Topical medications are strongly preferred over pills for hand OA because they deliver medicine directly to the finger joints without passing heavily through your stomach and kidneys.

• Topical NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): This is the gold-standard initial drug therapy. Diclofenac 1% gel (Voltaren, available over-the-counter or via prescription) is applied directly to the painful finger joints 4 times a day. It reduces localized inflammation and pain as effectively as oral pills but with a fraction of the systemic absorption.
• Topical Capsaicin: Derived from chili peppers, capsaicin cream depletes “Substance P” (a pain transmitter in the nerves). It must be applied consistently 3–4 times daily for a few weeks to become fully effective. *Tip: Apply with a glove so you don’t accidentally rub it in your eyes.*

If topical treatments don't provide enough relief, oral options may be introduced, usually for short-term use or during painful flare-ups.

• Oral NSAIDs: Prescription or over-the-counter options like Celecoxib (Celebrex), Meloxicam (Mobic), Naproxen, or Ibuprofen. Because regular use can impact blood pressure, stomach linings, and kidney function, doctors recommend the lowest effective dose for the shortest time possible.
• Acetaminophen (Tylenol): Historically a go-to, modern guidelines give it a conditional, secondary recommendation. It can help with mild, baseline pain but does not treat the underlying inflammation.

Non-drug therapies are foundational and should be paired with medication to maintain hand function and grip strength.

• Ergonomic Principles & Assistive Devices: Adapting how you use your hands is a game-changer. This means using wide-grip pens, electric jar openers, and leverage-based kitchen tools to reduce stress on the small finger joints.
• Hand Exercises: Guided by a physical or occupational therapist, specific range-of-motion and strengthening exercises help stabilize the joints. Exercises targeted at thumb-base (CMC joint) stability are especially helpful.
• Orthoses and Splints: Wearing a supportive brace or splint—especially at night or during heavy tasks—can significantly reduce pain by resting the joint. This is highly recommended for osteoarthritis at the base of the thumb.
• Thermal Therapy: Applying local heat (like a warm paraffin wax bath or holding a warm mug) relaxes stiff hand muscles and joints in the morning. Cold packs are better after a long day of manual work if the joints feel hot or swollen.

If conservative options fail and the pain severely impacts daily life:

• Intra-articular Corticosteroid Injections: A doctor can inject a steroid directly into a specific, highly painful finger joint. This provides temporary, potent relief from severe inflammation, though it is usually limited to a few times a year per joint.
• Surgery: As a last resort for severe, bone-on-bone pain that doesn't respond to anything else, an orthopedic hand surgeon may discuss joint fusion (arthrodesis) to eliminate pain by locking the joint, or joint replacement (arthroplasty) to preserve movement.

> Note on alternative treatments: Popular supplements like glucosamine and chondroitin, as well as therapies like hydroxychloroquine, are generally *not* recommended by modern ACR/EULAR guidelines for hand osteoarthritis due to a lack of clear clinical evidence showing they outperform placebos.

Here are four safe, gentle exercises specifically recommended by hand therapists to reduce stiffness, improve flexibility, and strengthen the muscles surrounding the finger joints.

Tips before you start:

• Warm up first: Doing these exercises after warming your hands (e.g., in a bowl of warm water or after a paraffin wax bath) makes the joints more pliable and less painful to move.
• Respect pain: You should feel a gentle stretch, but never sharp or worsening pain. Move slowly and smoothly.

This helps lubricate the finger joints and maintains your ability to grip objects.

1. Hold your hand up straight, as if you are going to wave.
2. Slowly bend your fingers inward to form a loose fist. Do not squeeze tightly; keep it relaxed.
3. Place your thumb gently across the outside of your fingers.
4. Hold for 2 to 5 seconds, then slowly unfold your fingers until they are straight again.
5. Repeat 10 times with each hand.

This exercise specifically targets the middle (PIP) and end (DIP) joints of the fingers, which are the most common areas hit by osteoarthritis.

1. Hold your hand out straight with your fingers close together.
2. Bend the top two knuckles of your fingers downward, keeping your main knuckles (where your fingers meet your hand) completely straight. Your hand will look like a claw or a hook.
3. Hold the stretch for 5 seconds.
4. Slowly straighten your fingers back out.
5. Repeat 10 times.

This exercise strengthens the muscles on the back of your hand, helping to balance out the gripping muscles and support the joints.

1. Place your hand flat on a table, palm down, with your fingers spread slightly apart.
2. Starting with your thumb, slowly lift it straight up off the table as high as is comfortable.
3. Hold for 2 seconds, then lower it back down.
4. Move to your index finger, lift it, hold, and lower.
5. Repeat this sequence for each finger, going down the line. Do the full sequence 3 to 5 times on each hand.

Because the base of the thumb is highly prone to painful osteoarthritis, preserving its mobility is crucial for tasks like turning keys or opening jars.

1. Hold your hand out straight.
2. Slowly curve your thumb and your index finger inward until the tips touch, forming a clean circle or “O” shape.
3. Hold for 5 seconds, feeling the stretch at the base of the thumb.
4. Straighten the fingers back out.
5. Repeat the movement by touching your thumb to your middle finger, then your ring finger, and finally your pinky finger.
6. Do this full cycle 3 times per hand.

Aim to do these once or twice a day. If your joints feel hot, swollen, or are experiencing an acute flare-up, take a break from the exercises and use cold therapy until the inflammation subsides.