Exercise to strengthen forearm muscles and hand grip may be the key to managing hand osteoarthritis, according to an Australian expatriate and osteoarthritis expert.

University of Leeds Professor of Musculoskeletal Medicine Philip Conaghan said a recent Cochrane Review had shown targeted hand exercises provided some benefits in terms of pain, function and stiffness.

Speaking at the Bone, Muscle & Joint Diseases Congress held on the Gold Coast last week, Professor Conaghan said there was also some evidence for physical and occupational therapy.

“Multimodal interventions seem effective to treat pain compared to single interventions such as splints.”

He said it was not enough to refer to hand therapists who simply gave out splints.

“Splints help the base of thumb but on their own they are not enough. Splints plus exercise; injection therapy plus exercise; but never on their own.”

He said even within the hand, osteoarthritis had different trajectories.

“The base of thumb is like your knee, weight bearing all the time, and tends to have chronic pain. Smaller joints often have pain for a year or two while deforming and then patients are often left with stiffness but not pain.”

He said pain persisting over many years was not just osteoarthritis but likely due to the added burden of tenosynovitis.

“Because they have pain, patients get weak and go into a life-long loop of tenosynovitis causing their pain. These patients need a muscle strengthening regimen.”

He said some pharmacological therapies will work in the subgroup of patients who don’t have tenosynovitis as the predominate cause of pain.

“There are things around now. For example, bisphosphonates, when people are just starting their deformity process might be useful in that group.”

Other novel therapies included anti-nerve growth factor and joint distraction.

“A lot of joint spacers and prostheses are being put in but we need randomised trials.”

He said the evidence for intra-articular therapies was mostly unimpressive.

Professor Conaghan said while not perceived as a very serious disease, large community studies had shown about 12% of people over 50 years had severe disability with everyday functioning because of hand pain.