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Hand osteoarthritis — SCE Rheumatology MCQ

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ModerateOsteoarthritis and soft tissue rheumatologyHand osteoarthritisSCE Rheumatology

A 64-year-old woman has activity-related pain and bony enlargement affecting several distal interphalangeal joints, with reduced grip strength. Morning stiffness lasts less than 10 minutes, and there is no clinical synovitis. Renal function is normal, and she has not previously received treatment for hand osteoarthritis. What is the most appropriate initial management plan?

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Correct answer: E — Use a topical NSAID with a tailored hand exercise programme

The correct answer is E. Her brief stiffness, DIP bony enlargement and absence of synovitis support non-inflammatory hand osteoarthritis. NICE recommends tailored therapeutic exercise for all people with osteoarthritis and advises considering a topical NSAID for non-knee joints; EULAR hand-specific guidance likewise prioritises hand exercises and topical NSAIDs. Oral naproxen is reserved for inadequate response to, or unsuitability of, topical treatment and requires toxicity assessment despite normal renal function. Hydroxychloroquine has no disease-modifying role in hand osteoarthritis, and long-term systemic glucocorticoids provide no appropriate benefit while causing substantial harm. Routine continuous immobilisation may worsen stiffness and function; splinting is reserved for selected biomechanical indications rather than all DIP joints.

Reference: National Institute for Health and Care Excellence. NG226, Osteoarthritis in over 16s: diagnosis and management, sections 1.3.1 and 1.4.1–1.4.4, 2022 (updated 2023). https://www.nice.org.uk/guidance/ng226/chapter/recommendations