectomy 4 weeks, thereafter hand hands) to III (E-­Li) 62.0 (7.8) 82.5 (PRWHE). Also measured
B: Open trapeziectomy therapy for up to 12 weeks 40 (42 grip strength.
hands)
Zarezadeh et al RCT A: LRTI A: Thumb immobilised with Long term 28 CMC-­OA 54.6 (21.0) 64.3 NR. Measured pain (VAS),
2021117 parallel B: Haematoma distraction Spike orthosis for 6 weeks 28 diagnosed by 54.3 (11.2) 71.5 and function (DASH)
arthroplasty B: Thumb immobilised expert orthopaedic
with orthosis for 4 weeks. surgeons
ROM exercises from week
4, strengthening exercises
from week 6

Colours denote RoB (green: low, yellow: some concern, red: high). (A) indicates conference abstract.
AUSCAN, Australian/Canadian Hand Osteoarthritis Index; CMC, first carpometacarpal joint; CO, cross-­over trial; DASH, Disabilities of the Arm, Shoulder and Hand; E-­L, Eaton-­Litter; N, number; NR, not reported; NRS, Numerical Rating Scale; OA,
osteoarthritis; PO, primary outcome; PRWHE, Patient-­Rated Wrist and Hand Evaluation; qDASH, quick DASH; RCT, randomised controlled trial; RoB, risk of bias; ROM, range of motion; Rx, radiography; VAS, Visual Analogue Scale.

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963

 Osteoarthritis

Figure 1 Effect of non-­pharmacological and pharmacological interventions on pain. The GRADE assessment is provided
in brackets after description of each intervention. CMC-­orthoses immobilise the CMC-­joint only, whereas MCP-­orthoses
additionally immobilises the MCP and/or wrist. bDMARDs, biological disease-­modifying anti-­rheumatic drugs; GRADE, Grading
of Recommendations Assessment, Development and Evaluation; MCP,metacarpophalangeal; NSAID, non-­steroidal anti-­
inflammatory drug; SMD, standardised mean difference.

effect on pain, and a moderate, significant long-­term and long-­term pain and in long-­term upper-­limb func-
effect on function; however, these results were graded tion in favour of the mobile-­app delivered programme.
with very low certainty (online supplemental material, pp No serious AEs were registered.
42, 67–69). The two other new studies compared a combination
programme with routine care+placebo (a massage ball)70
Ultrasound/laser therapy or information only.71 When pooling these with three
One new study evaluated the effect of high-­intensity laser previous studies,35 72 73 the certainty of the results was very
therapy67 and were pooled with results from two previous low for all outcomes of pain, function or grip strength.
studies.35 68 The results shows that, compared with a sham Two previous studies reported on AEs,72 73 which were
intervention, there is possibly small or no long-­ term few, mild and with no significant between-­group differ-
effects on grip strength (SMD −0.13 (−0.50, 0.24) (low
ences (pp 44, 72–74).
certainty)) (online supplemental material, pp 43, 70–71).

Combination programmes Pharmacological interventions

We identified three new studies of combination An overview of the characteristics and overall RoB of the
programmes. One of these, and so far the first study of 21 new studies including a pharmacological intervention
mobile health (mHealth) strategies, compared a mobile is presented in table 2. All were parallel RCTs, of which
app-­
delivered multimodal programme with a control 3 compared different pharmacological interventions
group receiving written exercises, and had a high RoB.69 against each other,74–76 14 investigated pharmacolog-
The results showed significant differences in short-­term ical interventions against placebo,77–90 and 4 compared

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963 17

RMD Open

Figure 2 Effect of non-­pharmacological and pharmacological interventions on function. The GRADE assessment is provided
in brackets after description of each intervention. CMC-­orthoses immobilise the CMC-­joint only, whereas MCP-­orthoses
additionally immobilises the MCP and/or wrist. CMC, first carpometacarpal joint; GRADE, Grading of Recommendations
Assessment, Development and Evaluation; MCP, metacarpophalangeal; NSAIDs, non-­steroidal anti-­inflammatory drugs; SMD,
standardised mean difference.

combination programmes that also included a pharma- participants), 16 lasted ≥3 months, and 3 specifically
cological intervention.91–94 The studies varied with regard included participants with signs of inflammatory OA
to number of participants (16–204; 10 studies with ≥80 (investigating oral glucocorticoids80 or DMARDs).83 84

Figure 3 Effect of non-­pharmacological and pharmacological interventions on grip strength. GRADE assessment is provided
in brackets after description of each intervention. GRADE, Grading of Recommendations Assessment, Development and
Evaluation; SMD, standardised mean difference.

