Researchers are calling for a review of current recommendations for treating osteoarthritis of the hands. Researchers at the University of Copenhagen looked at 72 studies involving 7,609 participants, 60 of which (5,246 participants) focused on pain, and found some surprising results across the 29 pharmaceutical interventions they investigated.
Among people aged 40-84, an estimated 15.9% of women and 8.2% of men have hand osteoarthritis. The joints of the hands are particularly susceptible to the disease due to the erosion of the protective cartilage at the ends of the bones, causing severe pain and disability. Although there is currently no new cure for this chronic disease, treatments include steroid injections and pills, oral and topical pain relievers, and anti-inflammatories.
Researchers found that nonsteroidal anti-inflammatory drugs (NSAIDs) and steroid pills were more effective than placebo, with steroid treatment proving to be the most effective method of pain relief. However, long-term use of steroid drugs can cause problems, increasing the risk of widespread chronic inflammation.
Most surprisingly, the study also uncovered potential problems with popular treatments being fully effective. Joint injections of hyaluronate and steroids were no better than placebo at relieving pain, with hyaluronate providing targeted lubrication to problem areas. Previous studies have raised questions about the use of these injections to treat knee arthritis.
Additionally, another common oral treatment, hydroxychloroquine, has been shown to be as effective as no medication. (Of course, the drug gained notoriety in 2020 when Donald Trump suggested it as a COVID-19 treatment).
Based on patient feedback, pain scores, and mobility measurements, NSAIDs and steroid tablets were the most effective treatments.
The analysis showed that topical ointments and gels were not significantly effective. The researchers note that while their study has limitations, they believe it calls for new, thorough clinical trials to better evaluate arthritis treatments. Especially if one of the first-line treatments -- joint injections -- may not be as effective as widely believed.
"These findings call into question the evidence supporting current recommendations for intra-articular therapy and highlight the need for future large-scale trials with rigorous methods to determine the efficacy of promising interventions such as topical NSAIDs," the researchers said.
"There are many pharmacological treatments for hand (osteoarthritis) OA pain, most of which have no proven efficacy. For hand OA, oral NSAIDs and oral corticosteroids appear to be effective, while 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 RMDOpen.