Most hand and finger arthritis is managed without an operation. The harder question is which non-surgical treatments are worth your time. This page goes through the published guidelines one treatment at a time, and names each one by year, because the newest update changed how firmly several treatments are recommended. It ends with an honest look at where embolization sits, which is outside all of them.
If you are still working out whether your pain is osteoarthritis (OA) at all, start with hand osteoarthritis causes, symptoms and diagnosis.
The three guidelines behind this page
- ACR/Arthritis Foundation 2019. The American College of Rheumatology guideline for hand, hip and knee OA, published in full in 2020.
- ACR 2026 update. Approved by the ACR Board on September 8, 2026. So far only a summary table has been released. The full paper, with the reasoning behind each change, is not yet published.
- EULAR 2018. The European recommendations written specifically for hand OA.
The ACR grades each recommendation as strong or conditional. Strong is the firmer grade. Conditional means the evidence is less certain or the choice depends more on the person. Many hand treatments carry the conditional grade, simply because few good trials have been done in the hand.
The step order below is how this page is laid out, not an order the guidelines set. The guidelines grade each treatment separately.
Step 1: Splints and other orthoses
A splint, also called an orthosis, supports a painful joint while you use your hand. It appears in all three guidelines, though the strength has shifted.
- Base of the thumb. The 2019 ACR guideline gave thumb-base (first CMC joint) orthoses a strong recommendation. The 2026 update lists hand orthoses for thumb-base and finger joint OA as a conditional recommendation, with low certainty of evidence.
- Finger joints. Conditional in 2019 and conditional in 2026.
- Taping. The 2026 update also conditionally recommends therapeutic taping of the thumb base.
EULAR 2018 also includes orthoses, along with education and assistive devices, which are tools that make gripping and twisting easier.
A softer grade in 2026 does not mean splints stopped being useful. The summary rates the evidence as low certainty; the panel's reasoning has not been published. Splints are still recommended.
Step 2: Exercise, hand therapy and self-care
The 2026 ACR update conditionally recommends hand exercise. It also includes a good-practice statement that people whose arthritis limits use of the arm or hand should be referred to occupational therapy. A hand therapist can teach exercises, fit a splint and show you ways to protect your joints during daily tasks.
The same update conditionally recommends several things you can do at home or add alongside therapy:
- Heat or cold
- Paraffin wax baths
- Arthritis gloves
- Cognitive behavioral therapy, a structured way of coping with long-term pain
- Acupuncture
EULAR 2018 also lists education and exercises among its recommended measures.
Step 3: Topical and oral NSAIDs
NSAIDs are anti-inflammatory pain medicines. They come as gels or creams you rub on (topical) and as pills (oral).
Topical NSAIDs. This is one of the clearest changes. In 2019, the ACR gave topical NSAIDs only a conditional recommendation for the hand, citing a lack of direct evidence in hand joints and the practical problem that people wash their hands often. The 2026 update makes it a strong recommendation for both knee and hand OA. EULAR 2018 already preferred topical over systemic treatment and called topical NSAIDs the first-line choice.
Oral NSAIDs. Strongly recommended by the ACR in both 2019 and 2026. The 2026 update conditionally prefers topical over oral NSAIDs. EULAR 2018 advises oral NSAIDs for a limited duration.
Other medicines. The 2026 update conditionally recommends acetaminophen and duloxetine. It conditionally recommends against opioids.
NSAID pills are not right for everyone. Ask your doctor or pharmacist whether they fit with your other health conditions and medicines.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Embolization Guide.
Step 4: Steroid injections
A steroid (glucocorticoid) injection places anti-inflammatory medicine directly into a joint. The guidelines are cautious here:
- ACR 2019: conditional recommendation for hand OA, "given the lack of evidence specific to this anatomic location."
- ACR 2026: still conditional, with low certainty of evidence.
- EULAR 2018: injections are "generally not recommended," but can be considered for painful finger (interphalangeal) joints.
The American Academy of Orthopaedic Surgeons (AAOS) tells patients that a steroid and anesthetic injection can give relief for weeks to months. It can be repeated only a limited number of times because of possible side effects, including lightening of the skin, weakening of tendons and ligaments, damage to cartilage and infection.
What the guidelines recommend against
Knowing what to skip can save you money and months of waiting. For hand OA, the 2026 ACR update recommends:
- Strongly against: hydroxychloroquine, bisphosphonates, glucosamine and chondroitin, TNF inhibitors and IL-1 inhibitors.
- Conditionally against: hyaluronic acid (gel) injections, topical capsaicin on the hands, opioids, colchicine, vitamin D and fish oil.
Two notes on changes. The 2019 guideline was already conditionally against hyaluronic acid injections at the thumb base and against capsaicin on the hands, because of the risk of getting it in your eyes. The 2026 update is strongly against both glucosamine and chondroitin. EULAR 2018 had allowed chondroitin sulfate for symptom relief.
The 2019 ACR guideline also noted that PRP and stem cell injections had not been evaluated in hand OA, so it made no recommendation for them in the hand.
One change for erosive hand OA
Erosive hand OA is a more aggressive, inflammatory-looking form. In 2019 the ACR recommended strongly against methotrexate, because trials in erosive hand OA had shown no benefit. The 2026 update reverses direction and conditionally recommends methotrexate for erosive hand OA. The reasoning has not been published yet. This is a decision for a rheumatologist.
