Table 2

 Experts’ propositions developed through three Delphi rounds—order according to topic (general, non-pharmacological, pharmacological, invasive, and surgical)

NoPropositionSOR (95% CI)
VAS100A-B (%)
SOR, strength of recommendation; VAS, visual analogue scale; OA, osteoarthritis; NSAIDs, non-steroidal anti-inflammatory drugs; SYSADOAs, symptomatic slow acting drugs for osteoarthritis.
1Optimal management of hand OA requires a combination of non-pharmacological and pharmacological treatment modalities individualised to the patient’s requirements95 (92 to 98)100
2Treatment of hand OA should be individualised according to localisation of OA; risk factors (age, sex, adverse mechanical factors); type of OA (nodal, erosive, traumatic); presence of inflammation; severity of structural change; level of pain, disability and restriction of quality of life; comorbidity and co-medication (including OA at other sites); and the wishes and expectations of the patient84 (76 to 92)92
3Education concerning joint protection (how to avoid adverse mechanical factors) together with an exercise regimen (involving both range of motion and strengthening exercises) are recommended for all patients with hand OA59 (45 to 74)38
4Local application of heat (for example, paraffin wax, hot pack), especially before exercise, and ultrasound are beneficial treatments
 Overall56 (40 to 71)33
 Heat77 (69 to 85)77
 Ultrasound25 (15 to 36)0
5Splints for thumb base OA and orthoses to prevent/correct lateral angulation and flexion deformity are recommended67 (57 to 77)69
6Local treatments are preferred over systemic treatments, especially for mild to moderate pain and when only a few joints are affected. Topical NSAIDs and capsaicin are effective and safe treatments for hand OA75 (68 to 83)86
7Because of its efficacy and safety paracetamol (up to 4 g/day) is the oral analgesic of first choice and, if successful, is the preferred long term oral analgesic87 (78 to 96)92
8Oral NSAIDs should be used at the lowest effective dose and for the shortest duration in patients who respond inadequately to paracetamol. The patient’s requirements and response to treatment should be re-evaluated periodically. In patients with increased gastrointestinal risk, non-selective NSAIDs plus a gastroprotective agent, or a selective COX-2 inhibitor (coxib) should be used. In patients with increased cardiovascular risk, coxibs are contraindicated and non-selective NSAIDs should be used with caution81 (74 to 88)100
9SYSADOA (for example, glucosamine, chondroitin sulphate, avocado soybean unsaponifiables, diacerhein, intra-articular hyaluronan) may give symptomatic benefit with low toxicity, but effect sizes are small, suitable patients are not defined and clinically relevant structure modification, and pharmacoeconomic benefits have not been established63 (48 to 76)69
10Intra-articular injection of long-acting corticosteroid is effective for painful flares of OA, especially trapeziometacarpal joint OA.60 (47 to 74)46
11Surgery (for example, interposition arthroplasty, osteotomy or arthrodesis) is an effective treatment for severe thumb base OA and should be considered in patients with marked pain and/or disability when conservative treatments have failed68 (56 to 79)62