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2018 update of the EULAR recommendations for the management of hand osteoarthritis
  1. Margreet Kloppenburg1,2,
  2. Féline PB Kroon1,
  3. Francisco J Blanco3,
  4. Michael Doherty4,
  5. Krysia S Dziedzic5,
  6. Elsie Greibrokk6,
  7. Ida K Haugen6,
  8. Gabriel Herrero-Beaumont7,
  9. Helgi Jonsson8,
  10. Ingvild Kjeken6,
  11. Emmanuel Maheu9,
  12. Roberta Ramonda10,
  13. Marco JPF Ritt11,
  14. Wilma Smeets1,2,3,
  15. Josef S Smolen12,
  16. Tanja A Stamm13,
  17. Zoltan Szekanecz14,
  18. Ruth Wittoek15,
  19. Loreto Carmona16
  1. 1 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3 Department of Rheumatology, INIBIC-Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
  4. 4 Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK
  5. 5 Institute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
  6. 6 National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  7. 7 Department of Rheumatology, Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
  8. 8 Department of Rheumatology, Landspitalinn University Hospital, University of Iceland, Reykjavik, Iceland
  9. 9 Department of Rheumatology, AP-HP, St Antoine Hospital, Paris, France
  10. 10 Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
  11. 11 Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands
  12. 12 Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  13. 13 Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  14. 14 Department of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
  15. 15 Department of Rheumatology, University Hospital Ghent, Ghent, Belgium
  16. 16 Instituto de Salud Musculoesquelética, Madrid, Spain
  1. Correspondence to Professor Margreet Kloppenburg, Department of Rheumatology, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands; g.kloppenburg{at}


Since publication of the European League Against Rheumatism (EULAR) recommendations for management of hand osteoarthritis (OA) in 2007 new evidence has emerged. The aim was to update these recommendations. EULAR standardised operating procedures were followed. A systematic literature review was performed, collecting the evidence regarding all non-pharmacological, pharmacological and surgical treatment options for hand OA published to date. Based on the evidence and expert opinion from an international task force of 19 physicians, healthcare professionals and patients from 10 European countries formulated overarching principles and recommendations. Level of evidence, grade of recommendation and level of agreement were allocated to each statement. Five overarching principles and 10 recommendations were agreed on. The overarching principles cover treatment goals, information provision, individualisation of treatment, shared decision-making and the need to consider multidisciplinary and multimodal (non-pharmacological, pharmacological, surgical) treatment approaches. Recommendations 1–3 cover different non-pharmacological treatment options (education, assistive devices, exercises and orthoses). Recommendations 4–8 describe the role of different pharmacological treatments, including topical treatments (preferred over systemic treatments, topical non-steroidal anti-inflammatory drugs (NSAIDs) being first-line choice), oral analgesics (particularly NSAIDs to be considered for symptom relief for a limited duration), chondroitin sulfate (for symptom relief), intra-articular glucocorticoids (generally not recommended, consider for painful interphalangeal OA) and conventional/biological disease-modifying antirheumatic drugs (discouraged). Considerations for surgery are described in recommendation 9. The last recommendation relates to follow-up. The presented EULAR recommendations provide up-to-date guidance on the management of hand OA, based on expert opinion and research evidence.

  • hand osteoarthritis
  • treatment
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  • MK and FPBK contributed equally.

  • Handling editor Francis Berenbaum

  • Contributors FPBK performed the systematic literature review, supervised by MK and LC. All authors were part of the Task Force, completed an online survey prior to the face-to-face meeting and voted on the level of agreement. MK, FPBK, FJB, KSD, EG, IKH, GH-B, HJ, IK, EM, MJPFR, WS, JSS, TAS, RW and LC attended the face-to-face meeting. FPBK and MK wrote the manuscript, with contribution and approval of all coauthors.

