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You have full access to this open access article. Hand osteoarthritis is the most common joint condition and is associated with significant morbidity. 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. 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. Hand osteoarthritis is a highly prevalent disease \[ 1 \] and is associated with substantial morbidity \[ 2 , 3 \]. In Europe there are an estimated million inhabitants \[ 5 \] and the proportion of those aged over 60 years is set to rise \[ 6 \]. Given osteoarthritis is strongly associated with ageing it is likely that the prevalence of hand osteoarthritis will grow \[ 7 \]. However, it is important to note that osteoarthritis is a verified disease in its own right and not merely a sequela of a generic ageing process, and so requires specific diagnosis and management. Indeed, the management of hand osteoarthritis should be multimodal including pharmacological and non-pharmacological approaches as documented in the recommendations from international learned bodies \[ 8 , 9 , 10 \]. In ESCEO The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases convened an expert working group which comprised patients, clinicians, researchers, economists and regulators who performed reviews of the current literature relating to the management and patient preferences research in hand osteoarthritis. The primary aim of this group was to appraise within the context of the current literature whether these US guidelines were appropriate for a European context and to highlight the importance of a patient-centered approach to hand osteoarthritis management. Hand osteoarthritis is an umbrella term under which sits an increasing number of clinical phenotypes \[ 11 \]. Possible risk factors of the condition include; age-related, genetic, inflammatory complement proteins, inflammageing, innate immunity and systemic mediators and metabolic encompassing obesity and diabetes mellitus and possible cardiovascular associations \[ 12 , 13 \]. These manifold causes are of paramount clinical importance when assessing a patient with hand pain. It is crucial to determine the types of symptoms, the onset of symptoms, the pattern of disease flares, extent of deformity both soft tissue and bony enlargement and the comorbid context of the condition, as these factors allow robust clinical decision-making with regard to diagnosis and management. The clinical complaints which lead patients to approach healthcare services include pain, stiffness, loss of function, reduced quality of life, worries about the future and aesthetic concerns related to deformity \[ 14 \]. The latter two of these are particularly prevalent in younger patients with osteoarthritis especially women , and, radiographic assessment is highly informative to ascertain the trajectory of progression. Hand radiographs are often used to confirm the diagnosis of hand osteoarthritis, to assess the degree of structural changes and to document the distribution of joint involvement. This latter point is particularly relevant given the different phenotypes of osteoarthritis affecting the interphalangeal joints or the thumb base joints \[ 15 \]. The extent of damage for osteoarthritis can be graded as none, doubtful, definite, moderate and severe according to Kellgren and Lawrence radiographic scoring \[ 16 \]. Erosive osteoarthritis is a particular phenotype which is characterised by central subchondral bone collapse and is associated with greater pain, a higher level of disability \[ 3 \] and even an inflammatory element \[ 17 , 18 \]. Erosive osteoarthritis can be graded as normal, stationary, destructive or remodelling, according to the radiographic appearances \[ 20 \]. The ESCEO expert working group included patients and their contribution provided novel insights into patient preferences and perspectives. This emphasises how important it is to have open channels of communication between patients and clinicians to address these kinds of potential safety concerns and improve adherence. Another patient had little response to pharmacological approaches and opted for surgical intervention and has been very satisfied with the result. This highlights the importance of communicating all available management options to patients as their disease progresses. All patients agreed that pharmacological therapies should focus on alleviating pain and dysfunction and be combined with a beneficial safety profile. In some healthcare systems economic considerations are also taken into account including costs of medication and non-pharmacological therapies such as rehabilitation and physical