Conservative treatment of thumb base osteoarthritis: a systematic review
Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders AR, Vermeulen GM (2015) · The Journal of Hand Surgery · n=23
Study Profile
- Design
- systematic review of randomized controlled trials of nonoperative treatment of thumb base (carpometacarpal) osteoarthritis (Utrecht, Rotterdam, Hilversum, Netherlands)
- Sample size (n)
- 23
- Intervention
- Synthesis of 23 RCTs covering conservative interventions for thumb base OA including hand therapy, intra-articular steroid and hyaluronate injections, orthoses, transdermal steroids, leech therapy, and analgesics
- Comparator
- Cross-intervention comparisons varying by individual included RCT
- Primary endpoint
- Methodological quality assessment plus pain, function, and strength outcomes by intervention type
- Primary result
- Insufficient evidence to support routine use of leech therapy for thumb base OA at the time of the 2014 literature search; orthoses and intra-articular hyaluronate or steroid injections showed limited but supportive evidence; authors concluded only few high-quality studies addressed conservative treatment of trapeziometacarpal OA
- Follow-up duration
- variable across included studies, up to 7 years for orthoses
- PMID
- 25534834
Key Findings
- Systematic review of 23 RCTs of conservative treatment for thumb base osteoarthritis, including the Michalsen 2008 leech RCT
- Authors explicitly concluded insufficient evidence to justify routine use of leech therapy for thumb base OA at the time of review
- Most supportive evidence found for orthoses and intra-articular hyaluronate or steroid injections (still limited)
- Highlights persistent gap of high-quality RCTs in thumb base OA conservative care
- Provides external Dutch perspective on the Michalsen 2008 + Andereya 2008 leech-thumb evidence base
Limitations
- Search closed in May 2014 - subsequent leech trials and meta-analyses not captured
- Includes only PubMed and Embase databases - non-Western literature underrepresented
- Heterogeneity across interventions and outcomes precluded formal meta-analysis
- Recommendation against leech therapy partly based on small available sample size at the time
- No GRADE-formal evidence quality assessment
Clinical Implications
Spaans 2015 is the principal external (non-leech-investigator) systematic review of conservative treatment for thumb base OA and provides a cautious Dutch hand-surgery community perspective on the Michalsen 2008 and Andereya 2008 leech-thumb evidence base. The 'insufficient evidence' conclusion does not contradict the underlying trials but reflects the small total sample size (~62 patients across two trials) and absence of independent replication outside Germany. For US hand surgeons advising patients on conservative thumb OA options, Spaans 2015 is the most balanced external reference. Subsequent replication trials would be needed to upgrade the GRADE rating for this indication.
Related Trials
Effectiveness of leech therapy in osteoarthritis of the thumb carpometacarpal joint: a randomized controlled trial
Michalsen A, Lüdtke R, Cesur Ö, Afra D, Musial F, Baecker M, Dobos GJ (2008)
Leech therapy versus topical diclofenac for thumb carpometacarpal osteoarthritis: a randomized pilot study
Andereya S, Stanzel S, Maus U, Mueller-Rath R (2008)