Medicine Matters rheumatology

We know that hand osteoarthritis is a very prevalent disease that is associated with a high disease burden. And from previous studies, we had learned that inflammation in the hand joints is often present in patients with hand osteoarthritis, and that is also associated with more pain and also with radiographic disease progression, so over the long term. And that is why we designed the HOPE study in which we investigated whether suppressing this inflammation using glucocorticoids may have an effect on the patient's symptoms.

So we did a randomized double blind placebo controlled trial in which we included 92 patients with hand osteoarthritis, who had to have pain in the hand joints and also signs of inflammation, which we checked with ultrasound. And then they were randomized one to one to either receive prednisone 10 milligrams for six weeks or placebo, and then the treatment after six weeks was tapered off in two weeks. And then there were six weeks that both groups were followed up without any medication use. And our main outcome was the pain in the hand joints as measured on a visual analog scale of zero to 100.

What we found was that in the primary outcome measure was the pain that the group who received prednisone after six weeks indeed had less pain than the patients who were in the placebo group. And we actually saw consistently the same findings in other secondary outcome measures. For example, the OMERACT-OARSI responder criteria, where there were 72% responders in the prednisone group compared to only 33 responders in the placebo group. But also, function and quality of life improved.

And we also did measures of imaging measures with the ultrasound and MRI to see whether inflammation also decreased when we gave the patients prednisone. And we did saw that the signs of inflammation decreased after six weeks of prednisone 10 milligrams. But then what we also saw was, after tapering the drug, the between group differences that we had seen at six weeks disappeared again. So the patients resumed their baseline values again.

If you would have treated for a longer time, well, we don't really know. Of course, what will happen, we can't-- it's hard to say whether we had already found them the maximum relief of symptoms or whether, if you would give them this for a longer period of time, symptoms would decrease even more. Or maybe after-- and then after tapering, it would not reoccur again. It's hard to say.

But on the other hand, we do feel that we have to be careful with long term prescription of glucocorticoids. As we know, it can have a lot of side effects, especially if you give it for prolonged periods of time. So at this point, we wouldn't encourage a long term prescription. We can only say we have efficacy data for a short course of prednisone with which we can help patients get through a flare. But for a long term, it still needs further study.

I think clinicians can take away from this study that prednisone 10 milligrams for six weeks can be a treatment option for patients with hand osteoarthritis who experience a flare of their disease, which is often-- which we often see with a lot of pain and also inflammation of hand joints. And I think that's also essential that you choose the right patient group to treat this with, and that you can help these patients get through their flare.