therapy , particularly if the patient is funding their own care. With regard to intra-articular therapies including hyaluronic acid and corticosteroids , all patients agreed that the size of the needle and volume of injection should be minimised, and the interval between injections should be as long as possible. ESCEO is a patient-centered organisation which aims to promote the use of patient perspectives in research and intervention development, policy-making and to ensure that patients are encouraged to take an active role in the clinical decision-making surrounding their individual care \[ 21 \]. These preferences are vital to decision-making for an individual in a clinical setting, but also a population at a policy level. At a policy level, patients should play a key role in the design of healthcare interventions and models of care, the population level assessment of risk-benefit from a regulatory perspective and the assessment of the value of an intervention from a reimbursement perspective. Stated preferences are based on hypothetical choices and can be established via exploration in focus groups or structured interviews or via elicitation using a discrete choice experiment DCE. The product can then be developed with these preferences in mind. DCEs have been utilised in an attempt to elicit patient preferences for the management of osteoarthritis. A previous ESCEO DCE of patients with hip and knee osteoarthritis showed that the most important treatment attributes were impact on disease progression followed by the ability to improve walking and reduce pain \[ 23 \]. In another US DCE study, including hip and knee osteoarthritis patients, healthcare providers and insurance company employees, the most important attribute was out of pocket costs \[ 24 \] though it should be noted that this was not included as an attribute in the ESCEO study and might be related to the US healthcare distribution system. Another DCE in the US included patients with osteoarthritis and chronic low back pain and found a preference for daily oral medication over longer term intravenous therapy \[ 25 \]. The only DCE in hand osteoarthritis was directly related to the question of preference for arthroplasty versus arthrodesis as a surgical intervention and found that post-operative stiffness, grip strength, cost and need for future surgical procedures were all important attributes \[ 26 \]. Despite the lack of specific hand osteoarthritis DCEs, it is possible to see that this tool could be used to create a holistic impression of patient preferences for therapies in this disease area and should be the subject of future research. In summary, there is an increasing emphasis on patient-centered research outcome assessment tools, expectations and therapeutic management and it is therefore vital to engage patients in identifying current research needs, the design and conduct of clinical studies and subsequent regulatory assessment \[ 21 \]. They should also be consulted on post-marketing safety surveillance and efficacy data collection and, if applicable, be represented in the learned bodies devising practice guidelines. Indeed, patient preferences should be incorporated throughout the medicinal and non-pharmacological product life cycle \[ 27 \]. It is not enough for patients to sit on panels. They should also be trained and educated to enable them to engage in the most comprehensive way possible and offer insights on the most complex elements of clinical science. Capturing patient perspectives is a highly active process and should incorporate multiple approaches to engagement \[ 28 \]. Thus, in managing hand osteoarthritis in the clinic, in drawing up a research road map and informing policy for hand osteoarthritis we must involve the patient as the key stake-holder. This will lead to better adoption of interventions, better patient satisfaction and better therapeutic adherence. In , ESCEO published a treatment algorithm for the management of knee osteoarthritis \[ 29 \] which has been endorsed beyond Europe in other continents \[ 30 , 31 \]. Although this is not specific to hand osteoarthritis, the key messages and progression through therapies can be transferred as a guide to use in osteoarthritis of the hand. Other European recommendations for the management of hand osteoarthritis have been published, but without a patient-centered focus or algorithm for therapeutic escalation \[ 32 \]. In , the ACR and AF published evidence-based recommendations for the management of hand osteoarthritis, which may be used to inform practice in Europe \[ 9 \]. In this guideline, hand osteoarthritis is defined according to ACR classification