Table 5

 Future research agenda

1Clinical trials on hand OA should separately consider the localisation (thumb base, interphalangeal joints) and the stage or type of OA (non-erosive, erosive, nodal) and examine clinical predictors of response
2Thorough evaluation is required of physical treatments, such as ultrasound, laser, TENS, and local application of heat (for example, paraffin wax, hot pack)
3Studies are required to determine the most appropriate form or combination of exercise (for example, strengthening, range of movement) for the different subsets of hand OA
4Further studies are required to better evaluate the symptom and structure modifying effects of SYSADOA
5The benefits of intra-articular injection of either corticosteroid or hyaluronan should be determined both for thumb base and interphalangeal OA
6Existing slow acting antirheumatic drugs and biological agents (especially anti-tumour necrosis factor therapy) should be investigated in erosive interphalangeal OA, to determine possible symptom benefits and structure modifying effects
7The efficacy and safety (both short and long term) of paracetamol, weak opioids, and oral NSAIDs need to be assessed and compared
8The potential benefits of surgery compared with conservative management, and the most appropriate surgical procedure for thumb base OA, remain to be determined