2019 and 2026 side by side
| Treatment for hand OA | ACR/Arthritis Foundation 2019 | ACR 2026 update (summary) |
|---|---|---|
| Thumb-base orthosis | Strong for | Conditional for |
| Finger joint orthosis | Conditional for | Conditional for |
| Topical NSAIDs | Conditional for | Strong for |
| Oral NSAIDs | Strong for | Strong for |
| Steroid injection | Conditional for | Conditional for |
| Hyaluronic acid injection | Conditional against (thumb base) | Conditional against |
| Topical capsaicin | Conditional against | Conditional against |
| Hydroxychloroquine | Strong against | Strong against |
| Methotrexate | Strong against | Conditional for, in erosive hand OA only |
| Embolization | Not mentioned | Not mentioned |
Where embolization sits
Embolization is not on this ladder. It does not appear in the 2019 ACR guideline, the 2026 ACR update or the EULAR 2018 recommendations.
It is a newer procedure in which a doctor reaches a wrist artery with a small needle or catheter and delivers a material, in most published studies a short-acting one, that slows blood flow through the abnormal small vessels around painful joints. In the three studies that state it, embolization was offered only after standard care had failed. One thumb-base study required at least three months of conservative treatment without enough relief. Another study required pain that persisted after three months of treatments such as injection, splinting, physical therapy and anti-inflammatory medicine.
The evidence is early. Five small studies, 204 patients in total, have been published. None had a comparison group and none was randomized. To give one example: a 2023 retrospective study from Taiwan followed 58 people with finger joint OA. The share counted as a clinical success on a patient-rated improvement scale was 62.1% at one month, 77.6% at three months and 63.4% at 12 months, and only 30 of the 58 were followed that long. No severe or life-threatening adverse events were reported.
Without a comparison group, results like these cannot be separated from the placebo effect or from the natural ups and downs of hand arthritis. That caution is not theoretical. In the knee, where embolization has been tested against sham procedures, reviews describe the results as mixed. A 2026 independent review called the hand data "hypothesis-generating."
Dr. David Fox evaluates patients for hand embolization when the steps above have not controlled the pain. Our hand arthritis embolization page explains the procedure, and am I a candidate covers who was and was not included in the studies. For other joints, see the embolization guide.
When non-surgical care is not enough
The National Institutes of Health describes surgery as an option when other treatments are not helping and joint damage is extensive. For the thumb base and finger joints, that can mean removing a small bone, fusing a joint or replacing it. The 2019 ACR guideline does not cover surgery, so that conversation belongs with a hand surgeon.
If you are weighing the later steps against each other, see embolization vs. injections and surgery.
Frequently Asked Questions
What is the first treatment for hand osteoarthritis?
Guidelines for hand osteoarthritis recommend topical and oral NSAIDs most firmly, alongside splints, hand exercise and occupational therapy, with steroid injections as a conditional option. The guidelines grade each treatment separately and do not set an order.
Do glucosamine and chondroitin help hand arthritis?
The 2026 ACR update is strongly against both glucosamine and chondroitin. The older EULAR 2018 recommendations had allowed chondroitin sulfate for symptom relief.
Are steroid injections recommended for hand arthritis?
Only conditionally. The ACR gave them a conditional recommendation in 2019 and again in 2026, citing limited evidence in the hand, and EULAR 2018 generally does not recommend them except to consider for painful finger joints.
Are gel (hyaluronic acid) injections recommended for thumb arthritis?
No. The 2019 ACR guideline conditionally recommended against hyaluronic acid injections at the thumb base, and the 2026 update is also conditionally against them.
Is embolization recommended by arthritis guidelines?
No. Embolization is not mentioned in the ACR 2019 guideline, the ACR 2026 update or the EULAR 2018 hand recommendations. The published evidence is five small studies without comparison groups.
Keep Reading
- Hand and Finger Arthritis Embolization in Manhattan
- Hand and Finger Osteoarthritis: Causes, Symptoms and Diagnosis
- Is Hand Arthritis Embolization Covered by Insurance?
- Is Hand Arthritis Embolization Painful? What to Expect
- Thumb Arthritis Embolization: What to Know About the Basal (CMC) Joint
- Hand Arthritis Embolization: Am I a Candidate?
- Embolization Guide: knee, heel, shoulder, elbow and hip
Sources
- American College of Rheumatology, 2026: update of recommendations for osteoarthritis of the knee, hip and hand (summary)
- Kolasinski et al., Arthritis Rheumatol, 2020: 2019 ACR/Arthritis Foundation guideline for osteoarthritis of the hand, hip and knee
- Kloppenburg et al., Ann Rheum Dis, 2019: 2018 EULAR recommendations for the management of hand osteoarthritis
- AAOS OrthoInfo: Arthritis of the Hand
- AAOS OrthoInfo: Arthritis of the Thumb
- NIAMS (National Institutes of Health): Osteoarthritis diagnosis, treatment and steps to take
- Inui et al., J Vasc Interv Radiol, 2021: intra-arterial imipenem/cilastatin for refractory thumb-base osteoarthritis (31 patients, single-arm)
- Liang et al., J Vasc Interv Radiol, 2023: intra-arterial imipenem/cilastatin for finger joint osteoarthritis pain (58 patients, retrospective)
- Kubo et al., Cardiovasc Intervent Radiol, 2023: temporary embolic injection for DIP and PIP joint osteoarthritis (92 patients, retrospective)
- Lee et al., Diagn Interv Radiol, 2024: short-term outcomes of transarterial embolization for hand osteoarthritis (9 patients, full text)
- Konduru et al., Hand (N Y), 2026: prospective analysis of transarterial embolization for thumb-base osteoarthritis (14 patients)
- Pelage et al., CVIR Endovasc, 2026: indication-stratified review of musculoskeletal embolization
- Can et al., Radiologie, 2026: review of transarterial embolization for joint pain
Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.
Living with joint or tendon pain that hasn’t improved? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether embolization is right for you. Call (212) 362-3470 or request an appointment online.
