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No Miracle Treatments on the Horizon, Despite New OA Guidelines Under Development
The ACR is about to preview new overall osteoarthritis guidelines, but so far there appears to be little change in the recommendations for hand osteoarthritis (OA).
Study Asked: Is There a Better Way to Control Hand OA Pain?
A small study published November 11, 2019, in The Lancet looked at the effect of low doses of prednisolone, an oral steroid, on pain and function in patients with hand osteoarthritis. “Currently, there is an unmet need for effective therapies for this disease. While several therapeutic options for hand OA are available to alleviate symptoms, the efficacy of these treatments is modest at best,” said the lead author, Féline Kroon, MD, a rheumatologist in training at Leiden University Medical Center in the Netherlands, in a press release. RELATED: 10 Hot and Cold Therapy Tips to Tame Joint Pain
Low-Dose of Drug Helps Avoid Side Effects
In the six-week trial, patients (the average age was 63; 79 percent were women) with painful hand OA and signs of synovial inflammation were divided into two groups, with half receiving 10 milligrams (mg) daily of prednisolone and the other half receiving a placebo. (Around 42 patients in each group completed the entire trial.) In the release, Dr. Kroon explained the logic. “We chose a dosage of 10 mg daily for six weeks to balance effectiveness and side effects. Glucocorticoid treatment may lead to serious complication, the risk of which increases with the dose and duration of therapy.” RELATED: Natural Ways to Ease Carpal Tunnel Pain
Subjects Who Took the Oral Steroid Reported Pain Relief, Other Improvements
The results? “We found that treatment with prednisolone led to a substantial reduction in finger pain after six weeks, almost a 40 percent improvement in the prednisolone group versus almost 10 percent improvement in the placebo group compared to baseline. In terms of function, there was a 72 percent improvement in the prednisolone group versus 33 percent in the placebo group,” reported Kroon. She added that it is unknown whether a higher dosage would have been effective, but at this moment there is no indication that the benefits of a higher dosage outweigh the higher risk of adverse events. RELATED: 13 Natural Remedies for Osteoarthritis
Study Did Not Show Improvements in Structural Damage
There was no evidence that prednisolone had any effect on improving joint damage due to disease.
Positive Effects Diminished Once Patients Were Tapered Off
When study participants went off the prednisolone, the pain came back and function diminished again to previous levels.
Caution: Prednisolone Cannot Be Safely Taken Long-Term
Prolonged exposure to prednisolone can have a range of side effects, such as hyperglycemia, hypertension, and the development of osteoporosis and its associated risk of fractures. Kroon said, “In our study we found no safety signals for a six-week course of prednisolone 10 mg daily in this patient population. Nevertheless, since this trial only provides evidence for the effectiveness of a six-week course of prednisolone 10 mg daily, and in light of the risk of complications, prescription of prednisolone for prolonged periods of time in patients with hand osteoarthritis should be discouraged.” RELATED: 8 Ways to Ease Arthritis Foot Pain
Further Study on Prednisolone for Treating Hand Osteoarthritis Is Needed
The hypothesis of this study was that inflammation plays a role in hand osteoarthritis, and that prednisolone, being a potent anti-inflammatory drug, improves signs and symptoms by suppressing this inflammation. “However, while it is possible that the observed effects are the result of decreased inflammation, we cannot rule out other mechanisms by which prednisolone may have led to these improvements. Future studies to investigate the optimal dosage and duration of treatment are warranted,” according to Kroon. Dr. Eakin points out that while the results are intriguing, pain is a very personal thing. “The placebo effect is actually quite strong in osteoarthritis, which has plagued many studies. It does complicate interpretation of data but it speaks to why studies with a small number of patients [such as this one] do need to be replicated with a broader patient base.”
