Low-dose prednisolone helps relieve pain in hand osteoarthritis
Patients with painful hand osteoarthritis can finally get relief from pain with low-dose prednisolone, suggests a study presented at EULAR 2019.
The pain inflicting the joints in patients with hand osteoarthritis can make it difficult for them to move their fingers and grasp objects, thus affecting their daily function.
In the double-blind study, 92 patients (mean age 63.9 years, 79 percent women) with hand osteoarthritis defined by ACR* criteria and signs indicative of synovial inflammation were randomized 1:1 to prednisolone 10 mg daily or placebo for 6 weeks. Upon nonsteroidal anti-inflammatory drug washout, only patients showing VAS finger pain of ≥30 mm and flaring ≥20 mm were considered eligible. [EULAR 2019, abstract OP0180]
Low-dose prednisolone led to a greater improvement in the primary endpoint of finger pain at week 6 compared with placebo, as indicated by a mean VAS difference of -16.5 point between the two treatments (95 percent confidence interval [CI], -26.1 to -6.9).
Similar result was seen when pain was assessed using the Australian Canadian Osteoarthritis Hand Index (AUSCAN; mean change, -4.7 vs -1.1; p<0.001).
In addition, patients treated with prednisolone were more likely to achieve the OARSI** responder criteria at week 6 than those who received placebo (72 percent vs 33 percent, odds ratio, 5.3; p=0.001).
In terms of functional outcome, a greater improvement was also seen with prednisolone vs placebo, regardless of whether the outcome was measured on the AUSCAN functional domain (mean change, -6.5 vs -2.7; p=0.01) or FIHAO*** (mean change, -2.6 vs -0.5; p=0.03).
There were also significant differences in other outcomes measured on the VAS patient global assessment (p=0.003) and the SF-36# physical component scale (p=0.01), in favour of prednisolone.
Importantly, synovitis was significantly reduced in the prednisolone arm vs the placebo arm, based on ultrasound imaging (mean change, -2.8 vs -0.3; p=0.02).
Previous studies have found that synovial inflammation occurs commonly in hand osteoarthritis and this inflammation is the main driver of pain and a risk factor for radiographic disease progression. Although the glucocorticoid prednisolone has been used to reduce pain associated with rheumatic diseases, its used is not currently endorsed for patients with hand osteoarthritis as existing data are limited and conflicting.
“Our study provides evidence that local inflammation is a suitable target for drug treatment in hand osteoarthritis,” said lead investigator Dr Féline Kroon from Leiden University Medical Center, Leiden, the Netherlands. “Six-week treatment with low-dose oral prednisolone led to a substantial improvement of symptoms in patients with painful hand osteoarthritis and signs of inflammation.”
Signs of local inflammation presented by the study participants included ≥1 interphalangeal joints (IPJ) with erythema or soft swelling, ≥4 IPJ with osteoarthritic nodes, and ≥1 IPJ with synovitis grade ≥2 on ultrasound or positive power Doppler signal.
“Significant improvements in pain and function were seen in the trial meaning prednisolone could be considered by physicians treating people suffering with hand osteoarthritis,” said Kroon.
After 6 weeks of treatment, the patients underwent 2 weeks of steroid tapering, beyond which, all between-group differences observed during treatment disappeared.