A new study has found that methotrexate, a widely available and affordable drug that’s usually prescribed as a first-line treatment for rheumatoid arthritis, is effective at reducing the pain and stiffness suffered by people with hand osteoarthritis. Until now, there has been no effective treatment for the condition.
Osteoarthritis (OA) causes the cartilage in joints to thin and joint surfaces to become rougher, meaning they may not move as smoothly. Although OA can affect any joint in the body, the stiffness and pain associated with hand OA, particularly, affect a person’s ability to grasp and hold objects, dress and eat.
According to the US National Institutes of Health, there was an 82% increase in the global incidence of hand OA between 1990 and 2019. Around half of people with symptomatic hand OA have synovitis, inflammation of the membrane that lines the joint that’s associated with pain and disease progression.
A new study by researchers at Monash University and the Alfred Hospital in Australia has discovered that a readily available, affordable drug called methotrexate is effective in reducing pain and stiffness in people with symptomatic hand OA.
“In our, as with most studies of osteoarthritis, both the placebo group and the methotrexate groups’ pain improved in the first month or so,” said Flavia Cicuttini, corresponding author of the study. “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.”
Methotrexate is an immunosuppressant widely used as a first-line treatment for autoimmune and inflammatory forms of arthritis, such as rheumatoid arthritis and psoriatic arthritis. It’s been used to treat rheumatoid arthritis since the mid-1980s.
In the current study, 97 participants with hand OA complicated by synovitis, detected using MRI, received 20 mg of methotrexate or placebo orally once a week for six months. The primary outcome was pain reduction, measured using a 100-mm visual analog scale (VAS). Participants were asked to place a mark on the scale corresponding to their pain. The distance, in millimeters, from the lower end of the scale is then measured and recorded.
The mean change in VAS pain at six months was –15.2 mm in the methotrexate group and –7.7 mm in the placebo group. The researchers concluded that methotrexate had a “moderate but potentially clinically meaningful effect” on pain reduction.
“Based on these results, use of methotrexate can be considered in the management of hand osteoarthritis with an inflammatory pattern,” Cicuttini said. “This provides clinicians with a treatment option for this group, which tends to get more joint damage.”
The fact that the effect of methotrexate was present at around three months and maintained at six months means that the patient and their clinician can decide if they continue the treatment beyond six months.
“At that time, patients and their doctors can decide whether to continue or stop it,” said Cicuttini. “This is very similar to what we do with other forms of inflammatory arthritis.”
Adverse effects were seen in 62% of participants in the methotrexate group and 60% of placebo group participants. Common side effects of methotrexate include nausea, vomiting, and loss of appetite, which can be easily managed. If taken for a long time, methotrexate may cause liver damage. Also, because methotrexate decreases immune system activity, those taking it can be prone to infections.
“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 said.
The study was published in the journal The Lancet.
Source: Monash University
