title: Pharmacological therapies for osteoarthritis of the hand: a review of the evidence.
abstract: 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.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Roy D
authors.initials: RD
authors.lastname: Altman
mesh_terms: D000279:Administration, Cutaneous; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D006225:Hand; D006801:Humans; D007270:Injections, Intra-Articular; D010003:Osteoarthritis / Q000188:drug therapy*; D018689:Sensory System Agents / Q000627:therapeutic use*; D055675:Viscosupplements / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D018689:Sensory System Agents; D055675:Viscosupplements
references.citation: J Hand Surg Am. 2009 Oct;34(8):1444-8
references.pmid: 19683880
references.citation: Osteoarthritis Cartilage. 2006 Oct;14(10):1075-80
references.pmid: 16713721
references.citation: Arzneimittelforschung. 1986 Jul;36(7):1092-6
references.pmid: 3768079
references.citation: Osteoarthritis Cartilage. 2008 Feb;16(2):137-62
references.pmid: 18279766
references.citation: Postgrad Med J. 2001 Nov;77(913):703-7
references.pmid: 11677279
references.citation: J Rheumatol. 2007 Jun;34(6):1323-7
references.pmid: 17516620
references.citation: Arthritis Rheum. 2004 Oct 15;51(5):746-54
references.pmid: 15478167
references.citation: Arthritis Rheum. 1998 Oct;41(10):1867-73
references.pmid: 9778229
references.citation: Rheumatology (Oxford). 2005 Apr;44(4):521-8
references.pmid: 15728421
references.citation: Twin Res. 2003 Feb;6(1):62-6
references.pmid: 12626230
references.citation: Br J Sports Med. 1999 Dec;33(6):423-4; discussion 424-5
references.pmid: 10597854
references.citation: Ann Rheum Dis. 2005 May;64(5):682-7
references.pmid: 15374852
references.citation: Rheumatology (Oxford). 2009 Sep;48(9):1160-5
references.pmid: 19608726
references.citation: JAMA. 2006 Jul 5;296(1):87-93
references.pmid: 16820551
references.citation: Arthritis Rheum. 2008 Feb;58(2 Suppl):S15-9
references.pmid: 18240261
references.citation: Osteoarthritis Cartilage. 2006 Sep;14(9):953-7
references.pmid: 16759885
references.citation: J Rheumatol. 1996 Jul;23(7):1221-6
references.pmid: 8823696
references.citation: Arthritis Res Ther. 2010;12(1):R7
references.pmid: 20064249
references.citation: Arzneimittelforschung. 1983;33(4A):656-9
references.pmid: 6349652
references.citation: Arthritis Care Res (Hoboken). 2010 Mar;62(3):323-34
references.pmid: 20391478
references.citation: J Am Podiatr Med Assoc. 1991 Nov;81(11):606-7
references.pmid: 1784017
references.citation: Clin Rheumatol. 2002 Jun;21(3):231-43
references.pmid: 12111630
references.citation: J Clin Rheumatol. 2004 Apr;10(2):59-62
references.pmid: 17043465
references.citation: Osteoarthritis Cartilage. 1998 Jul;6(4):245-51
references.pmid: 9876393
references.citation: Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004257
references.pmid: 16437479
references.citation: Arthritis Rheum. 1998 May;41(5):778-99
references.pmid: 9588729
references.citation: Am J Med. 1986 Mar;80(3):435-42
references.pmid: 3513560
references.citation: JAMA. 2002 Jul 17;288(3):321-33
references.pmid: 12117397
references.citation: J Hand Surg Am. 2008 Jan;33(1):40-8
references.pmid: 18261664
references.citation: Rev Rhum Ed Fr. 1993 Nov 30;60(11):836-41
