Hand Osteoarthritis

Erosive osteoarthritis (OA) of the hands is known for its severe pain and rapid loss of function, characteristic erosions in the joints that create distinctive deformities, along with local signs of inflammation such as swelling, redness, and warmth in the finger joints.

Erosive OA symptoms, along with imaging data confirming inflammation in affected joints, make some experts view the condition as more akin to various type of inflammatory arthritis (such as rheumatoid arthritis and psoriatic arthritis) than osteoarthritis — and perhaps better treated by disease-modifying anti-rheumatic drugs (DMARDs) than current therapies, which are pretty much limited to pain relief from non-steroidal anti-inflammatory (NSAID) meds and occupational therapy.

Now, the first trial using methotrexate to treat erosive hand OA has been presented at the 2019 American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting in Atlanta.

Those hoping for quick pain relief may be disappointed, but there are reasons to be encouraged about the ability of methotrexate to slow the erosion of finger joints and encourage repair, the study showed.

The study enrolled 64 patients with erosive OA; half received 10 mg of MTX per week and half got a placebo. After three months, pain as indicated on a visual scale decreased more, on average, in those taking MTX (falling 17.5 points from 28.4 at the beginning of the study) than in those receiving the placebo (falling 8.4 points from 25.2), but the difference between the groups was not statistically significant, which means that it could have happened by chance. Likewise, MTX did not improve pain or hand function measured at 12 months.

“The study does not demonstrate superior efficacy of MTX over placebo on pain and function in subjects with erosive hand OA… It is possible that we have to treat earlier if we want to have an effect on pain,” lead author Christian Roux, told the American College of Rheumatology in a press release. Roux is head of the joint unit in the rheumatology department at Cote d’Azur University in France.

However, the study provided encouraging evidence that MTX could slow erosion in affected joints. After 12 months, X-rays and magnetic resonance imaging revealed that affected joints had eroded significantly less in the MTX group (8 percent) than in the placebo group (29 percent). The treatment also seemed to facilitate bone remodeling, a sign of repair.

“Our results show a structural effect of the treatment that facilitates bone remodeling and seems to slow the erosive structural progression of digital osteoarthritis with a seemingly more pronounced effect in patients with early lesions. I think this is a major point. The main complaint for people is the deformity linked to structural evolution in this disease,” says Dr. Roux. “Our study’s results should encourage new studies to be conducted.”

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