Methotrexate may be an effective treatment

An elderly person holds their hand describing the pain experienced with osteoarthritis. Share on Pinterest
A low-cost, common drug may help improve pain caused by osteoarthritis. Westend61/Getty Images
  • Osteoarthritis of the hands is a disease that causes pain and swelling in the joints, making it difficult for people to carry out daily life.
  • Research is ongoing on how best to treat osteoarthritis of the hands.
  • Data from a recent study found that methotrexate, a common drug used to treat other types of arthritis, may help treat osteoarthritis and synovial inflammation in the hands.

People use their hands every day to complete tasks and live their lives. When the joints in the hand become stiff and difficult to move, it becomes weak and has difficulty functioning. This condition may occur in people with osteoarthritis of the hands. Researchers are interested in understanding the most effective treatment options for people with hand osteoarthritis.

recent study Published in lancet The drug methotrexate was studied for its effectiveness in treating osteoarthritis of the hand.

The study found that participants who received methotrexate for more than six months experienced moderate improvements in pain.

The results suggest that methotrexate helps treat other types of arthritis, such as psoriasis or rheumatoid arthritis, and may also benefit people with osteoarthritis and inflammation of the hands.

Osteoarthritis It is a disease that affects the joints of the body. One of the most common places is on the hands. People with osteoarthritis of the hands may experience difficulty moving, joint swelling, and pain. Joint swelling or synovitis can be particularly troublesome.

PhD.Fiona E. Watt, Reader in Rheumatology, Honorary Consultant in Rheumatology, UKRI Future Leaders Fellow and member of the Osteoarthritis Research Group in the Department of Immunology and Inflammation at Imperial College London (who was not involved in this study) explains to us Medical News Today:

“Osteoarthritis of the hands is the most common form of arthritis affecting the hands, and it is often associated with some inflammation of the lining of the joints, also known as inflammation of the synovium (synovitis), although this may not always be present, Or at some point. All stages of the condition.”

pain caused by osteoarthritis

“Those whose multiple joints are affected by synovial inflammation are more likely to have noticeable symptoms, such as greater pain and stiffness in their hands. They are also more likely to suffer from progressive injury or ‘erosive’ osteoarthritis, which is associated with associated with worsening hand function over time.”
— Dr. Fiona E. Watt

Hand osteoarthritis and associated joint swelling can be difficult to manage and treat. The authors of the current study wanted to see whether the drug methotrexate could help relieve pain in people with osteoarthritis and synovitis in the hands. Methotrexate is a common treatment for other types of arthritis, such as rheumatoid arthritis.

Professor Philip Conaghan,Director of the UK NIHR Leeds Biomedical Research Center and an arthritis expert (who was also not involved in this study) explained to us motor neurons Why this drug isn’t typically considered a first-line treatment for osteoarthritis:

“Methotrexate is the (most common) drug used around the world to treat immune-mediated inflammatory arthritis such as rheumatoid arthritis or psoriatic arthritis. It has several anti-inflammatory effects. Since bone The inflammation in arthritis is not primarily driven by the immune system, so it is unclear whether methotrexate is effective in osteoarthritis.”

Study author Professor Flavia Cicuttini, Head of the Musculoskeletal Unit at Monash University and Head of Rheumatology at The Alfred Hospital, explained the difficulties of treatment options for hand osteoarthritis.

“Osteoarthritis of the hand is a disabling disease that causes pain and affects function, preventing daily activities such as dressing and eating. It can significantly reduce quality of life,” she told motor neurons.

Lack of treatments for osteoarthritis

“Currently, if a person goes to the doctor with osteoarthritis of the hand, treatment options are very limited and not very effective. Often, patients are told that there is no alternative to getting relief with paracetamol or anti-inflammatory drugs like naproxen or Celebrex Apart from the pain, there is nothing doctors can do.”
— Professor Flavia Cicuttini

The current study was conducted to understand the effectiveness of methotrexate in improving pain in patients with hand osteoarthritis and synovitis.

The study was a double-blind, randomized, placebo-controlled trial. The researchers included 97 participants in their analysis. Of these, 50 participants received methotrexate and 47 received placebo. Participants took placebo or methotrexate weekly for six months.

All participants had hand osteoarthritis and synovitis in at least one joint, confirmed by MRI. They excluded participants with other types of arthritis as well as certain medical conditions such as cancer and hepatitis B.

In addition to participating in the study, participants received typical care from a health practitioner. They take folic acid on any other days of the week when they are not taking methotrexate because this can help relieve the side effects of methotrexate.

The methotrexate group had a slightly higher body mass index than the placebo group. Otherwise, the groups are very similar.

Researchers found greater reductions in pain and stiffness in the methotrexate group compared with the placebo group.

Some adverse events were reported in both groups, possibly related to the study drug. However, overall, methotrexate was well tolerated.

“The key finding of this study is that methotrexate, a drug widely used around the world to treat conditions such as rheumatoid arthritis, can treat osteoarthritis of the hands that is associated with inflammation. Our findings “This study supports the potential role of methotrexate in the treatment of hand osteoarthritis and inflammation and provides clinicians with a safe treatment option for this common type of hand osteoarthritis.”
— Professor Flavia Cicuttini

Professor Conaghan further commented on his views on the research:

“There is a plausible mechanism for benefit in this study, and overall the study was well designed. For example, it’s good to see that people were tested if they had blood test markers for rheumatoid arthritis.” Excluded.”

The nature of this study allowed for tight control and low risk of bias. Regardless, the researchers still acknowledge some potential limitations.

First, the intervention period lasted only six months. Therefore, future studies may include longer follow-up periods. Some data were missing for some participants, indicating the need for studies with larger sample sizes. The researchers did not study how methotrexate affects structural progression.

The researchers’ research was put on hold due to the COVID-19 lockdown. They were unable to collect data on the primary outcome from some participants. They were unable to determine how methotrexate affected the number of tender and swollen joints.

Some participants may also have underestimated the effects of methotrexate. Participants were at low risk for memory bias. The study also included more women than men.

Professor Cicuttini noted that further trials are needed “to determine whether the effects of methotrexate last beyond six months, how long we need to treat patients, and whether methotrexate can reduce the risk of hand osteoarthritis and related Joint damage in patients with inflammation.”

Dr. Watts offers the following warnings about the use of methotrexate in clinical practice to treat osteoarthritis of the hand:

“There are also some practical considerations before this drug enters routine practice. Trial participants all had hand MRIs, which is not something we currently do in usual practice. MRIs are expensive and more testing may be needed Cheap alternative.”

Both Dr. Watts and Professor Conaghan noted that the use of methotrexate requires regular monitoring.

“Methotrexate is a drug that requires safety monitoring by blood tests during treatment, so before such treatments can be implemented we need to establish and fund appropriate care pathways within the NHS and other healthcare systems – which are currently not available No such form of arthritis exists. The next step will be to test whether this drug is effective in practice, either alongside or in addition to other standard treatments, which will be a very important next step,” said Dr. Watts.

“(B)Because osteoarthritis is such a common problem and methotrexate requires monitoring, including regular blood tests (which means more work for the health system), I think we need a second trial to validate the results of Wang’s study before we can identify dramatic changes in clinical practice,” Professor Conaghan said.

Finally, Professor Philip Conaghan reported that a few years ago, he presented positive results from a trial of methotrexate in the treatment of knee osteoarthritis at the OARSI World Osteoarthritis Congress. However, the full results of the study have not yet been published.

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