MELBOURNE, Australia — One of the most common forms of arthritis, osteoarthritis (OA) occurs most frequently in the knees, hips, or hands and is the result of the breakdown and loss of essential cartilage within joints meant to protect bones. Osteoarthritis can make performing the simplest of everyday activities incredibly painful, especially hand osteoarthritis. Now, new research suggests medicinal relief may finally be on the way for OA patients dealing with hand pain.
Scientists at Monash University and Alfred Health say a pre-existing, quite affordable, drug that already treats issues including inflammatory joint conditions such as rheumatoid arthritis and psoriatic arthritis also shows serious promise as a means of alleviating osteoarthritis pain. The drug in question, methotrexate, has been in use all over the world since the 1980s and works by reducing immune system activity.
Researchers discovered methotrexate — available under brand names including Otrexup (PF), Xatmep, Trexall, and Rasuvo — reduced symptoms among people living with hand osteoarthritis. A dose of 20mg administered orally over a six-month period displayed a “moderate effect” in the reduction of pain and stiffness among patients with symptomatic hand OA.
Osteoarthritis of the hand is an especially debilitating form of arthritis because it usually causes both intense pain and altered hand functioning, making it much harder for patients to perform simple daily activities like dressing and eating. In other words, hand OA can significantly reduce one’s quality of life. Hand OA is far from rare; roughly one in two women and one in four men will develop hand OA symptoms by the age of 85. About half of those individuals have inflamed joints, which can be quite painful and associated with significant joint damage. Unfortunately, no effective medications exist today for hand OA.
Senior study author Professor Flavia Cicuttini, who heads Monash University’s Musculoskeletal Unit and is The Alfred’s Head of Rheumatology, adds this study identified the role of inflammation in hand OA, as well as the potential benefit of targeting patients living with painful hand OA.
“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 says in a media release. “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.”
According to Prof. Cicuttini, among patients with both hand OA and inflammation, the effects of methotrexate were present after about three months – and by six months, it was very clear the approach worked.
“At that time patients and their doctors can decide whether to continue or stop it,” she notes. “This is very similar to what we currently do with other forms of inflammatory arthritis.”
This NHMRC-funded randomized, double-blind, placebo-controlled trial encompassing 97 people analyzed if 20mg of methotrexate weekly would reduce pain and improve function in comparison to placebos in patients with symptomatic hand OA and synovitis (inflammation) over the course of six months.
The research team recruited studied patients with hand OA and MRI-detected inflammation from Melbourne, Hobart, Adelaide, and Perth. Prof. Cicuttini adds these findings could provide relief for people with hand OA inflammation, which is particularly common in women as they experience menopause.
“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,” Cicuttini concludes.
Moving forward, Prof. Cicuttini plans on conducting an extension trial aimed at addressing these questions. More specifically, researchers want to know if methotrexate can help women who develop hand OA around menopause and have severe pain and joint damage.
The study is published in The Lancet.
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