Research raises questions over the relevance of current guidelines on treating hand osteoarthritis
Taking steroids and painkillers by mouth are much more likely to be effective in tackling the symptoms of hand osteoarthritis than joint injections, according a pooled data analysis of the evidence that is published today (28 September) in the open access journal RMD Open.
Indeed, the authors, led by Anna Døssing from the Bispebjerg and Frederiksberg Hospital at the University of Copenhagen and the Parker Institute in Copenhagen, found that joint injections were no more effective than placebos, while the effectiveness of topical creams and gels were uncertain.
In response, they issued a call for a review of the evidence supporting current recommendations on joint injections for hand osteoarthritis, which affects around one woman in six and one man in 12 over the age of 40.
Dr Døssing and her colleagues’ study focused on 72 comparative clinical trials published up to 2021, involving 7,609 participants and 29 pharmacological interventions provided over an average period of three months. A total of 60 trials, involving 5,246 participants, looked specifically at pain and were included in a pooled data analysis.
The results of this showed that non-steroidal anti-inflammatories (NSAIDs) and steroid tablets were better than placebo, with the record of steroid tablets proving slightly better than standard painkillers.
The effectiveness of topical creams and gels wasn’t clear but joint injections of hyaluronate (a type of therapeutic lubricant) or steroids, and hydroxychloroquine tablets (a drug used to treat arthritis) were no better than placebo, the international research team found.
These findings raise questions about the evidence supporting the current treatment recommendation for intra-articular therapies and emphasise the need for future large scale trials with rigorous methodology ... [Anna Døssing et al]
NSAID and steroid tablets performed well in reducing pain, improving physical function, and in patient feedback. But while the analysis points to the safety of both steroid and NSAID tablets, the researchers acknowledge that they only assessed treatment withdrawals due to side effects and not long-term safety.
Most of the trial participants were women (85) with an average age of 62. And most were of White ethnicity, so potentially limiting the generalisability of the findings, acknowledge the researchers. Meanwhile, the quality of the included studies varied, with two thirds (48) at high risk of bias.
Challenge to existing clinical guidelines
While the findings on joint injections echo those of previous pooled data analyses, they contradict the recommendations of existing clinical guidelines, Dr Døssing and her colleagues conclude.
‘These findings raise questions about the evidence supporting the current treatment recommendation for intra-articular therapies and emphasise the need for future large scale trials with rigorous methodology to establish the efficacy of promising interventions such as topical NSAIDs.’
They add: ‘Many pharmacological treatments for hand OA [osteoarthritis] 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. Current intra-articular therapies are ineffective for thumb OA.’
Osteoarthritis results from the wearing away of the protective cartilage on the ends of bones, causing pain, swelling and impaired joint mobility. While any joint can be affected, it’s most commonly found in the knees, hips, and hands.
Various forms of medical treatment are available, the evidence for some has thus far been contradictory, while new evidence has emerged for others.
To access the full version of the article – titled Comparative effectiveness of pharmacological interventions for hand osteoarthritis: a systematic review and network meta-analysis of randomised trials doi: 10.1136/rmdopen-2023-003030 – click
Author: Ian A McMillan