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Low-Dose Prednisolone Improves Symptoms Related to Hand Osteoarthritis
Short-term, low-dose prednisolone can improve pain-related symptoms and inflammation caused by hand osteoarthritis (OA), according to a new study presented at the Annual European Congress of Rheumatology. The findings suggest local inflammation may be a target for drug treatment in this patient population.
Therapeutic options for hand OA are limited to topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs). The glucocorticoid prednisolone is not recommended for use in hand OA due to a lack of evidence of effectiveness.
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For the double-blinded, placebo-controlled trial, the researchers randomly assigned 92 individuals with visual analogue scale (VAS) finger pain of at least 30 mm and flaring of at least 20 mm upon NSAID washout to 10 mg prednisolone daily for 6 weeks (n=46) or placebo (n=46), followed by a 2-week tapering scheme and 6 weeks without the study medication.
VAS finger pain at 6 weeks served as the primary endpoint in intention-to-treat analysis. Secondary clinical endpoints included fulfilled criteria of the Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI), Functional Index for Hand Osteoarthritis (FIHOA), and VAS patient global assessment, among other criteria.
A total of 42 participants in each group completed the study.
On average, the change in VAS finger pain from baseline to week 6 was greater in the prednisolone group (-21.5), which corresponded with improved pain, than in the placebo group (-5.2), which indicated less improvement.
At 6 weeks, 33 participants in the prednisolone group (odds ratio, 5.3; 95% CI, 2-13.6) had fulfilled OMERACT-OARSI criteria, an indication of response to treatment by improved pain or function, compared with 15 participants in the placebo group.
Ultrasonography showed improvement in synovitis at 6 weeks in the prednisolone group compared with the placebo group. However, no difference in synovitis was observed with power Doppler signal.
No between-group differences were observed after tapering. Most adverse events were mild and comparable between the groups.
“Our study provides evidence that local inflammation is a suitable target for drug treatment in hand osteoarthritis,” said lead author Féline Kroon, MD, from the Department of Rheumatology, Leiden University Medical Center, the Netherlands. “Significant improvements in pain and function were seen in the trial meaning prednisolone could be considered by physicians treating people suffering with hand osteoarthritis.”
—Melinda Stevens
References:
- 1) Kroon F, Kortekaas M, Boonen A, et al. Low-dose prednisolone in patients with hand osteoarthritis (HOPE): results from a randomised double-blind placebo-controlled trial [EULAR OP0180]. Ann Rheum Dis. 2019;78(suppl 2):A165. https://scientific.sparx-ip.net/archiveeular/index.cfm?searchfor=OP0180&view=1&c=a&item=2019OP0180. Accessed June 12, 2019.
- 2) Low-dose prednisolone significantly improves pain symptoms and function in hand osteoarthritis [press release]. Madrid, Spain: Annual European Congress of Rheumatology; June 12, 2019. https://www.eular.org/sysModules/obxContent/files/www.eular.2015/1_42291DEB-50E5-49AE-5726D0FAAA83A7D4/01_abstract_op0180_prednisolone_in_hand_oa_final.pdf. Accessed June 12, 2019.
