Call to revise hand arthritis treatments due to efficacy concerns

Researchers have called for a review of current recommendations for treatment of hand osteoarthritis, after a broad study revealed that injections were shown to be as effective as a placebo in relieving pain. Looking at 72 studies involving 7,609 participants, with 60 (5,246 participants) focused on pain, University of Copenhagen researchers found some surprising results among the 29 pharmacological interventions investigated.

Hand osteoarthritis affects an estimated 15.9% of women and 8.2% of men aged 40-84. Caused by the erosion of protective cartilage at the end of bones, hand joints are particularly prone to the condition, which can cause significant pain and disability. While there is no cure, despite research into new ways to tackle the chronic condition, treatments range from steroid injections and tablets, to oral and topical painkillers and anti-inflammatory medicines.

The researchers found that non-steroidal anti-inflammatories (NSAIDs) and steroid tablets were more effective than placebos, with steroid treatment proving the most effective for combatting pain. However, long-term steroidal use is problematic, raising the risk of developing broad chronic inflammation conditions.

Most surprisingly, though, the study turned up potential issues with how popular treatments are working across the board. Joint injections of hyaluronate, which provide targeted lubrication to the problem area, and of steroids, were no better than placebos in relieving pain. Previously, studies have questioned the use of these injections for knee joint arthritis.

What’s more, another common oral treatment, hydroxychloroquine, which works to counter the body’s natural inflammation responses, also proved as effective as no drug at all. (The drug, of course, gained infamy in 2020 when Donald Trump suggested it as a COVID-19 treatment.)

Looking at patient feedback, pain scores and mobility measurements, NSAIDs and steroid tablets were the most effective treatments.

The analysis didn’t turn up any conclusive significant results for topical cream and gel efficacy.

Researchers point out that while there were limitations to their study, they believe it calls for new, thorough clinical trials to better assess arthritis treatment. Especially if one of the front-line responses – joint injections – may not be as effective as they are widely considered to be.

“These findings raise questions about the evidence supporting the current treatment recommendation for intra-articular therapies and emphasize the need for future large-scale trials with rigorous methodology to establish the efficacy of promising interventions such as topical NSAIDs,” the researchers said.

“Many pharmacological treatments for hand [osteoarthritis] OA pain are available, of which most have no proven efficacy. For hand OA, oral NSAIDs and oral glucocorticoids appear effective, whereas the efficacy of topical NSAIDs remains questionable," they added. "Current intra-articular therapies are ineffective for thumb OA.”

The research was published in the journal RMD Open.

Source: University of Copenhagen via Scimex