Table 2

Research agenda for hand OA

ThemeResearch questions
Pathophysiology
  • Does treatment of inflammation lead to a decrease in structural progression?

Treatment strategy
  • Which contextual factors influence treatment effects?

  • Assessing efficacy of stratified treatment based on contextual factors.

Trial methodology
  • Clear definition of study population to accommodate later subgroup analyses or stratification based on patient characteristics.

Outcomes
  • Evaluation of outcome measures in hand OA, and use of existing outcome core sets for future hand OA trials.

  • Cost-effectiveness studies.

  • Defining treatment targets for disease-modifying drugs.

Education
  • Evaluation of efficacy of education without concomitant exercise.

  • Definition of the desired content of education.

Exercise
  • Assessment of most effective type of hand exercises, most optimal method of delivery and most optimal frequency.

  • Assessment of methods to increase adherence to exercise.

Orthoses
  • Assessment of orthosis design (material, which joints are supported), and instructions or frequency for use of orthoses.

  • Evaluation of daytime orthoses, night-time orthoses and a combination of daytime and night-time orthoses.

  • Placebo-controlled trial of orthoses for thumb base OA.

  • Evaluation of effect of use of orthoses on CMC-1 subluxation.

Topical treatments
  • Another placebo-controlled trial of topical NSAID.

Oral analgesics
  • Placebo-controlled trial of paracetamol.

  • Placebo-controlled trial of tramadol.

Nutraceuticals
  • Placebo-controlled trial of glucosamine.

  • Another placebo-controlled trial of chondroitin sulfate, also to assess possible effect on structural damage.

Intra-articular therapies
  • Placebo-controlled trial of intra-articular glucocorticoids specifically in CMC-1 joints with OA inflammation.

  • Image-guided injection vs blind injection.

DMARDs
  • Placebo-controlled trial of methotrexate.

  • Placebo-controlled trial of low dose oral glucocorticoids.

Surgery
  • Randomised controlled trial of most commonly used surgical interventions.

  • Assessment of best timing of referral to surgery.

  • Evaluation of whether early non-pharmacological interventions may prevent or delay surgery.

Follow-up
  • Investigation of trajectories in hand OA to define subgroups.

Implementation
  • Determination of optimal implementation of the guidelines in people with hand OA.

  • CMC-1, first carpometacarpal; DMARDs, disease-modifying antirheumatic drugs; OA, osteoarthritis.