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Hand OA Splinting — SCE Rheumatology MCQ

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EasyOsteoarthritisHand OA SplintingSCE Rheumatology

A 65-year-old man has painful, deforming distal interphalangeal joint osteoarthritis with an extension lag causing abnormal biomechanical loading. Education, joint-protection advice, therapeutic hand exercises and a topical NSAID have not provided adequate relief. Hand-therapy assessment suggests that an aid could improve movement and function. Which additional conservative treatment is most appropriate?

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Correct answer: D — A custom thermoplastic DIP gutter splint worn at night

The best answer is **A: a custom thermoplastic DIP gutter splint worn at night**. This patient has painful, deforming DIP osteoarthritis with extension lag and abnormal biomechanical loading despite therapeutic exercise, fitting NICE criteria for selective use of a splint. A UK clinical study found that night-time custom DIP splinting reduced pain and improved extension lag without increasing stiffness. Splints should not be offered routinely to everyone with osteoarthritis, so the mechanical and functional features in the stem are important. Methotrexate and biological DMARDs are not recommended for hand osteoarthritis because it is not a disease-modifying inflammatory arthritis. Colchicine has no established routine role. NICE advises against intra-articular hyaluronan for osteoarthritis.

Reference: NICE, Osteoarthritis in over 16s: diagnosis and management (NG226), section 1.3.11 Devices, 2022. https://www.nice.org.uk/guidance/ng226/chapter/Recommendations