18 Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963

 Osteoarthritis

Eight studies had low RoB. Reasons to judge studies to bDMARDs/TNF inhibitors
be at high (n=9) or unclear RoB (n=5) were most often We identified three new studies comparing the effect
related to the randomisation process, outcome meas- of subcutaneous lutikizumab injections (anti-­IL-­1α/β)9;
urement and/or selective reporting. Two meta-­analyses intravenous tocilizumab infusions (anti-­IL-­6)82; or subcu-
were graded with high certainty, two with moderate and taneous otilimab injections (anti-­GM-­CSF)83 to placebo.
the rest with low or very low certainty. The detailed RoB There were no significant between-­group differences in
and GRADE assessment are presented in online supple- any clinical outcome in any of the three studies, whereas
mental material (pp. 19–24, 45–52). AEs were more frequent in the intervention groups
compared with placebo groups. We pooled results from
Topical pharmacological interventions four previous studies on adalimumab18 106 107 or etaner-
We identified one new study with 106 participants and cept (anti-TNF).17 The results showed that, compared
low RoB comparing a topical corticosteroid ointment to with placebo, there is evidence of very low certainty for
placebo.79 The results showed no significant between-­ no effect on long-­term pain (−0.04 (−0.38, 0.30)) and
group differences in any measure of pain or function of moderate certainty for no between-­group differences
after 6 weeks of treatment, and comparable rates of AEs in all AEs (RR 0.95 (0.79, 1.15)) (online supplemental
between groups. material, pp 49, 82–83).
No new studies assessed the effect of topical NSAIDs.
Meta-­analyses of three previous studies comparing Synthetic DMARDs
diclofenac95 96 or ibuprofen cream97 to placebo showed a One new study on the effect of oral hydroxychloroquine84
very small significant between-­group difference in short-­ was detected and pooled with two previous studies.19 23
term function in favour of topical NSAIDs (SMD −0.17 The results from meta-­analyses showed that, compared
(–0.33, –0.01), high certainty), and possibly a small or no with placebo, there is low and moderate certainty for
short-­term effect on pain (SMD −0.07 (−0.37, 0.24), low no effect on short-­term or long-­term pain ((0.08 (−0.2,
certainty) (online supplemental material, pp 45, 75). 0.36)) and (0.01 (−0.18, 0.16)), respectively, and of very
low certainty for any effect on long-­term function (SMD
Oral NSAIDs −0.03 (−0.24, 0.18)) or all AEs (online supplemental mate-
No new studies of oral NSAIDs were detected. A meta-­ rial, pp. 50, 84–85). New to this SLR, we also detected and
analysis of three previous studies comparing ibuprofen,98 pooled results from two studies on the effect of meth-
lumiracoxib99 or meclofenamate100 to placebo showed otrexate against placebo.85 86 There is possibly a small
that there were possibly a moderate effect on short-­term effect on long-­term pain (SMD −0.31 (−0.61, 0.00), low
pain (SMD −0.59 (−1.07, –0.11), low certainty), and no certainty) and long-­term function (SMD −0.17 (−0.49,
significant between-­group differences in any measure of 0.15), low certainty), and very low certainty evidence
adverse events (low, moderate or high certainty) (online for an effect on all adverse events (RR 0.80 (0.37, 1.73))
supplemental material, pp 46, 76–78). (online supplemental material, pp 51, 86–87).