criteria \[ 33 \]. These include the presence of hand symptoms limited to pain, aching, stiffness and the findings of clinical examination \[ 33 \]. Three key features are elicited from specific examination of the distal and proximal interphalangeal joints of the 2nd and 3rd fingers and the trapezio-metacarpal joints of both hands 10 joints. In addition to the above, there must be fewer than three swollen metacarpophalangeal joints. If three or four of the above features in addition to the presence of hand symptoms are identified then this confers a clinical diagnosis of hand osteoarthritis. The outcomes were defined as improvement in pain and improvement in function. Literature searches were performed up to and including August and a meta-analysis was performed for the collated papers. A patient panel was also formed as part of the guideline formulating team. A conditional recommendation meant that a process of shared decision-making between patient and clinician should be used to decide if the patient was to receive the intervention. In the first of these, strong recommendations were made for the use of self-efficacy programmes, self-management programmes and 1 st carpo-metacarpal joint orthoses. Conditional recommendations were made for the use of cognitive behavioural therapy, acupuncture complementary medicine , heat therapies including paraffin wax baths and orthoses for the interphalangeal joints. For pharmacological agents, a strong recommendation was made for oral non-steroidal anti-inflammatory drugs NSAIDs and conditional recommendations for topical NSAIDS, intra-articular injections of glucocorticoid, chondroitin sulphate, paracetamol, duloxetine and tramadol the latter three inferred from knee osteoarthritis studies, in the absence of hand osteoarthritis-specific literature. Strong recommendations were made against the use of glucosamine hydrochloride and sulphate , hydroxychloroquine, methotrexate, anti-TNF and IL-1 inhibitors. Conditional recommendations were made against intra-articular injection of hyaluronic acid and the use of topical capsaicin. This is followed by a summary of potential novel interventions for hand osteoarthritis. These medications have been in usage for the treatment of osteoarthritis for decades and their efficacy in osteoarthritis though perhaps not hand-specific disease and safety profiles are well-established with documented adverse effects including GI complications, cardiovascular events, renal impairment and hypersensitivity, headaches, dizziness, rarely hepatotoxicity, drug interactions \[ 34 \]. Non-selective NSAIDs are well known to be associated with upper gastrointestinal, renal and cardiovascular adverse effects. A large meta-analysis demonstrated that the relative risk RR of upper gastrointestinal adverse events with naproxen RR 4. Cardiovascular adverse effects of NSAIDs have been the subject of extensive investigation with a comparison of agents showing that a significantly increased risk is observed with naproxen RR 1. A more recent meta-analysis included 26 randomised controlled trials of non-selective NSAIDs and COX-2 inhibitors which provides a granular assessment of cardiovascular risk and showed that rofecoxib was the only agent with an increased odds of myocardial infarction OR 1. Celecoxib was associated with reduced odds of stroke and cardiovascular adverse events though there was substantial heterogeneity in the doses of celecoxib used in the meta-analysis \[ 37 \]. This was supported by the safety outcomes of the PRECISION trial which demonstrated that celecoxib was non-inferior to both ibuprofen and naproxen in terms of cardiovascular risk \[ 38 \]. Cardiovascular and gastro-intestinal risks seem to increase with age, but recent data did not show an age-related increase of the RR. Patients should be counselled using this information prior to prescription. Analyses performed by an ESCEO working group investigated the adverse effect profiles of pharmaceutical interventions in osteoarthritis. Topical agents were associated with an increased risk of any adverse event RR 1. Based on these data the true risk of paracetamol may well be higher than currently perceived in the clinical community and, thus, paracetamol should only be used for short-term relief, if at all. Meta-analyses have demonstrated small to moderate benefit for prescription-grade crystalline glucosamine sulphate, chondroitin sulphate and diacerein in osteoarthritis it general \[ 44 , 47 , 48 , 49 \] and a meta-analyses of safety found no substantial adverse effects from this class of medications \[ 50 \]. Hand-specific osteoarthritis studies include a retrospective, observational