Pharmacological therapies for osteoarthritis of the hand: A review of the evidence

Osteoarthritis (OA) of the hand is highly prevalent in US senior citizens, developing in >50 of individuals aged >60 years. Hormonal, genetic and inflammatory mechanisms are known to increase the risk of hand OA and influence the course of the disease. However, the underlying processes in the development of hand OA are not well understood, and there is no known disease-modifying drug. Likewise, surgical interventions for affected hand joints have not proven as successful as joint replacement for the knee or hip. Current treatment of hand OA focuses on reducing pain and improving patient function to improve quality of life. Pharmacological approaches have included several oral therapies, such as paracetamol (acetaminophen), oral nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, all of which carry a risk of adverse events that typically increases with age. Topical NSAIDs, recently approved in the US, appear to provide efficacy similar to that of oral NSAIDs for hand OA, with less systemic NSAID exposure. Intra-articular corticosteroids and hyaluronic acid have also shown modest symptomatic efficacy with generally good tolerability. Two proposed disease-modifying therapies, chondroitin sulfate and hydroxychloroquine, have had unclear effects on disease modification in clinical trials. This review of pharmacotherapies for the treatment of hand OA focuses on their efficacy and safety in elderly patients. Articles cited herein were identified via a search of PubMed from January 2005 to November 2009. The bibliographies of articles identified through this search were searched manually for additional references of interest.