Oral glucocorticoids Colchicine

We identified one new study of oral glucocorticoids,80 New to this review, we detected and pooled two studies
which we pooled with two previous studies.101 102 The comparing colchicine to placebo.88 108 The results show
results showed that, compared with placebo, oral gluco- that colchicine is not superior to placebo in terms of effi-
corticoids likely had a small significant effect on short-­ cacy, while there is likely a higher risk of adverse events
term function (SMD −0.35 (−0.64, –0.07), moderate (RR 1.70 (1.27, 2.28), moderate certainty). The certainty
certainty), and possible a small or no effect on long-­ for the results regarding pain, function and grip strength
term function (SMD −0.11 (−0.58, 0.37), low certainty). was very low (online supplemental material, pp 52,
Further, there is possibly a large to no effect on short-­ 87–89).
term pain (SMD −1.44 (−3.63, 0.74), very low certainty)
and a small to no effect on long-­term pain (SMD 0.12 Surgical interventions
(−0.36, 0.59), low certainty) (online supplemental mate- We identified nine new studies of surgical interven-
rial, pp 47, 79–80). tions109–117 and one118 reporting the 17-­ year follow-­
up
results of a trial also included in the review by Kroon et
Intra-articular injections al (see table 3). All studies were parallel RCTs. No trials
We did not detect any new studies assessing the effect of compared surgery to no surgery, sham surgery or non-­
intra-­articular (IA) glucocorticoids or hyaluronic acid surgical interventions. All but one study109 were judged to
injections against placebo. We performed meta-­analyses have high RoB or some concerns (online supplemental
of three previous studies assessing glucocorticoid injec- material, pp 25–26). Due to the heterogeneity of new and
tions,103–105 showing no between-­ group differences in previous studies, we did not perform any meta-­analyses
long-­term pain (SMD −0.17 (−0.69, 0.35) or all AEs. of efficacy. New to this SLR, four studies compared joint
However, the results were of very low certainty (online replacement to trapeziectomy with or without ligament
supplemental material, pp 48 and 81). reconstruction and tendon interposition.109–112 In three

