Hand osteoarthritis (OA) is one of the most common localization of OA affecting predominantly women. The etiology seems to be multifactorial and the disease heterogeneous, comprising several clinical and radiological subsets. Hand OA includes thumb base (trapeziometarcarpal joint), metacarpophalangeal joints, distal and proximal interphalangeal joints OA. We reviewed below the prevalence, diagnosis, imaging, epidemiology, risk factors, but mostly the last discoveries in the biology and pathophysiology with particular attention to the potential role of adipokines and genetic factors. Finally, we also reviewed the different treatments currently available as well as potential future therapies.