references.pmid: 8054933
references.citation: J Am Geriatr Soc. 1985 Apr;33(4):278-85
references.pmid: 3989190
references.citation: Hepatobiliary Pancreat Dis Int. 2003 Feb;2(1):32-7
references.pmid: 14599926
references.citation: Osteoarthritis Cartilage. 2007 Aug;15(8):957-65
references.pmid: 17398122
references.citation: BMJ. 2006 Jun 3;332(7553):1302-8
references.pmid: 16740558
references.citation: Hepatology. 2005 Dec;42(6):1364-72
references.pmid: 16317692
references.citation: Radiology. 1984 Dec;153(3):615-8
references.pmid: 6494459
references.citation: J Hand Surg Am. 2008 May-Jun;33(5):726-32
references.pmid: 18590856
references.citation: Osteoarthritis Cartilage. 2001 Oct;9(7):606-11
references.pmid: 11597172
references.citation: Int J Tissue React. 2002;24(1):29-32
references.pmid: 12013151
references.citation: J Rheumatol. 1996 Aug;23(8):1477-8
references.pmid: 8856633
references.citation: Semin Arthritis Rheum. 2005 Aug;35(1 Suppl 1):1-10
references.pmid: 16084227
references.citation: J Hand Surg Eur Vol. 2008 Feb;33(1):38-44
references.pmid: 18332018
references.citation: BMJ. 2004 Apr 24;328(7446):991
references.pmid: 15033881
references.citation: Am J Kidney Dis. 1996 Jan;27(1):162-5
references.pmid: 8546133
references.citation: Arthritis Rheum. 2007 May 15;57(4):626-32
references.pmid: 17471533
references.citation: J Rheumatol. 2005 Jul;32(7):1305-6
references.pmid: 15996069
references.citation: Clin Exp Rheumatol. 2004 Sep-Oct;22(5):589-96
references.pmid: 15485012
references.citation: J Psychiatr Pract. 2005 Jan;11(1):5-15
references.pmid: 15650617
references.citation: Am J Phys Med Rehabil. 2007 Jan;86(1):12-21
references.pmid: 17304684
references.citation: BMC Musculoskelet Disord. 2004 Aug 19;5:28
references.pmid: 15317652
references.citation: J Hand Surg Am. 2007 Jan;32(1):1-11
references.pmid: 17218170
references.citation: Arthritis Rheum. 2006 Apr;54(4):1328-33
references.pmid: 16575858
references.citation: Osteoarthritis Cartilage. 2006 Jan;14(1):82-8
references.pmid: 16242353
references.citation: Arthritis Rheum. 2006 Aug;54(8):2665-73
references.pmid: 16871531
references.citation: Rheumatol Int. 2009 Jun;29(8):961-5
references.pmid: 19198842
references.citation: BMC Musculoskelet Disord. 2008 Mar 07;9:32
references.pmid: 18328090
references.citation: BMJ. 2005 Jun 11;330(7504):1366
references.pmid: 15947398
references.citation: Ann Rheum Dis. 2005 Nov;64(11):1633-8
references.pmid: 15829571
references.citation: Ann Rheum Dis. 1991 Jan;50(1):8-13
references.pmid: 1994877
references.citation: Am J Epidemiol. 1994 Jan 15;139(2):119-29
references.pmid: 8296779
references.citation: Am J Ther. 2004 Mar-Apr;11(2):124-9
references.pmid: 14999364
references.citation: Arthritis Rheum. 1998 Jan;41(1):58-67
references.pmid: 9433870
references.citation: Postgrad Med. 2009 Mar;121(2):139-47
references.pmid: 19332972
references.citation: Ann Intern Med. 2003 Oct 7;139(7):539-46
references.pmid: 14530224
references.citation: Arthritis Rheum. 2009 Dec 15;61(12):1704-11
references.pmid: 19950318
references.citation: Ann Rheum Dis. 2004 Aug;63(8):901-7
references.pmid: 15020311
references.citation: Int J Immunopathol Pharmacol. 2009 Apr-Jun;22(2):455-60
references.pmid: 19505398