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963 19

RMD Open

of the studies,110–112 the participants treated with pros- its effect in studies with a sufficient number of partici-
thesis improved faster; however, after 6–12 months, pants. Future studies should also monitor adherence, as
there were no significant differences between the two it is crucial for achieving any meaningful effect. More-
groups. In the fourth study,109 which was the only study over, to develop more effective interventions, it is essen-
with low RoB, those receiving prothesis had significantly tial to conduct research that deepens our understanding
better grip strength and range of motion after 12 months of the factors influencing grip strength.
compared with those treated with trapeziectomy. The development of mobile health devices (mHealth)
The other six trials compared trapeziectomy performed represents a paradigm shift in healthcare, enhancing
with different or additional surgical techniques or inter- the delivery of evidence-­ based and sustainable care.
ventions. In general, there were no significant between-­ However, to date, there are few mobile applications with
group differences in any measure of pain, function or programmes specifically developed for people with hand
grip strength in any of the studies. OA.121 Interestingly, results from the study comparing
home exercise therapy delivered via a mobile application
The efficacy of various treatments with regard to outcome or on paper suggest that the app-­based approach has at
In a final step, we combined the results from the meta-­ least the same efficacy as the traditional paper method.
analyses described above to visualise the efficacy of the This indicates that mobile applications can serve as
different non-­ pharmacological and pharmacological a viable and feasible mode of treatment delivery.69
treatments on pain, function and grip strength. As visual- However, further research is warranted to understand
ised in figure 1, there is evidence of moderate certainty the full impact of mHealth for people with hand OA,
that hydroxychloroquine has no long-­term effect on pain, including high-­quality trials evaluating the efficacy and
and evidence of low certainty that hand exercises may cost-­effectiveness of this delivery mode.
have a small long-­term effect, hand orthoses a moderate We found that thumb orthoses possibly had a moderate
long-­term effect, oral NSAIDs a moderate short-­ time long-­term effect on pain. Thumb orthoses are, however,
effect, and methotrexate a small long-­term effect on pain. not included in the updated NICE guidelines,10 most likely
With regard to function (figure 2), there is high-­ due to a recent large placebo-­controlled RCT showing
certainty evidence for a very small short-­ term effect no additional benefit after 8 and 12 weeks of adding
of topical NSAIDs, moderate-­ certainty evidence for a a thumb orthosis to a self-­ management programme
moderate long-­ term effect of assistive devices and a for CMC-­OA.29 However, among the RCTs on thumb
small short-­term effect of oral glucocorticoids, and low-­ orthoses included in our SLR, only the two studies with
certainty evidence for a small long-­term effect of exer- follow-­up ≥6 months48 50 suggested a notable decrease in
cises and a moderate effect of thermal modalities. Lastly, pain within the intervention group, thereby supporting
there is moderate-­ certainty evidence that hand ultra- the EULAR recommendation advocating long-­term use
sound/laser has no effect on grip strength. when CMC-­orthoses are indicated.9 Also, to better deci-
pher which thumb orthoses works best for whom, studies
linking design to hypothesised working mechanisms and
DISCUSSION evaluating long-­term effects of such orthoses are needed.
The aim of this SLR was to summarise the evidence for Although the results from meta-­analyses were graded
efficacy and safety of non-­ pharmacological, pharma- with very low certainty, we found that thermal interven-
cological, and surgical treatments for hand OA. In line tions in general was beneficial. This is a low-­cost and
with the current guidelines,6–10 recommending non-­ probably safe intervention which often is included at
pharmacological interventions as the first choice of inter- the beginning of exercise programmes to warm up the
vention, we found moderate-­ certainty or low-­
certainty hands.122 Also, in line with results from a study on patients
evidence of the efficacy of hand exercises, thumb with rheumatoid arthritis,123 one of the new RCTs showed
orthoses and use of assistive devices for pain and/or func- that hot wax bath followed by hand exercises resulted in
tion. In the few studies which collected data on AEs, the significant short term improvements in pain, function
reported AEs were infrequent and mild, indicating that and grip strength compared with hand exercises only.59
these interventions are safe. However, high-­quality studies are needed to decide if a
Research has demonstrated that the reduced grip warm-­up exercise should be included in future exercise
strength of people with hand OA negatively impacts their programmes.
function.119 120 Even if the exercise programmes varied in Looking at pharmacological interventions, there was
the type and number of exercises, as well as in the inten- high-­certainty evidence for a small short-­term effect of
sity, duration and frequency of sessions per day and week, topical NSAIDs on function, low-­certainty evidence for
most programmes included strengthening exercises. a moderate short-­term effect of oral NSAIDs on pain,
The meta-­analyses showed a moderate estimated effect moderate-­certainty evidence for a small short-­term effect
on grip strength; however, this evidence was of very low of oral glucocorticoids on function and low-­ certainty
certainty. To improve the quality of these programmes, a evidence for a small long-­term effect of methotrexate
key next step is to design an exercise programme based on pain. Considering the lack of any convincing pain-­
on current evidence and recommendations, and evaluate relieving effects of topical NSAIDs, one might question

