A combination of conservative strategies can be effective in improving function and reducing pain in patients with thumb base osteoarthritis.
An Australian study, presented at the OARSI 2019 World Congress in Toronto earlier this month, involved 204 patients with symptomatic and radiographic osteoarthritis of the first carpometacarpal joint.
Patients were randomised to receive either education on self-management and joint protection or education in combination with a soft neoprene splint for the base of the thumb to be worn fours hours per day during activity, hand exercises and topical diclofenac for six weeks.
The hand exercises were demonstrated during a face-to-face session with a physiotherapist at baseline then performed unsupervised at home three times per week.
The study found hand function scores in the intervention group significantly improved at both six and twelve weeks from baseline compared to the control group.
While there was no statistically significant difference between the groups for change in pain at six weeks, it did become significant by 12 weeks.
Dr Sarah Robbins, from the Institute of Bone and Joint Research at the University of Sydney, told the limbic that there was good compliance overall.
“Most patients really liked the exercise and were quite adherent – 82% with exercise, 77% with the splint and 74% with Voltaren gel.”
“Even the patients in the control group really liked to learn new ways of using their hands and adapting the way they do things. All patients improved their grip strength,” she said.
“The idea for any joint with osteoarthritis is actually to move – to learn how to use the joint a bit better but keep moving.”
Joint protection strategies in the education component included how to pace activity, how to hold objects and advice on assistive devices for the home such as can openers.
Dr Robbins said results at a six-month follow up would also be interesting.
“My personal opinion is that with pain, it actually takes longer for the patient to perceive an improvement because it is such a chronic condition.”
“And also it takes time to change behaviour – the way they do activities. It takes 2-3 months to establish a new habit. So we think that’s why pain improvement was only seen at 12 weeks,” she said.