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A common drug used to treat inflammatory joint conditions could play a role in the management of hand osteoarthritis, which currently has no effective treatment.
The study, published in The Lancet, looked at whether methotrexate, a low-cost, effective treatment for rheumatoid arthritis and psoriatic arthritis, could reduce symptoms in those with hand osteoarthritis (OA).
It found that a 20mg weekly oral dose over six months had a moderate effect in reducing pain and stiffness in patients with symptomatic hand OA.
Hand OA is a disabling condition that causes pain and affects function, impeding daily activities such as dressing and eating. It can significantly reduce quality of life. About one in two women and one in four men will experience symptoms from hand OA by the time they turn 85. About half will have inflamed joints, which cause pain and are associated with significant joint damage. Despite the high prevalence and disease burden, there are no effective medications.
New treatment option for hand osteoarthritis
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.
She added: “In our study, as with most studies of osteoarthritis, both the placebo group and methotrexate groups’ pain improved in the first month or so. 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.”
The NHMRC-funded randomised, double-blind, placebo-controlled trial of 97 people assessed whether 20mg of methotrexate weekly reduced pain and improved function compared to placebo in patients with symptomatic hand OA and synovitis (inflammation) over six months.
Participants with hand OA and MRI-detected inflammation were recruited from Melbourne, Hobart, Adelaide, and Perth.
Professor Cicuttini said: “Further trials are needed to establish whether the effect of methotrexate extends beyond six months, for how long we need to treat patients, and whether methotrexate reduces joint damage in patients with hand osteoarthritis and associated inflammation.”
Professor Cicuttini now 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.