study of glucosamine sulphate in participants which demonstrated a significant reduction in pain visual-analogue score and Functional Index of Hand Osteoarthritis FIHOA score against control at both 3 and 6 months of follow-up \[ 51 \]. Chondroitin sulphate is a complex sugar found in the cartilage of some animals and fish and is taken as dietary supplement in order to stimulate cartilage repair and reduce cartilage degradation. There are data to support the use of chondroitin sulphate in osteoarthritis \[ 46 \] including beneficial effects on symptoms of up to 3 months \[ 54 \] but fewer relating specifically to hand osteoarthritis. Structural improvements including reduced structural damage and reduced occurrence of erosive hand osteoarthritis have previously been demonstrated \[ 55 \]. Gabay and colleagues performed a well-powered, randomised controlled trial of chondroitin sulphate which included participants 80 chondroitin sulphate and 82 placebo and 6 months of follow-up. For the primary outcomes there was an approximately 20 mm reduction in visual analogue score for pain, a reduction in FIHOA score of approximately 3 units, where 30 is the worst possible score and for secondary outcomes a reduction in the duration of early morning stiffness by approximately 5 min for those treated with chondroitin sulphate compared to the placebo group \[ 56 \]. It is recognised, from a scoping review by Honvo and colleagues \[ 57 \] on the role of collagen derivatives in osteoarthritis, that further research is needed to make definitive conclusions regarding the role of SYSADOAs in the treatment of osteoarthritis as a whole and hand osteoarthritis as a specific case. In the EULAR guideline\[ 8 \] it is not recommended to inject the base of the thumb with steroid hyaluronic acid is not addressed in hand osteoarthritis, likely based on findings such as that of Kroon and colleagues\[ 32 \] of no clear benefit of corticosteroid or hyaluronic thumb base injections. However, intra-articular, base of thumb injections of hyaluronic acid \[ 58 , 59 \] for chronic management and corticosteroid \[ 59 , 60 , 61 \] for acute phase management appear to be promising approaches and could be conditionally proposed though with the caveat that further efficacy and safety data are required. There are a host of non-pharmacological interventions considered for hand osteoarthritis. Weight loss is strongly recommended for hip and knee osteoarthritis but not for hand osteoarthritis \[ 9 \]. The recommendation for exercise in hand osteoarthritis is supported by a Cochrane review from which stated benefits such as reduced pain and stiffness \[ 62 \]. However, the type of exercise to perform, the duration, number and rhythm of sessions need to be precisely specified to patients who frequently ask for this kind of information. Iontophoresis is conditionally recommended against for patients with 1 st CMC osteoarthritis due to an absence of randomised controlled trials \[ 9 \]. The gut microbiome is an area of interest with regard to osteoarthritis symptoms and it is clear that alterations in gut microbiota are associated with osteoarthritis and can alter drug metabolism and bioavailability \[ 63 \]. Nutritional interventional studies support a potential contribution of the gut microbiome to osteoarthritis in both animal models and human subjects \[ 63 \]. It is also worth considering and treating concurrent conditions including fibromyalgia which have a substantial prevalence in patients with osteoarthritis \[ 64 \]. There are a number of therapeutic approaches being evaluated or developed for the treatment of hand osteoarthritis. Indeed, at the time of writing, there are 87 studies of hand osteoarthritis on clinicaltrials. A total of 16 non-pharmacological interventions have been trialled including exercise, orthoses, education, mud packs and transcutaneous auricular vagus nerve stimulation. Studied pharmacological agents included topical therapies, SYSADOAs, cannabidiol, pregabalin, apremilast and biologic agents including denosumab, tocilizumab and adalimumab. Trials of biologic agents have shown no significant benefit to date, including; lutikizumab \[ 65 \], etanercept \[ 66 \], otilimab \[ 67 \], adalimumab \[ 68 , 69 \], tocilizumab \[ 70 \]. Benefit is yet to be demonstrated for hydroxychloroquine \[ 71 , 72 , 73 \], colchicine \[ 74 \] or methotrexate \[ 75 \] and the recent published trials do not advocate in favour of the use of these drugs. Oral steroid does appear to provide some benefit for flares of hand osteoarthritis, as observed in the Hand Osteoarthritis Prednisolone Efficacy HOPE trial \[ 76 \]. This was a