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Karanasios S, Mertyri D, Karydis F, Gioftsos G. Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Healthcare (Basel) 2024; 12:823. [PMID: 38667585 PMCID: PMC11049805 DOI: 10.3390/healthcare12080823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: -21.91; 95% confidence interval [CI]: -36.59, -7.24; p = 0.003) and wrist disability (MD: -8.1, 95% CI: -4.6, -11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: -0.76; 95% CI: -1.30, -0.21; p = 0.007) and short-term (SMD: -0.93; 95% CI: -1.86, -0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: -0.94; 95% CI: -1.68, -0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term.
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Affiliation(s)
- Stefanos Karanasios
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica, 122 43 Aigaleo, Greece;
- Hellenic OMT eDu, 116 31 Athens, Greece; (D.M.); (F.K.)
| | | | - Fotis Karydis
- Hellenic OMT eDu, 116 31 Athens, Greece; (D.M.); (F.K.)
| | - George Gioftsos
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica, 122 43 Aigaleo, Greece;
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2
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Oo WM, Hunter DJ. Efficacy, Safety, and Accuracy of Intra-articular Therapies for Hand Osteoarthritis: Current Evidence. Drugs Aging 2023; 40:1-20. [PMID: 36633823 DOI: 10.1007/s40266-022-00994-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Abstract
The lifetime risk of symptomatic hand osteoarthritis (OA) is 39.8%, with one in two women and one in four men developing the disease by age 85 years and no disease-modifying drug (DMOAD) available so far. Intra-articular (IA) therapy is one of the options commonly used for symptomatic alleviation of OA disease as it can circumvent systemic exposure and potential side effects of oral medications. The current narrative review focuses on the efficacy and safety profiles of the currently available IA agents in hand OA (thumb-base OA or interphalangeal OA) such as corticosteroids and hyaluronic acid (HA), as well as the efficacy and safety of IA investigational injectates in phase 2/3 clinical trials such as prolotherapy, platelet-rich plasma, stem cells, infliximab, interferon-? and botulinum toxin, based on the published randomized controlled trials on PubMed database. The limited published literature revealed the short-term symptomatic benefits of corticosteroids in interphalangeal OA while long-term data are lacking. Most of the short-term studies showed no significant difference between corticosteroids and hyaluronic acid in thumb-base OA, usually with a faster onset of pain relief in the corticosteroid group and a slower but greater (statistically insignificant) pain improvement in the HA group. The majority of studies in investigational agents were limited by small sample size, short-term follow-up, and presence of serious side effects. In addition, we reported higher accuracy rates of drug administrations under imaging guidance than landmark guidance (blind method), and then briefly describe challenges for the long-term efficacy and prospects of IA therapeutics.
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Affiliation(s)
- Win Min Oo
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar.
- Rheumatology Department, Faculty of Medicine and Health, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, NSW, Australia.
| | - David J Hunter
- Rheumatology Department, Faculty of Medicine and Health, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, NSW, Australia
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Fuggle N, Bere N, Bruyère O, Rosa MM, Prieto Yerro MC, Dennison E, Dincer F, Gabay C, Haugen IK, Herrero-Beaumont G, Hiligsmann M, Hochberg MC, Laslop A, Matijevic R, Maheu E, Migliore A, Pelletier JP, Radermecker RP, Rannou F, Uebelhart B, Uebelhart D, Veronese N, Vlaskovska M, Rizzoli R, Mobasheri A, Cooper C, Reginster JY. Management of hand osteoarthritis: from an US evidence-based medicine guideline to a European patient-centric approach. Aging Clin Exp Res 2022; 34:1985-1995. [PMID: 35864304 PMCID: PMC9464159 DOI: 10.1007/s40520-022-02176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/08/2022] [Indexed: 12/02/2022]
Abstract
Hand osteoarthritis is the most common joint condition and is associated with significant morbidity. It is of paramount importance that patients are thoroughly assessed and examined when complaining of hand stiffness, pain, deformity or disability and that the patient's concerns and expectations are addressed by the healthcare professional. In 2019 the American College of Rheumatology and Arthritis Foundation (ACR/AF) produced guidelines which included recommendations for the treatment of hand osteoarthritis. An ESCEO expert working group (including patients) was convened and composed this paper with the aim to assess whether these guidelines were appropriate for the treatment of hand osteoarthritis therapy in Europe and whether they met with the ESCEO patient-centered approach. Indeed, patients are the key stakeholders in healthcare and eliciting the patient's preference is vital in the context of an individual consultation but also for informing research and policy-making. The patients involved in this working group emphasised the often-neglected area of aesthetic changes in hand osteoarthritis, importance of developing pharmacological therapies which can alleviate pain and disability and the need of the freedom to choose which approach (out of pharmacological, surgical or non-pharmacological) they wished to pursue. Following robust appraisal, it was recommended that the ACR/AF guidelines were suitable for a European context (as described within the body of the manuscript) and it was emphasised that patient preferences are key to the success of individual consultations, future research and future policy-making.