  • Funding EULAR

  • Disclaimer The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests The individual declaration of conflicts of interest is available on demand at the EULAR secretariat and is summarised below: MK has received consultancy fees/fee as local investigator of industry driven trials from AbbVie, GlaxoSmithKline, Merck, Levicept (all through institution) and has received research funding (through the institution) from Pfizer and APPROACH-IMI. FJB has received honoraria from Boehringer Ingelheim España, SA, Boehringer Ingelheim International GmbH, Fundación Española de Reumatología (FER), Janssen Cilag International NV, Pfizer Inc, Sanofi-Aventis Recherche & Developpement, Bristol-Myers Squibb International Corporation, Bristol Myers Squibb Research and Development, Hospira Inc., Grunenthal GmbH, Bioiberica, UCB, Gebro and research funding (all through institution) from Novartis Farmacéutica, SA, Bristol, Menarini International Operations Luxembourg SA, AbbVie Deutschland GmbH & Co KG, Boehringer Ingelheim España, SA, Boehringer Ingelheim International GmbH, Fundación Española de Reumatología (FER), Janssen Cilag International NV, Gedeon Richter Plc, Pfizer Inc, Glaxosmithkline Research & Development Limited, YL Biologics Limited, Amgen, Inc, Sanofi-Aventis Recherche & Developpement, Gilead Sciences, Inc, Eli Lilly and Company, Ablynx NV, Bristol-Myers Squibb International Corporation, Bristol-Myers Squibb Research and Development, Hospira Inc, Astellas Pharma Europe BV, TRB Chemedica International SA, Archigen Biotech Limited, ONO Pharma UK Ltd, UCB Biosciences GMBH, Nichi-Iko Pharmaceutical Co, Ltd, Genentech Inc Grunenthal GmbH, Celgene Corporation. MD has received research funding from AstraZeneca for a PI-led ’sons of gout' study and honoraria for advisory boards on osteoarthritis and gout from AstraZeneca, Grunenthal, Mallinckrodt and Roche. KSD is part-funded by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands. GHB has received honoraria from Pfizer, AstraZeneca, Roche, Glaxo, Expanscience and research funding (all through institution) from Pfizer and Roche. EM has received honoraria from Celgène, Expanscience, Fidia, Genevrier, Ibsa, LCA, Rottapharm-Meda-Mylan-France, Rottapharm Biotech-Italy, TRB Chemedica. RR has received honoraria from AbbVie, MSD, Celgene, Janssen, Pfizer, UCB and research funding from HORIZON 2020 (going through the institution). JSS has received honoraria from AbbVie, Amgen, AstraZeneca, Astro, BMS, Celgene, Celltrion, Chugai, Gilead, Glaxo, ILTOO, Janssen, Lilly, Medimmune, MSD, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi, UCB and research funding from AbbVie, AstraZeneca, Janssen, Lilly, MSD, Pfizer, Roche. JSS is Editor-in-Chief of ARD and Editor of Rheumatology (Textbook). TS has received honoraria from AbbVie, Janssen, MSD, Novartis and Roche and grant support from AbbVie (going through the institution). ZS has received honoraria from AbbVie, Roche, Pfizer, Berlin Chemie, UCB, Bristol-Myers. RW has received honoraria from AbbVie, UCB, Bristol-Meyers Squibb, MSD, Janssen-Cilag, Menarini. LC has received research funding (through the institution) from Pharmaceutical laboratories (AbbVie Spain, Bristol-Myers Squibb, Celgene, Eisai Farmacéutica, Gebro Pharma, Grünenthal Pharma, LEO Pharma, Merck Sharp & Dohme España, Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, UCB Pharma), Scientific societies (Academia de Dermatología y Venereología, Asociación Emeritense de Reumatología, Eular, Italian Society of Rheumatology, Sociedad Castellano-Manchega, SORCOM, SEDISA, SEIO, Sociedad Española de Neumología y Cirugía Torácica, SERPE, Societat Catalana de Reumatología), Contract Research organisations (Scientia Salus, Continuing Medical Communication, Mediaevents AA, Congresos Eventos y Azafatas, Meed Comunicación, Proyectos Incentivos y Congresos), Research groups and Foundations (AIRE-MB, FISABIO, Fundació Parc Taulí, Fundación Asturcor , Fundación Clínic, Fundación de Investigación Sanitaria Illes Balears, Fundación Española de Reumatología, Fundación para la Investigación Biomédica del Hospital Universitario de La Princesa, Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud, Hospital Universitario Fundación Alcorcón, Reumacare), Individual researchers (Dr Ramón Mazzuchelli, Dr Xavier Juanola, Dr Afnan Abdelkader) and is director of Instituto de Salud Musculoesquelética.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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