double-blind, placebo-controlled trial of 10 mg oral prednisolone across two sites in the Netherlands, focused on hand osteoarthritis patients with evidence of active inflammation at the interphalangeal joints. Six weeks of prednisolone with a 2-week tapering period led to a reduction in finger pain visual analogue score with a mean between-group difference for prednisolone vs placebo of GCSB-5, a mixture of 6 herbal extracts, has shown promise in a Korean study which demonstrated some symptomatic benefit in hand osteoarthritis at 4 weeks sustained to 16 weeks with a reduction of AUSCAN pain score greater than that seen with placebo There is a relative paucity of literature relating to the potential benefits of alternative therapies including ginger, curcumin, protein-rich plasma for osteoarthritis and further high quality research is required \[ 78 \]. Hand osteoarthritis is a distinct disease rather than simply a sequela of aging which requires multimodal management in the form of non-pharmacological and pharmacological approaches. It would, nevertheless, be interesting to see further trials confirming the study by Gabay and colleagues \[ 56 \] despite the fact that this study was conducted with a robust methodology and an independent statistical analysis of the outcomes. The ESCEO guidelines are written using a patient-centric approach and in this particular case, we received two fascinating case-studies from patients who highlighted the patient experience and patient preference. The main point that should be reemphasized is that both patients described hand osteoarthritis as a truly disabling disorder. One of them was very happy with the therapeutic approaches that were offered to her chondroitin sulphate and Celecoxib but her Celecoxib therapy was interrupted due to concerns born of the lay press regarding the possible cardiovascular adverse effects of coxibs. This highlights that it is immensely important to facilitate proper communication between physicians and patients, since these putative adverse effects have not been confirmed for celecoxib. She clearly expressed a cyclical pattern of pain with periods of inflammation flares followed by periods of relief. She also experimented with alternative medicines some of which had had a positive effect. The second patient also described the serious impact of hand osteoarthritis on her daily life. As opposed to the first patient, she was not content with the pharmacological approaches that were offered to her and decided to pursue surgical intervention proximal interphalangeal prosthesis. Despite the significant financial implication, she is very satisfied with the surgical outcome. Both patients insisted that pharmacological approaches should provide alleviation for pain and disability, and should be associated with a good safety profile. They highlighted the fact that they might be prepared to consider paying a financial premium, providing that the medication or the surgical treatment was effective. Regarding intra-articular hyaluronic acid or steroid injections, they emphasised that they need to see some proof of efficacy and that they would prefer devices using a small needle, minimal volume of injection and, if possible, as few injections as possible. Patient preference research and the derived health economics analyses support the use of a pharmacological management of hand osteoarthritis. Corticosteroid injections appear to be a promising approach in the acute phase of the disease with hyaluronic acid for chronic symptoms but both require further demonstrations of efficacy and safety. This is also the case for several medications including glucosamine sulphate which were or are currently undergoing investigation. Biologic agents have shown no significant benefit, to date. Ann Rheum Dis — Article PubMed Google Scholar. Kwok WY, Kloppenburg M, Marshall M et al Comparison of clinical burden between patients with erosive hand osteoarthritis and inflammatory arthritis in symptomatic community-dwelling adults: the Keele clinical assessment studies. Rheumatology Oxford. Kwok WY, Kloppenburg M, Rosendaal FR et al Erosive hand osteoarthritis: its prevalence and clinical impact in the general population and symptomatic hand osteoarthritis. Osteoarthritis Cartilage — Worldometer Accessed Jan United Nations WB. Population projections Arthritis Care Res Hoboken — Article Google Scholar. Nat Rev Rheumatol — Mobasheri A, Batt M An update on the pathophysiology of osteoarthritis. Ann Phys Rehabil Med — Courties A, Sellam J, Maheu E et al Coronary heart disease is associated with a worse clinical outcome of hand osteoarthritis: a cross-sectional and longitudinal