20 Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963

 Osteoarthritis

the consensus across several guidelines that this should with different content, and studies with different medi-
be the first choice when it comes to medication. However, cation dosage. The large number of meta-­analyses also
as stated in the EULAR recommendations,9 the recom- required numerous decisions, which can lead to either
mendation also takes into consideration the benefi- overestimation or underestimation of the true effects
cial effect on function and the favourable safety profile of interventions. Moreover, combining pilot or feasi-
compared with oral analgesics, making it a safe choice. bility studies with full-­scale studies in these meta-­analyses
Further, the lack of evidence on any effect of IA corti- may have inflated the observed effects.127 Additionally,
coid injections, biological DMARDs and hydroxychloro- restricting the review to RCTs may limit the general-
quine strengthens the recommendations against the use isability of the findings, as the effects observed under
of such medication. controlled conditions may differ from those in real-­world
New to this SLR, we identified two studies evaluating clinical settings, where there is greater variability among
the effect of methotrexate in patients with symptom- patients and clinicians. Still, we probably have included
atic hand OA.85 86 The meta-­analyses showed that there a mixture of studies examining efficacy (referring to
is low-­certainty evidence for a small long term-­effect on studies performed under ideal or controlled conditions)
pain and no effect on function, indicating that further and effectiveness (studies assessing the effect under more
research is needed to clarify the role methotrexate may ‘real world’ clinical settings). However, even if these two
have in the treatment of hand OA. Interestingly, the most concepts may be easy to distinguish between in theory,
recent of the two studies86 is the only study in this SLR in practice, they represent a continuum. As a result, we
applying synovitis detected by MRI as an inclusion crite- did not attempt to differentiate between them in this
rion. Research has shown that the presence of synovitis SLR. Readers should also be aware that effect estimates
is consistently associated with joint pain and structural of results from the studies (as visualised in figures 1–3)
progression.124 Hand OA subtyping should therefore be are not directly comparable due to clinical heteroge-
included in all future studies to better understand the neity of the study populations and differences in risk of
mechanism of action. bias. Further, as we included studies with high RoB in
As in the review by Kroon et al,11 the large heteroge- meta-­analyses and conducted GRADE assessments, our
neity and lack of control groups prevented us from doing results sometimes differ from those in Kroon’s review.
any meta-­analyses of surgical studies, and thus, no conclu- Also, defining a timeframe of 3 months or more as
sions regarding which interventions may be effective can ‘long-­term’ may limit the relevance of these results for
be drawn. Nevertheless, in an RCT investigating whether informing clinical practice and policy. Lastly, the possi-
occupational therapy in the waiting period before surgical bility of missing relevant publications cannot be entirely
consultation for CMC-­OA could reduce the likelihood of excluded. However, the strengths include an extensive
surgery, there were no significant differences after 2 years literature search, independent study and data extraction
in pain or hand function between those opting for surgery by two authors, and thorough RoB and GRADE assess-
and those who did not.125 Interestingly, surgery did not ments to evaluate the certainty of the evidence.
result in additional improvements in pain and hand func-
tion within the group that received occupational therapy.
To establish an evidence-­based practice, it is now time for CONCLUSIONS
surgery to be compared with non-­surgical treatments or The results from this SLR largely support current treat-
placebo in robust RCTs, instead of comparing a variety of ment recommendations. However, the evidence for most
surgical interventions to each other. current treatments is still limited, particularly a lack of
A positive finding in this SLR is a significant increase interventions that efficiently improve grip strength and
in RCTs investigating the efficacy of treatments for hand of studies comparing non-­pharmacological or surgical
OA. The first EULAR recommendations, published interventions to placebo or no intervention. To better
in 2007, were based on 48 RCTs or CTs.126 Seventy-­five understand the action mechanisms, future trials should
studies were added to the evidence-­base for the updated include hand OA subtyping and be powered for subgroup
recommendations in 2018,11 whereas we detected 65 new analyses.
RCTs published up to 2024, suggesting a growing interest
in hand OA research. On the negative side is the fact that Author affiliations
1
the majority of studies included rather few participants. Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo,
Norway
Additionally, in most of the non-­pharmacological studies, 2
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY),
the context varies, seemingly identical treatments often Diakonhjemmet Hospital, Oslo, Norway
differ in design and content, and blinding of participants 3
Department of Rheumatology, Clinical Epidemiology, Leiden University Medical
and therapists is usually not possible. Overall, this means Center, Leiden, The Netherlands
4
that the studies have a high risk of systematic biases, indi- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The
Netherlands
cating that the evidence base for hand OA treatments still 5
HTA Medical Devices, Norwegian Medical Products Agency, Oslo, Norway
is rather weak.
A limitation of the current SLR is that we have Acknowledgements We thank the librarian Elise Davis-­Keaveny, Diakonhjemmet
pooled results from studies comparing programmes Hospital, for supporting the literature searches.