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Affiliation(s)
- Nicholas Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Nathalie Bere
- European Medicines Agency, Amsterdam, The Netherlands
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
| | | | | | - Elaine Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cem Gabay
- Division of Rheumatology, University Hospital of Geneva, and Department of Pathology and Immunology, University of Geneva of Medicine, Geneva, Switzerland
| | - Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Gabriel Herrero-Beaumont
- Head of Rheumatology Department, Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz UAM, 28040, Madrid, Spain
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD, Maastricht, The Netherlands
| | - Marc C Hochberg
- Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrea Laslop
- Scientific Office, Federal Office for Safety in Health Care, Vienna, Austria
| | - Radmila Matijevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinical Center of Vojvodina, Clinic for Orthopedic Surgery, Novi Sad, Serbia
| | - Emmanuel Maheu
- Rheumatology Department, Hospital Saint-Antoine, AP-HP, and Private Office, Paris, France
| | - Alberto Migliore
- Rheumatology Unit - San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM) and Arthritis Division, University of Montreal Hospital Centre (CHUM), Montreal, Canada
| | - Régis Pierre Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liège, CHU de Liège, Liège, Belgium
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires-Paris Centre, Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, INSERM U1124, Paris, France
| | - Brigitte Uebelhart
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel Uebelhart
- Division of Musculoskeletal, Internal Medicine and Oncological Rehabilitation, Leukerbad Clinic -Private Rehabilitation Clinic, 3954, Leukerbad, Switzerland
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Mila Vlaskovska
- Medical Faculty, Department of Pharmacology and Toxicology, Medical University Sofia, Sofia, Bulgaria
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ali Mobasheri
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, 90014, Oulu, Finland
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, 08406, Vilnius, Lithuania
- Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
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Gabriel C, Barbier O, David M, Manon J, Detrembleur C, Libouton X. Effect of splint on pain, function and quality of life in trapeziometacarpal osteoarthritis patients? Acta Orthop Belg 2022; 88:179-185. [PMID: 35512169 DOI: 10.52628/88.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Trapeziometacarpal (TM) Osteoarthritis is one of the most common osteoarthritis. It causes pain, loss of mobility and strength and affected function in daily life. Splint is one of the conservative treatments proposed to patients. The purpose of this study was to assess the effect of this conservative treatment on pain, function and quality of life at long-term. We sent 193 questionnaires to patients who received a CMC splint for their TM osteoarthritis. The CMC splint immobilizes only the TM joint and leaves free the interphalangeal joint of the thumb and the wrist. First, we comptuted how many patients had finally undergone surgical treatment. On the non-operated patients, we analyzed the pain (VAS), the function (QuickDASH score) and the quality of life (SF-12). We compared the results to literature and norms. Finally, 186 people could be included in the study ,115 we answered and 28 were operated on (24%). After 4 years (3.8±1.7 yrs) of conservative treatment, The VAS and QuickDASH scores were significantly worse comparatively to a cohort of healthy patients, trapezectomy and arthrodesis patients. The SF-12 scores were reduced from 20% comparative to norms. In conclusion, few patients had surgery after splinting as a conservative treatment. However, these non- operated patients do not provide good results.
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Falkner F, Tümkaya MA, Thomas B, Bigdeli AK, Kneser U, Harhaus L, Bickert B. [Conservative treatment options for symptomatic thumb trapeziometacarpal joint osteoarthritis]. DER ORTHOPADE 2021; 51:2-8. [PMID: 34910236 DOI: 10.1007/s00132-021-04195-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are numerous non-surgical treatment options for basal thumb osteoarthritis (OA). OBJECTIVES Aetiology, clinical appearance and diagnosis of basal thumb OA, explanation of the individual non-surgical treatment options, presentation of the current state of studies. MATERIAL AND METHODS Search for case analyses, studies, systematic reviews and meta-analyses using PubMed and LIVIVO. RESULTS Intraarticular injections have no more than short-term success with the risk of infection, which should not be underestimated. Radiotherapy seems to be an effective treatment, but little research has been done on this. Physiotherapy and splinting treatment promise long-term improvement of clinical symptoms and hand function. CONCLUSION Basal thumb OA is a common and serious condition, which in the case of continuous pain should be diagnosed and treated adequately. A multi-modal therapeutic regimen with avoidance of repetitive intra-articular injections seems to provide the best long-term results.
