The options are very limited at this point. Analgesics such as acetaminophen and NSAIDs are sort of primarily the pharmacologic agents that are currently available. And then we use mostly conservative measures to manage osteoarthritis as well, including thermal modalities, and then sending people to occupational therapy, where they can get resting hand splints, and that sort of thing. So the idea is to just minimize symptoms, but we don't have anything right now that's available that modifies structural progression. I think that the utility of those two studies is that they're sort of opening the area for looking at the treatment of inflammation for treatment of hand osteoarthritis. So I think that's the great benefit of those two studies. But I think they both have a lot of limitations to them, and I certainly wouldn't use those findings to then modify my clinical practice right now.
So if we're talking about the ADEM study, that's the methotrexate study that was quite small. And the primary outcome measure was looking at pain, not looking at structure. And, in fact, they didn't see any difference in pain. And Dr Weinblatt very nicely pointed out in his question, or in his comment, that really, they didn't meet their endpoint. And so what they found is sort of like a secondary finding, and they're sort of reporting that. And they're probably over-concluding what they can say, right? They were sort of making an implication that you can use methotrexate in the treatment of early osteoarthritis, but their study does not support that really to speak of. You would need a longer-term study that really identified people who had early osteoarthritis and then followed them longitudinally to see if there's actually a clinical benefit. Because at the end of the day, we're treating patients, right? We're not treating radiographs.
And as far as the HOPE Study, it also is quite a small study. It's only 92 people, I think. And my main concern with that study-- actually, I have a number of concerns about that study. One is that I do feel like they really worked hard to identify people who had inflammation. And I'm concerned that they are actually selecting out a group of people who have inflammatory arthritis instead of hand osteoarthritis. I did ask a question at the end of the session in regards to what efforts they made to rule out inflammatory arthritis. And so I asked if they checked CCP antibody and rheumatoid factor. And it sounds like they did rule out all those people. Like, they excluded them for having a positive CCP antibody or rheumatoid factor, and so I'm glad for that.
But there are still 30% of people who are serum-negative at the time of presentation when they have rheumatoid arthritis. And so without seeing the full length manuscript, it's a little hard to know exactly what they did to rule out inflammatory arthritis. But that's my concern, because the findings from their results really suggest that it was so perfect, right? As soon as they started treatment for prednisone, the pain went down. And as soon as they stopped, it went right up. And that's exactly what would happen in rheumatoid arthritis. And so that's my main concern is that, in fact, they may not be treating hand osteoarthritis. So I guess with greater scrutiny of the actual data, maybe I'll change my mind. But for now, I'm not really entirely convinced. And the other sort of point that was made a little bit is that this study was just for six weeks. And so what good is that, really, to give somebody a six-week treatment for hand osteoarthritis? And exactly what context would you use that in? And I'm not entirely sure. I mean, when people have arthritis, it's a long-term condition. And I think that what will end up happening is that people will become chronic prednisone users, and then there's no end game, right?
So in rheumatoid arthritis, we have sort of our DMARDs that we will switch people on to when we get them off of prednisone when they're in a lot of pain when they first get diagnosed. But there's no end game here, right? You just start them on prednisone, and then you leave them on it indefinitely, and I think that that is a concern. For the ADEM Trial, they used a very low dose of methotrexate. I'm not really entirely sure why they chose such a low dose. So when we treat people with rheumatoid arthritis, we give them, I would say the median dose of methotrexate is 15 milligrams. So it's unclear to me why they chose such a low dose of methotrexate.
So I do think that another study where they are very clear about what the outcome measures are, and if they are really convinced that these bone changes are going to be important, that then they power the study for that, and then they use higher strength of methotrexate. I think methotrexate is a wonderful medication, and it has completely changed the way that we treat rheumatoid arthritis. And so it would be wonderful if this became also a great treatment for osteoarthritis. But I would sort of wait for more definitive studies before I would make any changes in the way that I practice treating people who have hand osteoarthritis.