Kjeken I, et al. RMD Open 2025;11:e004963. doi:10.1136/rmdopen-2024-004963 21

 RMD Open

Contributors IK, ATT, NØ and GS conceived and designed the study and 7 Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American
contributed to the development of the protocol. ATT and IK developed the search College of Rheumatology/Arthritis Foundation Guideline for the
strategy. ATT, DHB, IS, KAAF and IK sorted the references and extracted all the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis
data. GS conducted statistical analyses. All authors assisted in the final manuscript Rheumatol 2020;72:220–33.
and agreed to its final approval before submission. IK is responsible for the overall 8 Ariani A, Manara M, Fioravanti A, et al. The Italian Society for
content as guarantor. IK accepts full responsibility for the finished work and the Rheumatology clinical practice guidelines for the diagnosis and
conduct of the study, had access to the data, and controlled the decision to publish. management of knee, hip and hand osteoarthritis. Reumatismo
2019;71:5–21.
Funding The authors have not declared a specific grant for this research from any 9 Kloppenburg M, Kroon FP, Blanco FJ, et al. 2018 update of
funding agency in the public, commercial or not-­for-­profit sectors. the EULAR recommendations for the management of hand
osteoarthritis. Ann Rheum Dis 2019;78:16–24.
Competing interests This study had no competing financial interests. Interests
10 Wood G, Neilson J, Cottrell E, et al. Osteoarthritis in people
disclosed in the international Committee of Medical Journal Editors (ICMJE) conflict
over 16: diagnosis and management-­updated summary of NICE
of interest forms are as follows: IKH has received consulting fees from Novartis and guidance. BMJ 2023;380:24.
GSK and is a member of the OARSI executive committee. MK has received grants 11 Kroon FPB, Carmona L, Schoones JW, et al. Efficacy and safety
from IMI APPROACH and the Dutch Arthritis Society, royalties/licences from Wolters of non-­pharmacological, pharmacological and surgical treatment
Kluwer and Springer Verlag, and consulting fees from AbbVie, Pfizer, Kiniksa for hand osteoarthritis: a systematic literature review informing the
Flexion, Galapagos, CHDR, Novartis and UCB, and she is a member of the OARSI 2018 update of the EULAR recommendations for the management
board, the EULAR council and President of the Dutch Society for Rheumatology. of hand osteoarthritis. RMD Open 2018;4:e000734.
Patient consent for publication Not applicable. 12 Kloppenburg M, Bøyesen P, Visser AW, et al. Report from the
OMERACT Hand Osteoarthritis Working Group: Set of Core
Ethics approval Not applicable. Domains and Preliminary Set of Instruments for Use in Clinical
Provenance and peer review Not commissioned; externally peer reviewed. Trials and Observational Studies. J Rheumatol 2015;42:2190–7.
13 Pham T, van der Heijde D, Altman RD, et al. OMERACT-­OARSI
Data availability statement Data are available upon reasonable request. The Initiative: Osteoarthritis Research Society International set
data generated from this study will not be uploaded to a public repository, but can of responder criteria for osteoarthritis clinical trials revisited.
be made available from the corresponding authors to researchers on reasonable Osteoarthr Cartil 2004;12:389–99.
request, subject to a data sharing agreement. 14 Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan-­a web and
mobile app for systematic reviews. Syst Rev 2016;5:210.
Supplemental material This content has been supplied by the author(s). It has 15 Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for
not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been assessing risk of bias in randomised trials. BMJ 2019;366:l4898.
peer-­reviewed. Any opinions or recommendations discussed are solely those 16 GRADE handbook for grading quality of evidence and strength of
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and recommendations. The GRADE Working Group, 2013.
responsibility arising from any reliance placed on the content. Where the content 17 Kloppenburg M, Ramonda R, Bobacz K, et al. Etanercept
includes any translated material, BMJ does not warrant the accuracy and reliability in patients with inflammatory hand osteoarthritis (EHOA): a
of the translations (including but not limited to local regulations, clinical guidelines, multicentre, randomised, double-­blind, placebo-­controlled trial.
terminology, drug names and drug dosages), and is not responsible for any error Ann Rheum Dis 2018;77:1757–64.
and/or omissions arising from translation and adaptation or otherwise. 18 Aitken D, Laslett LL, Pan F, et al. A randomised double-­blind
placebo-­controlled crossover trial of HUMira (adalimumab) for
Open access This is an open access article distributed in accordance with the
erosive hand OsteoaRthritis – the HUMOR trial. Osteoarthr Cartil
Creative Commons Attribution Non Commercial (CC BY-­NC 4.0) license, which 2018;26:880–7.
permits others to distribute, remix, adapt, build upon this work non-­commercially, 19 Kingsbury SR, Tharmanathan P, Keding A, et al.
and license their derivative works on different terms, provided the original work is Hydroxychloroquine Effectiveness in Reducing Symptoms of Hand
properly cited, appropriate credit is given, any changes made indicated, and the Osteoarthritis. Ann Intern Med 2018;168:385.
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