Methotrexate Controls Joint Damage in Hand Osteoarthritis, Small Study Shows

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The first-ever study designed to assess the effectiveness of methotrexate on hand osteoarthritis finds that while the treatment did not demonstrate superior efficacy over placebo on pain or function, it did significantly reduce the progression of joint damage.

"Our results show a structural effect of the treatment that facilitates bone remodeling and seems to slow the erosive structural progression of digital osteoarthritis with a seemingly more pronounced effect in patients with early lesions. I think this is a major point. The main complaint for people is the deformity linked to structural evolution in this disease," according to Prof. Christian Roux, head of the joint unit in rheumatology at Cote d’Azur University in France, and the study’s lead author. Dr. Roux presented the findings earlier this month at the American College of Rheumatology annual meeting.

Erosive hand osteoarthritis is characterized by bone erosion and remodeling, which suggests pro-inflammatory cytokines are active. Inflammation of the joints in osteoarthritis patients may suggests a similarity to inflammatory rheumatism, such as rheumatoid arthritis and psoriatic arthritis.

This was a year-long prospective, monocentric, randomized, double-blind, placebo-controlled study of patients with erosive osteoarthritis of the hand. The study included 64 patients who were split into two groups:  placebo and a treatment group receiving 10 mg per week of methotrexate.

The study’s primary endpoint was a reduction in pain at three and 12 months. The secondary endpoint included a reduction in pain and the progression as demonstrated by magnetic resonance imaging (MRI) at 12 months. The VAS pain score was 17.5 (from 28.4) compared to 8.4 (from 25.2) for the placebo group.

Related:  "Treatment Guidelines for Hand Osteoarthritis"

“The study did not demonstrate superior efficacy of methotrexate over placebo on pain and function in subjects with erosive hand osteoarthritis. It did significantly reduce joint damage progression compared to placebo and seems to facilitate bone remodeling," Dr. Roux said in a written statement. “It is possible that we have to treat earlier if we want to have an effect on pain. However, our results show a structural effect of the treatment that facilitates bone remodeling and seems to slow the erosive structural progression of digital osteoarthritis with a seemingly more pronounced effect in patients with early lesions. I think this is a major point. The main complaint for people is the deformity linked to structural evolution in this disease.”

Osteoarthritis is a disease of the entire joint, involving the cartilage, joint lining, ligaments, and bone characterized by breakdown of the cartilage, bony changes of the joints, deterioration of tendons and ligaments, and various degrees of inflammation of the joint lining.

REFERENCE:  ABSTRACT NUMBER: 1759:  "Methotrexate in Patients with Hand Erosive Osteoarthritis Refractory to Usual Treatments: A Randomized, Double-blind, Placebo-controlled Trial." 2019 ACR/ARP Annual Meeting