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.
Highlights
Thumb-base osteoarthritis (TBOA) is a highly prevalent condition affecting middle-aged and older people; the condition increases with age, is more common in women— post-menopausal—and it is often bilateral (Dahaghin et al, 2005; Haugen et al, 2011; Kloppenburg et al, 2017).The prevalence of symptomatic TBOA among people aged >50 years was estimated from 5 to 7%, while the prevalence of radiographic TBOA is higher, ranging from 45 to 60% (Sodha et al, 2005; Sonne-Holm and Jacobsen, 2006).The main symptoms of TBOA are pain, localized to the base of the thumb, stiffness, tenderness and loss of range of motion
The search strategy was applied to the following bibliographic databases: Cochrane Library, PubMed, MEDLINE, EMBASE, Web of Science, and Scopus, using the terms “thumb-base joint osteoarthritis,” “trapezio-metacarpal joint osteoarthritis,” “first carpo-metacarpal joint osteoarthritis,” “rizoartrhosis” in combination with “intra-articular injections,” “injection-based therapy,” “steroid injections,” “hyaluronic acid injections,” “platelet-rich plasma injections,” and “prolotherapy.” Additional articles were identified by searching bibliographies of each paper
We identified 38 assessable studies, six analyzing the effect of IA injections of corticosteroids, 20 evaluating the effects of IA hyaluronic acid, of whom seven in comparison to steroids, five dealing with IA injections of platelet-rich plasma (PRP) and the remaining seven exploring new emerging IA therapy
Summary
Thumb-base osteoarthritis (TBOA) is a highly prevalent condition affecting middle-aged and older people; the condition increases with age, is more common in women— post-menopausal—and it is often bilateral (Dahaghin et al, 2005; Haugen et al, 2011; Kloppenburg et al, 2017).The prevalence of symptomatic TBOA among people aged >50 years was estimated from 5 to 7%, while the prevalence of radiographic TBOA is higher, ranging from 45 to 60% (Sodha et al, 2005; Sonne-Holm and Jacobsen, 2006).The main symptoms of TBOA are pain, localized to the base of the thumb, stiffness, tenderness and loss of range of motion. Thumb-base osteoarthritis (TBOA) is a highly prevalent condition affecting middle-aged and older people; the condition increases with age, is more common in women— post-menopausal—and it is often bilateral (Dahaghin et al, 2005; Haugen et al, 2011; Kloppenburg et al, 2017). The prevalence of symptomatic TBOA among people aged >50 years was estimated from 5 to 7%, while the prevalence of radiographic TBOA is higher, ranging from 45 to 60% (Sodha et al, 2005; Sonne-Holm and Jacobsen, 2006). The main symptoms of TBOA are pain, localized to the base of the thumb, stiffness, tenderness and loss of range of motion. Patients with concomitant osteoarthritis (OA) of the interphalangeal (IP) joints and TBOA complain of more pain, functional disability, and reduced quality of life (Bijsterbosch et al, 2010; Tenti et al, 2020)
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