Hand osteoarthritis is a painful and disabling condition which effects about one in two women and one in four men by age 85, but relief could be on the way.
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Until now there has been no effective treatment for hand osteoarthritis which can significantly reduce quality of life by making daily activities such as dressing and eating difficult. About half of those affected have painful inflamed joints and joint damage.
However, a Monash University and Alfred Health-led study has found an affordable, existing drug can help.
The research study involved methotrexate, a low-cost, effective treatment for inflammatory joint conditions such as rheumatoid arthritis and psoriatic arthritis. It has been widely used in Australia and globally since the early 1980s.
There were 95 people in the trial recruited from Melbourne, Hobart, Adelaide and Perth..
Researchers found that methotrexate reduced symptoms in those with hand osteoarthritis - with a 20mg weekly oral dose over six months having a moderate effect in reducing pain and stiffness in patients.
Senior author Professor Flavia Cicuttini, who heads Monash University's Musculoskeletal Unit and is The Alfred's Head of Rheumatology, said the study identified the role of inflammation in hand OA and the potential benefit of targeting patients who experience painful hand OA.
"In our study, as with most studies of osteoarthritis, both the placebo group and methotrexate groups' pain improved in the first month or so," Professor Cicuttini said.
"However, pain levels stayed the same in the placebo group but continued to decrease in the methotrexate group at three and six months, when they were still decreasing. The pain improvement in the methotrexate group was twice as much as in the placebo group."
Professor Cicuttini said the results could provide relief for people with hand OA inflammation, which was particularly common in women as they experienced menopause.
"Further trials are needed to establish whether the effect of methotrexate extends beyond six months, for how long we need to treat patients, and whether methotrexate reduces joint damage in patients with hand osteoarthritis and associated inflammation," she said.
Professor Cicuttini now plans to conduct an extension trial to address these questions, in particular whether women who develop hand OA around menopause and often have severe pain and joint damage may benefit.
The study was published in The Lancet
As a younger man Tony Hodge-Williams was involved in a serious car accident which, among other injuries caused damage to his hands when the steering wheel was ripped out of his grip.
Over the years Tony developed osteoarthritis in his hands so much so, he had to give up his work in hospitality when he could no longer pick up plates.
Tony went to work in pastoral care in a palliative care unit and then an oncology unit while the deterioration of his hands grew worse and he ended up on strong opioid patch medication.
The 72-year-old from Victoria now works as a minister at the Carmel Welsh Presbyterian Church.
Tony joined a drug trial for methotrexate as a treatment for hand osteoarthritis.
"I found it extremely helpful," said Tony. "My pain reduced considerably. Before starting the methotrexate the pain level in my hands was often a five to an eight but after six months on methotrexate it was down to a three to five and I had greater flexibility in them."
However Tony said the drug did not appear to help the arthritis pain in other parts of his body.
Some months after the trial ended and he stoped taking the methotrexate Tony's pain level increased again.