Systematic review of non-surgical therapies for osteoarthritis of the hand: an update

Objective: To update our earlier systematic review which evaluated all published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA). Surgical therapies were not evaluated. Method: RCTs published between August 2004 and February 2008 were added to the original systematic review. Results: A total of 44 RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this update. Generally, these RCTs were of low quality. RCTs were weakened by a lack of consistent case definition and by a lack of standardized outcome assessments. The methods used for randomization, blinding, and allocation concealment were rarely described. The number and location of symptomatic hand joints per treatment group at baseline was usually not stated. The number and location of evaluated hand joints at the end of the study was also usually not stated. A meta-analysis could not be performed since most of the treatments studied did not have more than one identical comparison to allow pooling of the data. Conclusions: It is apparent that hand OA is a more complex area in which to study the efficacy of therapies when compared to hip and knee OA. The recently published OARSI Consensus Recommendations will improve the design and conduct of future RCTs in hand OA. (c) 2009 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.