A randomized, double-blind, placebo-controlled trial of low-dose oral prednisolone for treating painful hand osteoarthritis.

Abstract

OBJECTIVE:

Anti-inflammatory therapies are effective analgesics for OA. This study determined whether low-dose oral prednisolone (PNL) was an effective analgesic for hand OA.

METHODS:

This was a randomized, double-blind, placebo-controlled trial of people with ACR criteria hand OA and baseline hand pain visual analogue scale (VAS) of >40/100 mm. Participants received 5 mg PNL or placebo daily for 4 weeks. Pain VAS, disease activity VAS, Australian/Canadian Hand Osteoarthritis Index and joint counts were performed at baseline, 4 and 12 weeks. Primary outcome was the change in hand pain VAS at 4 weeks. Analysis of covariance was used for analysis, controlling for baseline values. To explore potential mechanism of action of PNL, non-contrast 0.2 Tesla MRI was performed on the most painful hand at baseline and 4 weeks.

RESULTS:

A total of 70 participants were recruited (57 women, mean age 61 years, mean baseline pain VAS 61.5 mm); 75% had more than one joint with definite MRI synovitis/effusion. At 4 weeks the adjusted mean reduction in pain VAS was 19.9 mm (PNL group) and 16.8 mm (placebo group) (P = 0.54). There were no statistically significant differences in VAS, Australian/Canadian Hand Osteoarthritis Index or joint counts between placebo and PNL groups at 4 or 12 weeks. A total of 20 participants in each group achieved an Outcome Measures in Rheumatology-Osteoarthritis Research Society International response. Baseline synovitis/effusion did not predict response to treatment.

CONCLUSION:

This is the first randomized controlled trial of low-dose corticosteroid alone for painful hand OA, which demonstrated that short-term low-dose oral PNL is not an effective analgesic treatment for hand OA.

TRIAL REGISTRATION:

International Standard Randomised Controlled Trial Number Register, www.isrctn.org, Trial number 99697616.

• Authors: Claire Y J Wenham, Elizabeth M A Hensor, Andrew J Grainger, Richard Hodgson, Sharon Balamoody, Caroline J Doré, Paul Emery, Philip G Conaghan
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 51 Issue 12 Pg. 2286-94 (Dec 2012) ISSN: 1462-0332 [Electronic] England
• PMID: 22956551 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Analgesics
• Anti-Inflammatory Agents
• Capsules
• Prednisolone

Topics

• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Analgesics (administration & dosage)
• Analysis of Variance
• Anti-Inflammatory Agents (administration & dosage)
• Capsules
• Double-Blind Method
• Female
• Hand
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Musculoskeletal Pain (prevention & control)
• Osteoarthritis (complications, drug therapy, pathology)
• Pain Measurement
• Prednisolone (administration & dosage)
• Synovitis (pathology)
• Treatment Outcome