Six weeks of low-dose prednisolone improved pain, function in hand OA

A 6-week course of low-dose prednisolone was associated with significant improvement in hand osteoarthritis symptoms compared with placebo, according to results of a trial presented at the EULAR Annual Congress.

“Our study provides evidence that local inflammation is a suitable target for drug treatment in hand osteoarthritis,” Féline Kroon, MD, of the department of rheumatology at Leiden University Medical Center in the Netherlands, said in a press release.

The randomized, double-blind, placebo-controlled trial included 92 patients; 46 were assigned 10 mg prednisolone or and 46 were assigned placebo, for 6 weeks. There was also a 2-week tapering scheme and 6 weeks without study medication. Kroon and colleagues assessed outcomes at 2, 4, 6, 8 and 14 weeks. Forty-two patients each arm completed the study.

Eligible participants had four or more interphalangeal joints with osteoarthritic nodes, at least one joint with swelling or erythema, at least one joint with positive power Doppler signal, synovitis of 2 or greater on ultrasound, visual analogue scale (VAS) finger pain of 30 mm or more, and flaring of 20 mm or more upon NSAID drug washout. VAS finger pain at 6 weeks served as the primary endpoint.

The researchers observed a mean change in VAS finger pain of –21.5 (SD = 21.7) in the prednisolone group and –5.2 (SD = 24.3) in the placebo group. This amounted to a mean difference between the study arms of -16.5 (95% CI, –26.1 to –6.9).

“Significant improvements in pain and function were seen in the trial, meaning prednisolone could be considered by physicians treating people suffering with hand osteoarthritis,” Kroon said.

Secondary endpoint results showed that 72% of patients in the active therapy arm and 33% of those in the placebo arm fulfilled OARSI responder criteria (OR = 5.3; P = .001).

In addition, prednisolone yielded an improvement as measured by between-group differences in a number of parameters, including Australian and Canadian Osteoarthritis Hand Index (AUSCAN) pain score (between-group difference = –3.5; P < .001); AUSCAN function (–3.7; P = .01); VAS patient global assessment (–15.4; P = .003); and synovitis (–2.5; P = .02).

The researchers noted, however, that the differences between groups disappeared after tapering. No new safety signals were reported, with mostly mild events occurring in both groups. – by Rob Volansky

Reference:
Kroon F, et al. OP0180. Presented at: EULAR Annual Congress; June 12-15, 2019; Madrid.

Disclosure: Kroon reports no relevant financial disclosures.