references.citation: Arthritis Rheum. 1987 Nov;30(11):1214-25
references.pmid: 3689459
references.citation: Ann Rheum Dis. 2009 Jan;68(1):8-17
references.pmid: 18250111
references.citation: J Clin Rheumatol. 2005 Dec;11(6):299-302
references.pmid: 16371798
references.citation: J Am Geriatr Soc. 2009 Aug;57(8):1331-46
references.pmid: 19573219
references.citation: Rheumatology (Oxford). 2009 Mar;48(3):277-80
references.pmid: 19153142
references.citation: Ann Rheum Dis. 2007 Mar;66(3):377-88
references.pmid: 17046965
references.citation: Ann Rheum Dis. 1997 Jul;56(7):432-4
references.pmid: 9486006
references.citation: J Rheumatol. 2006 Mar;33(3):567-73
references.pmid: 16511925
references.citation: Best Pract Res Clin Gastroenterol. 2009;23(6):839-48
references.pmid: 19942162
references.citation: J Rheumatol. 2009 Sep;36(9):1991-9
references.pmid: 19648310
references.citation: BMJ. 2005 Dec 3;331(7528):1310-6
references.pmid: 16322018
references.citation: Epidemiology. 2001 Sep;12(5):570-6
references.pmid: 11505178
references.citation: Ann Rheum Dis. 2005 Mar;64(3):438-43
references.pmid: 15458958
references.citation: Rheumatology (Oxford). 2003 Oct;42(10):1173-8
references.pmid: 12777639
references.citation: Arthritis Rheum. 1998 Jul;41(7):1227-32
references.pmid: 9663480
references.citation: J Clin Pharmacol. 2010 Jan;50(1):50-61
references.pmid: 19841157
references.citation: Drugs Exp Clin Res. 2004;30(1):11-6
references.pmid: 15134386
references.citation: Drugs Aging. 2008;25(4):343-55
references.pmid: 18361544
references.citation: J Gerontol. 1976 Mar;31(2):155-63
references.pmid: 1249404
references.citation: Ann Intern Med. 1991 Nov 15;115(10):787-96
references.pmid: 1834002
references.citation: Am J Manag Care. 2002 Oct;8(15 Suppl):S383-91
references.pmid: 12416788
references.citation: Ann Rheum Dis. 2003 Feb;62(2):151-8
references.pmid: 12525385
references.citation: Arch Orthop Trauma Surg. 2004 May;124(4):258-61
references.pmid: 12827394
references.citation: Clin Rheumatol. 2009 May;28(5):529-33
references.pmid: 19137353
references.citation: J Rheumatol. 1992 Apr;19(4):604-7
references.pmid: 1375648
references.citation: Postgrad Med. 2009 Nov;121(6):9-20
references.pmid: 19940413
references.citation: J Hand Surg Am. 2004 Mar;29(2):247-51
references.pmid: 15043897
references.citation: Ann Rheum Dis. 2005 Jan;64(1):29-33
references.pmid: 15208174
references.citation: Arthritis Rheum. 1990 Nov;33(11):1601-10
references.pmid: 2242058
references.citation: Ann Fam Med. 2007 Sep-Oct;5(5):395-402
references.pmid: 17893380
references.citation: Circulation. 2007 Feb 6;115(5):e69-171
references.pmid: 17194875
references.citation: Am J Epidemiol. 2002 Dec 1;156(11):1021-7
references.pmid: 12446258
references.citation: Epidemiology. 1999 Mar;10(2):161-6
references.pmid: 10069252
references.citation: Joint Bone Spine. 2007 Jul;74(4):368-72
references.pmid: 17590369
references.citation: J Bone Joint Surg Am. 2004 May;86(5):963-74
references.pmid: 15118039
references.citation: Am J Sports Med. 2006 Dec;34(12):1992-7
references.pmid: 16902230
references.citation: J Hand Surg Am. 2004 Sep;29(5):785-95
references.pmid: 15465226
references.citation: Australas Chiropr Osteopathy. 1997 Jul;6(2):58-62
references.pmid: 17987151