11 Nov Short Course of Low-dose Prednisolone for Painful Hand Osteoarthritis
MedicalResearch.com Interview with:
Dr. Kroon
Féline PB Kroon MD
Department of Rheumatology
Leiden University Medical Centre LUMC ·
MedicalResearch.com: What is the background for this study?
Response: Hand osteoarthritis (OA) is a prevalent joint condition that causes pain, functional disability, and decreased quality of life, for which patients frequently consult health-care providers. Symptoms usually fluctuate over time, with episodes of joint swelling and erythema. Evidence from previous studies has shown that inflammation plays an important role in the disease, being an important predictor for pain and radiographic damage progression.
Therefore, we hypothesized that inflammation could be a treatment target in OA, and we investigated this using prednisolone, a potent anti-inflammatory drug. The aim of the HOPE study was to investigate the clinical efficacy and safety of a six-week course of prednisolone 10 mg daily in patients with painful hand OA who had evidence of synovial inflammation.
MedicalResearch.com:? What are the main findings?
Response: We included 92 patients in a double-blind randomised placebo-controlled trial, and found that treatment with 10 mg prednisolone led to a substantial reduction in finger pain (primary outcome; mean difference on visual analogue scale of pain of -16.5 (95% CI -26.1 to -6.9, p=0.001)). Prednisolone was also consistently better than placebo in secondary outcome measures of pain and function, with a large difference in the proportion of OMERACT-OARSI responders (72% vs. 33%). MRI and ultrasound measures also showed signs of decreasing inflammation.
MedicalResearch.com: What should readers take away from your report?
Response: Six-week treatment with 10 mg prednisolone effectively improved signs and symptoms compared with placebo in patients with painful hand OA and signs of synovial inflammation. The results of our study provide clinicians with a new short-term treatment option for patients with hand OA who report a flare-up of their disease. However, the HOPE study only provides evidence for the effectiveness of a six-week course of 10 mg prednisolone daily, and in light of the risk of complications such as glucocorticoid-induced osteoporosis, prescription of prednisolone for prolonged periods of time in patients with hand osteoarthritis should be discouraged.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: After tapering the study medication, symptoms resumed baseline levels. It is unknown whether further improvement would have been achieved with continued treatment, or whether timely suppression of inflammation can eventually alter the disease course. Future studies to investigate the optimal dosage and duration of treatment are warranted.
Disclosures: This study was funded by the Dutch Arthritis Society, I have no disclosures.
Citation:
2019 ACR/ARP presentation:
Six-week Treatment with Low-dose Prednisolone in Patients with Painful Hand Osteoarthritis (HOPE): Results from a Randomised Double-blind Placebo-controlled Trial
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Last Updated on November 11, 2019 by Marie Benz MD FAAD