study. RMD Open 3:e Clin Exp Rheumatol — Haugen IK, Mathiessen A, Slatkowsky-Christensen B et al Synovitis and radiographic progression in non-erosive and erosive hand osteoarthritis: is erosive hand osteoarthritis a separate inflammatory phenotype? Osteoarthritis Cartilage. Wittoek R, Cruyssen BV, Verbruggen G Predictors of functional impairment and pain in erosive osteoarthritis of the interphalangeal joints: comparison with controlled inflammatory arthritis. Arthritis Rheum — J Hand Surg — Aging Clin Exp Res — Patient preferences Innovative Medicines Initiative. Semin Arthritis Rheum — Turk D, Boeri M, Abraham L et al Patient preferences for osteoarthritis pain and chronic low back pain treatments in the United States: a discrete-choice experiment. Harris CA, Shauver MJ, Yuan F et al understanding patient preferences in proximal interphalangeal joint surgery for osteoarthritis: a conjoint analysis. J Hand Surg Am Front Pharmacol. Lancet — Kroon FPB, Carmona L, Schoones JW et al Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the update of the EULAR recommendations for the management of hand osteoarthritis. RMD Open. Cadet C, Maheu E Non-steroidal anti-inflammatory drugs in the pharmacological management of osteoarthritis in the very old: prescribe or proscribe? Ther Adv Musculoskelet Dis. Bhala N, Emberson J, Merhi A et al Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Wang X, Tian HJ, Yang HK et al Meta-analysis: cyclooxygenase-2 inhibitors are no better than nonselective nonsteroidal anti-inflammatory drugs with proton pump inhibitors in regard to gastrointestinal adverse events in osteoarthritis and rheumatoid arthritis. Eur J Gastroenterol Hepatol — J Clin Pharm Ther — N Engl J Med — Curtis E, Fuggle N, Shaw S et al Safety of cyclooxygenase-2 inhibitors in osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging — Honvo G, Leclercq V, Geerinck A et al Safety of topical non-steroidal anti-inflammatory drugs in osteoarthritis: outcomes of a systematic review and meta-analysis. A meta-analysis of randomised controlled trials. A systematic literature review of observational studies. J Rheumatol — PubMed Google Scholar. Cochrane Database Syst Rev. Rheumatology Oxford — Eriksen P, Bartels EM, Altman RD et al Risk of bias and brand explain the observed inconsistency in trials on glucosamine for symptomatic relief of osteoarthritis: a meta-analysis of placebo-controlled trials. Hochberg MC Structure-modifying effects of chondroitin sulfate in knee osteoarthritis: an updated meta-analysis of randomized placebo-controlled trials of 2-year duration. Osteoarthritis Cartilage S Honvo G, Reginster JY, Rabenda V et al Safety of symptomatic slow-acting drugs for osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging. Tenti S, Giordano N, Mondanelli N et al A retrospective observational study of glucosamine sulfate in addition to conventional therapy in hand osteoarthritis patients compared to conventional treatment alone. Clin Ther — Reginster JY, Veronese N Highly purified chondroitin sulfate: a literature review on clinical efficacy and pharmacoeconomic aspects in osteoarthritis treatment. Verbruggen G, Goemaere S, Veys EM Systems to assess the progression of finger joint osteoarthritis and the effects of disease modifying osteoarthritis drugs. Clin Rheumatol — Gabay C, Medinger-Sadowski C, Gascon D et al Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial at a single center. Rheumatol Ther — Clin Exp Rheumatol Tenti S, Cheleschi S, Mondanelli N et al New trends in injection-based therapy for thumb-base osteoarthritis: where are we and where are we going? Rocchi L, Merolli A, Giordani L et al Trapeziometacarpal joint osteoarthritis: a prospective trial on two widespread conservative therapies. Muscles Ligaments Tendons J — Khan M, Waseem M, Raza A et al Quantitative assessment of improvement with single corticosteroid injection in thumb cmc joint osteoarthritis? Open Orthop J — Ageing Res Rev Slatkowsky-Christensen B, Mowinckel P, Kvien TK Health status and perception of pain: a comparative study between female patients with hand osteoarthritis and rheumatoid arthritis. Scand J Rheumatol — Schett G, Bainbridge C, Berkowitz M et al Anti-granulocyte-macrophage colony-stimulating factor antibody otilimab in patients with hand osteoarthritis: a phase 2a randomised trial. Lancet Rheumatol 2:e—e Richette P, Latourte A, Sellam J et al Efficacy of tocilizumab in patients with hand osteoarthritis: double blind, randomised, placebo-controlled, multicentre trial. Ann Rheum Dis. Kedor C, Detert J, Rau R et al Hydroxychloroquine in patients with inflammatory and erosive osteoarthritis of the hands: