Short-term Benefit with Prednisolone in Hand Osteoarthritis Save

Lancet reports that prednisolone 10 mg daily for 6 weeks can effectively control the pain of hand osteoarthritis (OA), according to results from the Hand Osteoarthritis Prednisolone Efficacy (HOPE) study.

This was a double-blind, randomized, placebo-controlled trial aimed to assess the short-term effects of prednisolone in painful hand OA and synovial inflammation. Patients were required to have hand OA and signs of inflammation in their distal and proximal interphalangeal (DIP/PIP) joints and > 4 DIP/PIP osteoarthritic nodes and at least one DIP/PIP joint with soft swelling/erythema or evidence of synovitis on power Doppler ultrasound. The primary endpoint was finger pain. 

A total of 149 were screened and 112 patients were treated with either placebo or 10 mg prednisolone daily for 6 weeks, followed by a 2-week tapering scheme, and a 6-week follow-up without study medication.

By week 6 patients in the prednisolone group had significantly improved VAS pain compared to placebo (−21·5 vs. 5·2; p=0·0007).

There was one serious adverse event in the prednisolone group (a myocardial infarction) and four serious adverse events in the placebo group. 

The clinical benefits disapated with the cessation of steroid therapy suggesting that short-term treatment with low dose prednisolone may be an option for patients with a flare-up of their hand osteoarthritis.