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

C Y Wenham, E M Hensor, A J Grainger, R Hodgson, S Balamoody, C J Dore, P Emery, P G Conaghan

    Research output: Contribution to journalArticlepeer-review

    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.
    Original languageEnglish
    Pages (from-to)2286-94
    Number of pages2191
    JournalRheumatology (Oxford)
    Volume51
    Issue number12
    DOIs
    Publication statusPublished - 2012

    Keywords

    • 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

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