Hand osteoarthritis: A fresh look.

Area of Science:

• Rheumatology
• Immunology
• Pharmacology

Background:

• Hand osteoarthritis (OA) is a common condition with significant research into its imaging and therapeutic interventions.
• Imaging studies highlight the link between synovitis, subchondral edema, and joint pain in hand OA.
• Recent years have seen increased focus on understanding the inflammatory component of hand OA.

Purpose of the Study:

• To review the efficacy of recent therapeutic strategies for symptomatic hand osteoarthritis.
• To evaluate the outcomes of randomized controlled trials (RCTs) investigating biologics and conventional disease-modifying antirheumatic drugs (DMARDs).
• To assess the role of inflammation in hand OA pathogenesis and treatment response.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) focusing on hand OA therapeutics.
• Analysis of trials evaluating anti-interleukin (IL)-1, anti-tumor necrosis factor (TNF), and anti-IL-6 agents.
• Inclusion of trials assessing conventional DMARDs like hydroxychloroquine and short-term corticosteroid use.

Main Results:

• Multiple RCTs involving biologics (anti-IL-1, anti-TNF, anti-IL-6) and hydroxychloroquine showed no significant benefit over placebo for symptomatic hand OA.
• Six RCTs evaluating biologic agents did not demonstrate superiority to placebo in symptomatic or structural efficacy.
• One positive trial indicated that 10mg oral prednisone for six weeks was effective for hand OA flares with synovitis, but this is not a long-term solution.

Conclusions:

• Current biologic and conventional DMARD therapies have been largely ineffective for managing symptomatic hand OA.
• Inflammation plays a role in symptomatic flares of hand OA, as evidenced by the positive prednisone trial.
• While short-term corticosteroid use may alleviate inflammatory flares, it is not recommended for long-term management of hand OA due to potential side effects.