Efficacy and safety of non-pharmacological, pharmacological and surgical treatments for hand osteoarthritis in 2024: a systematic review

Hand Osteoarthritis: Molecular Mechanisms, Randomized Controlled Trials, and the Future of Targeted Treatment

Hand osteoarthritis (OA) is a prevalent and disabling condition, yet its pathogenesis remains less studied than OA in large weight-bearing joints. Emerging genetic, epigenetic, and microbiome research suggests that hand OA might be biologically distinct, involving joint-specific pathways not shared by knee or hip OA. This review integrates genome-wide association studies specific to hand OA, highlighting key molecular contributors such as inflammatory cytokines. These genetic insights, together with emerging data on epigenetic alterations and gut microbial dysbiosis, point to broader systemic and regulatory influences on hand OA onset and progression. We also assess pharmacologic interventions tested in randomized controlled trials that have attempted to target these pathways. While agents such as TNF and IL-6 inhibitors, hydroxychloroquine, and corticosteroids have shown limited success, emerging evidence supports the potential of methotrexate in synovitis-positive general hand OA, platelet-rich plasma in thumb carpometacarpal (CMC) OA, and prolotherapy in interphalangeal (IP) OA. These findings illustrate the persistent gap between mechanistic understanding and therapeutic success. Future work must prioritize multifactorial strategies for addressing pain and translational frameworks that link molecular mechanisms to treatment response. In summary, this review offers an update on hand OA and identifies key opportunities for more targeted and effective therapy.

Nanomaterial-Based Drug Delivery Systems Targeting Functional Cells for Osteoarthritis Treatment: Mechanisms, Challenges and Future Prospects

Osteoarthritis (OA) represents a chronic joint disease characterized by articular cartilage degeneration, synovial inflammation, and subchondral bone erosions. Functional cells in OA mainly include macrophages, synoviocytes, chondrocytes, and mesenchymal stem cells. These cells can secrete cytokines and non-coding RNAs and exosomes and interact with each other to coregulate the progression of OA. Some nanomaterial-based drug delivery systems (DDSs) surface ligands can alleviate OA by targeting receptors on the surface of functional cells. Meanwhile, other nanomaterial-based DDSs, whose surfaces are masked by the cell membranes or extracellular vesicles of these functional cells, treat OA by targeting and attacking the diseased site. When ligand-modified nanomaterials target specific functional cells to treat OA, the functional cells are attacked. Functional cells become attackers, similar to arrows, when their cell membranes or extracellular vesicles are modified into nanomaterials to deliver drugs for OA treatment. An increasing number of studies have been conducted on nanomaterial-based DDS-targeted functional cells for the treatment of OA, but none has summarized the corresponding research progress and mechanism of action. In this review, the related references on the treatment of osteoarthritis with nanomaterial-based DDSs targeting functional cells have been included, and how a variety of functional cells can be engineered into nanomaterial-based DDSs serving as targets or arrows to treat OA has been summarised for the first time, providing a new idea and method for the targeted treatment of OA.

Development of quality indicators for hand osteoarthritis care - Results from an European consensus study

Background

People with hand osteoarthritis (OA) often have poor access to recommended treatments. To enhance care quality, quality indicators (QIs) based on clinical recommendations are essential. Current QI sets, like the Osteoarthritis Quality Indicator Questionnaire (OA-QI v.2), primarily address hip- and knee OA, and not hand OA.

Objectives

To adapt the OA-QI v.2 for assessing patient-reported quality of hand OA care.

Design

We used the OA-QI v.2. set as a starting point and adapted it to reflect hand OA care. A literature search was performed to identify potential QIs for hand OA following the Rand/UCLA Appropriateness method. A European expert panel, comprising researchers, clinicians, and patient research partners, participated in online meetings to discuss adaptation and suggest new QIs based on treatment recommendations for hand OA, and anonymously rated each suggested QI regarding its importance, validity, usefulness, and feasibility. Consensus was defined by predefined rating cut-off scores. The adapted questionnaire was translated from English into Norwegian. Cognitive debriefing interviews with Norwegian and UK hand OA patients were conducted to ensure clarity.

Results

Our initial literature search provided 1670 articles, with none describing relevant QIs. After three voting rounds, sixteen QI items reached consensus, reflecting current hand OA care standards. Items were generally well understood, requiring only minor clarity amendments after patient interviews (N ​= ​28).

Conclusion

The OA-QI v.2 was successfully adapted into a 16-item Hand OA-QI set ensuring alignment with international care standards for hand OA through literature review, international expert panels and patient feedback on language and layout.