Existing drug found to improve hand osteoarthritis symptoms
Hand OA is a disabling condition that causes pain and affects function, impeding daily activities such as dressing and eating. One in two women and one in four men will experience symptoms from hand OA by the time they turn 85, with about half of them having inflamed joints which cause pain and are associated with significant joint damage. Yet despite the high prevalence and disease burden, there are no effective medications on the market for the condition.
Researchers conducted a randomised, double-blind, placebo-controlled trial of 97 people to investigate methotrexate, a low-cost treatment for inflammatory joint conditions such as rheumatoid arthritis and psoriatic arthritis that has been widely available since the early 1980s. Participants with hand OA and synovitis (inflammation) were recruited from Melbourne, Hobart, Adelaide and Perth, with results published in The Lancet.
Senior author Professor Flavia Cicuttini, who heads Monash University’s Musculoskeletal Unit and is The Alfred’s Head of Rheumatology, said the study identified the role of inflammation in hand OA and the potential benefit of targeting patients who experience painful hand OA. The researchers found that a 20 mg weekly oral dose over six months had a moderate effect in reducing pain and stiffness in patients with symptomatic hand OA.
“In our study, as with most studies of osteoarthritis, both the placebo group and methotrexate group’s pain improved in the first month or so,” Cicuttini said.
“However, pain levels stayed the same in the placebo group but continued to decrease in the methotrexate group at three and six months, when they were still decreasing. The pain improvement in the methotrexate group was twice as much as in the placebo group.
“Based on these results, use of methotrexate can be considered in the management of hand osteoarthritis with an inflammatory pattern. This provides clinicians with a treatment option for this group, which tends to get more joint damage.”
Cicuttini said in patients with hand OA and inflammation, the effects of methotrexate were present at about three months and by six months it was very clear if it worked. “At that time, patients and their doctors can decide whether to continue or stop it,” she said. “This is very similar to what we currently do with other forms of inflammatory arthritis.”
Cicuttini said the results could provide relief for people with hand OA inflammation, which is particularly common in women as they experienced menopause. She did note, however, that further trials are needed to establish whether the effect of methotrexate extends beyond six months, for how long patients need to be treated and whether methotrexate reduces joint damage in patients with hand osteoarthritis and associated inflammation.
Cicuttini plans to conduct an extension trial to address these questions, in particular whether women who develop hand OA around menopause and often have severe pain and joint damage may benefit.
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