results of the OA-TREAT study-a randomised, double-blind, placebo-controlled, multicentre, investigator-initiated trial. Kingsbury SR, Tharmanathan P, Keding A et al Hydroxychloroquine effectiveness in reducing symptoms of hand osteoarthritis: a randomized trial. Ann Intern Med — Lee W, Ruijgrok L, Boxma-de Klerk B et al Efficacy of hydroxychloroquine in hand osteoarthritis: a randomized, double-blind placebo-controlled trial. Ferrero S, Wittoek R, Allado E et al Methotrexate treatment in hand osteoarthritis refractory to usual treatments: a randomised, double-blind, placebo-controlled trial. Controlled Trial Clin Ther Download references. The authors would like to express particular gratitude to the patients who took part in this ESCEO working group. Their contribution was invaluable to this article. The ESCEO receives unrestricted educational grants to support its educational and scientific activities from non-governmental organizations, not-for-profit organizations, non-commercial or corporate partners. The choice of topics, participants, content and agenda of the Working Groups as well as the writing, editing, submission and reviewing of the manuscript are the sole responsibility of the ESCEO, without any influence from third parties. You can also search for this author in PubMed Google Scholar. All authors contributed to the review conception and design. All authors read and approved the final manuscript. Correspondence to Cyrus Cooper. NF reports educational grants from Pfizer and Eli Lilly. IKH reports consultancies for Novartis and Abbvie, research grant from Pfizer paid to institution , all outside of the submitted work. This article is a retrospective review. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Fuggle, N. Management of hand osteoarthritis: from an US evidence-based medicine guideline to a European patient-centric approach. Aging Clin Exp Res 34 , — Download citation. Received : 13 March Accepted : 08 June Published : 21 July Issue Date : September Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Download PDF. Abstract Hand osteoarthritis is the most common joint condition and is associated with significant morbidity. Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial Article Open access 16 February Efficacy of conservative treatments for hand osteoarthritis Article 30 June Use our pre-submission checklist Avoid common mistakes on your manuscript. Introduction Hand osteoarthritis is a highly prevalent disease \[ 1 \] and is associated with substantial morbidity \[ 2 , 3 \]. Heterogeneity of hand osteoarthritis Hand osteoarthritis is an umbrella term under which sits an increasing number of clinical phenotypes \[ 11 \]. The opinion of patients The ESCEO expert working group included patients and their contribution provided novel insights into patient preferences and perspectives. Patient preferences and shared decision-making ESCEO is a patient-centered organisation which aims to promote the use of patient perspectives in research and intervention development, policy-making and to ensure that patients are encouraged to take an active role in the clinical decision-making surrounding their individual care \[ 21 \]. NSAIDs and COX-2 inhibitors These medications have been in usage for the treatment of osteoarthritis for decades and their efficacy in osteoarthritis though perhaps not hand-specific disease and safety profiles are well-established with documented adverse effects including GI complications, cardiovascular events, renal impairment and hypersensitivity, headaches, dizziness, rarely hepatotoxicity, drug interactions \[ 34 \]. Physical, psychosocial and mind—body approaches There are a host of non-pharmacological interventions considered for hand osteoarthritis. Novel therapeutic options There are a number of therapeutic approaches being evaluated or developed for the treatment of hand osteoarthritis. Conclusion Hand osteoarthritis is a distinct disease rather than simply a sequela of aging which requires multimodal management in the form of non-pharmacological and pharmacological approaches. Acknowledgements The authors would like to express particular gratitude to the patients who took part in this ESCEO working group. View author publications. Human and animal rights This article is a retrospective review. Informed consent For this retrospective review, formal consent is not required. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. About this article. Cite this article Fuggle, N. Copy to clipboard. Search Search by keyword or author Search. Navigation Find a journal Publish with us Track your research.

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