A study led by Monash University and Alfred Health suggests that an affordable existing drug could offer relief for individuals suffering from painful hand osteoarthritis. This medication, methotrexate, has been widely utilized since the early 1980s to effectively treat inflammatory joint conditions like rheumatoid arthritis and psoriatic arthritis. The research, published in The Lancet, demonstrates that a weekly oral dose of 20mg over six months had a moderate impact in reducing pain and stiffness in patients with symptomatic hand osteoarthritis.
Hand osteoarthritis is a debilitating condition causing pain and impairing daily activities like dressing and eating. It can significantly diminish quality of life, affecting roughly one in two women and one in four men by the age of 85. About half of these individuals will experience inflamed joints, leading to pain and significant joint damage. Despite its high prevalence and the burden it imposes, there have been no effective medications until now.
Professor Flavia Cicuttini, the senior author and head of Monash University’s Musculoskeletal Unit and The Alfred’s Head of Rheumatology, emphasized the study’s identification of inflammation’s role in hand osteoarthritis and the potential benefit of targeting patients experiencing this condition.
“In our study, as with most studies of osteoarthritis, both the placebo group and methotrexate groups’ pain improved in the first month or so,” Professor Cicuttini explained. “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 findings, the use of methotrexate may be considered in managing hand osteoarthritis with an inflammatory pattern. This offers clinicians a treatment option for this group, which tends to experience more joint damage.
Professor Cicuttini noted that in patients with hand osteoarthritis and inflammation, the effects of methotrexate were noticeable at around three months, becoming very clear by six months. At this point, patients and their doctors can decide whether to continue or stop it, mirroring the approach taken with other forms of inflammatory arthritis.
The study, funded by the NHMRC, involved a randomized, double-blind, placebo-controlled trial of 97 individuals. It assessed whether a weekly dosage of 20 mg of methotrexate reduced pain and improved function compared to a placebo in patients with symptomatic hand osteoarthritis and synovitis (inflammation) over six months. Participants with hand osteoarthritis and MRI-detected inflammation were recruited from Melbourne, Hobart, Adelaide, and Perth.
Professor Cicuttini emphasized the potential relief this could bring to individuals with hand osteoarthritis inflammation, which is particularly common in women going through menopause. She also highlighted the need for further trials to establish whether the effects of methotrexate extend beyond six months, the optimal duration of treatment, and whether it reduces joint damage in patients with hand osteoarthritis and associated inflammation.
Professor Cicuttini intends to conduct an extension trial to address these questions, especially focusing on whether women who develop hand osteoarthritis around menopause, often experiencing severe pain and joint damage, may benefit from this treatment.
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