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Affiliation(s)
- Florian Falkner
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland. .,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland.
| | - Mahmut Arman Tümkaya
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
| | - Benjamin Thomas
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
| | - Amir K Bigdeli
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
| | - Ulrich Kneser
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
| | - Leila Harhaus
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
| | - Berthold Bickert
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
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Tenti S, Cheleschi S, Mondanelli N, Giannotti S, Fioravanti A. New Trends in Injection-Based Therapy for Thumb-Base Osteoarthritis: Where Are We and where Are We Going? Front Pharmacol 2021; 12:637904. [PMID: 33927620 PMCID: PMC8079141 DOI: 10.3389/fphar.2021.637904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/23/2021] [Indexed: 01/06/2023] Open
Abstract
Thumb-base osteoarthritis (TBOA) is a common condition, mostly affecting post-menopausal women, often inducing a significant impact on quality of life and hand functionality. Despite its high prevalence and disability, the therapeutic options in TBOA are still limited and few have been investigated. Among the pharmacological strategies for TBOA management, it would be worthwhile to mention the injection-based therapy. Unfortunately, its efficacy is still the subject of debate. Indeed, the 2018 update of the European League Against Rheumatism (EULAR) recommendations for the management of hand osteoarthritis (OA) stated that intra-articular (IA) injections of glucocorticoids should not generally be used, but may be considered in patients with painful interphalangeal joints, without any specific mention to the TBOA localization and to other widely used injections agents, such as hyaluronic acid (HA) and platelet-rich plasma (PRP). Even American College of Rheumatology (ACR) experts conditionally recommended against IA HA injections in patients with TBOA, while they conditionally encouraged IA glucocorticoids. However, the recommendations from international scientific societies don’t often reflect the clinical practice of physicians who routinely take care of TBOA patients; indeed, corticosteroid injections are a mainstay of therapy in OA, especially for patients with pain refractory to oral treatments and HA is considered as a safe and effective treatment. The discrepancy with the literature data is due to the great heterogeneity of the clinical trials published in this field: indeed, the studies differ for methodology and protocol design, outcome measures, treatment (different formulations of HA, steroids, PRP, and schedules) and times of follow-up. For these reasons, the current review will provide deep insight into the injection-based therapy for TBOA, with particular attention to the different employed agents, the variety of the schedule treatments, the most common injection techniques, and the obtained results in terms of efficacy and safety. In depth, we will discuss the available literature on corticosteroids and HA injections for TBOA and the emerging role of PRP and other injection agents for this condition. We will consider in our analysis not only randomized controlled trials (RCTs) but also recent pilot or retrospective studies trying to step forward to identify satisfactory management strategies for TBOA.
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Affiliation(s)
- Sara Tenti
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, Clinic for the Diagnosis and Management of Hand Osteoarthritis, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Sara Cheleschi
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, Clinic for the Diagnosis and Management of Hand Osteoarthritis, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Nicola Mondanelli
- Department of Medicine, Surgery and Neuroscience, Orthopedics and Traumatology Unit, University of Siena, Siena, Italy
| | - Stefano Giannotti
- Department of Medicine, Surgery and Neuroscience, Orthopedics and Traumatology Unit, University of Siena, Siena, Italy
| | - Antonella Fioravanti
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, Clinic for the Diagnosis and Management of Hand Osteoarthritis, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Hamasaki T, Laprise S, Harris PG, Bureau NJ, Gaudreault N, Ziegler D, Choinière M. Efficacy of Nonsurgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2020; 72:1719-1735. [DOI: 10.1002/acr.24084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Tokiko Hamasaki
- Centre Hospitalier de l’Université de Montréal and Université de Montréal Montreal Quebec Canada
| | | | - Patrick G. Harris
- Centre Hospitalier de l’Université de Montréal and Université de Montréal Montreal Quebec Canada
| | - Nathalie J. Bureau
- Centre Hospitalier de l’Université de Montréal and Université de Montréal Montreal Quebec Canada
| | - Nathaly Gaudreault
- Université de Sherbrooke and Centre Hospitalier Universitaire de Sherbrooke Sherbrooke Quebec Canada
| | - Daniela Ziegler
- Centre Hospitalier de l’Université de Montréal Montreal Quebec Canada
| | - Manon Choinière
- Centre Hospitalier de l’Université de Montréal and Université de Montréal Montreal Quebec Canada
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