New treatment option for hand osteoarthritis identified
Relief could be on the way for people with painful hand osteoarthritis after a Monash University and Alfred Health-led study found that an affordable existing drug could help. Until now, no effective treatment existed.
Published in The Lancetthe article examined methotrexate, a cheap, effective treatment for inflammatory joint diseases such as rheumatoid arthritis and psoriatic arthritis. It has been widely used in Australia and worldwide since the early 1980s.
Researchers found that methotrexate reduced symptoms in people with hand osteoarthritis (OA). A weekly oral dose of 20 mg for six months had a moderate effect on reducing pain and stiffness in patients with symptomatic hand osteoarthritis.
Hand osteoarthritis is a debilitating condition that causes pain and affects function, interfering with daily activities such as dressing and eating. It can significantly reduce the quality of life. About one in two women and one in four men will experience symptoms of hand osteoarthritis by the time they turn 85.
About half have inflamed joints, which cause pain and are associated with significant joint damage. Despite the high prevalence and burden of disease, no effective medications exist.
Senior author Professor Flavia Cicuttini, head of Monash University’s Musculoskeletal Unit and head of rheumatology at The Alfred, said the study identified the role of inflammation in hand osteoarthritis and the potential benefit of targeting patients experiencing painful hand osteoarthritis.
“In our study, as in most osteoarthritis studies, pain improved in both the placebo and methotrexate groups in the first month or so,” Professor Cicuttini said.
“However, pain levels remained the same in the placebo group but continued to decrease in the methotrexate group at three and six months, while still decreasing. The pain improvement in the methotrexate group was twice as much as in the placebo group.
“Based on these results, the use of methotrexate may be considered in the treatment of hand osteoarthritis with an inflammatory pattern. This provides physicians with a treatment option for this group, which tends to sustain more joint damage.”
Professor Cicuttini said that in patients with hand osteoarthritis and inflammation, the effects of methotrexate were visible after about three months and it was very clear after six months whether it was working.
At that point, patients and their doctors can decide whether to continue or stop. This is very similar to what we are currently doing with other forms of inflammatory arthritis.”
Professor Flavia Cicuttini, Monash University
The NHMRC-funded randomized, double-blind, placebo-controlled trial of 97 people assessed whether methotrexate 20 mg weekly reduced pain and improved function compared to placebo in patients with symptomatic hand osteoarthritis and synovitis (inflammation) for six months.
Participants with hand osteoarthritis and MRI-detected inflammation were recruited from Melbourne, Hobart, Adelaide and Perth.
Professor Cicuttini said the results could provide relief for people with hand osteoarthritis, which was particularly common in women during the menopause.
“Further studies are needed to determine whether the effect of methotrexate lasts longer than six months, how long we should treat patients and whether methotrexate reduces joint damage in patients with hand osteoarthritis and associated inflammation,” she said.
Professor Cicuttini now plans to conduct a follow-up study to answer these questions, specifically whether women who develop hand osteoarthritis around menopause and often have severe pain and joint damage can benefit.
Source:
Magazine reference:
Wang, Y., et al. (2023) Methotrexate for the treatment of hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel group, double-blind, randomized, placebo-controlled trial. The Lancet. doi.org/10.1016/S0140-6736(23)01572-6.
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