Oral corticosteroids effective for hand osteoarthritis treatment over short term

Australia: In a new study conducted by Mahnuma Mahfuz Estee and the team, it was shown that at 4-6 weeks, there was low-certainty evidence indicating a moderate impact of oral corticosteroids on pain alleviation, stiffness reduction, and functional improvement in hand osteoarthritis (OA). 

"Corticosteroids had no significant effect on any outcomes over a longer term (3-12 months) off treatment, the researchers wrote in their study. The findings of this study were published in BMC Musculoskeletal Disorders.

Anti-inflammatory drugs called corticosteroids are routinely used for musculoskeletal conditions. Inflammatory hand OA pain can be effectively treated with oral corticosteroids, but their usage is limited because of their systemic adverse effects. The purpose of this study was to assess the effectiveness of corticosteroids on symptoms and structural outcomes in hand OA using a systematic review and meta-analysis of randomized controlled trials.

From the beginning until October 2021, randomized controlled trials looking at the effectiveness of corticosteroids in treating hand osteoarthritis were searched in Embase, Ovid MEDLINE, and Cochrane Central Register of Controlled Trials. Using the RoB 2 tool, two writers independently reviewed the records, extracted the data, and evaluated the risk of bias. It was determined if the difference was standard or mean, and random-effects meta-analyses were carried out.

The key findings of this study were as follows:

1. Of the 13 trials that were considered, 3 looked at oral corticosteroids and clinical results in any hand joints, 9 at intra-articular corticosteroid injection, and clinical outcomes at the first carpometacarpal joint, and 1 at the interphalangeal joints.

2. In a meta-analysis, oral corticosteroids enhanced stiffness and function at 4-6 weeks while reducing discomfort.

3. At three months, which was six to eight weeks after the study drug was discontinued, there was, however, no discernible permanent effect on pain or function.

4. Intra-articular corticosteroids had no discernible impact on pain or function in first-stage carpometacarpal osteoarthritis at 4-6 weeks or over the course of 3–12 months.

5. Two studies looked at the anatomy of the joints after 4-6 weeks; one revealed that oral corticosteroids decreased synovial thickness, but neither trial found a difference in synovitis.

In conclusion, given the risk of side effects and in particular the lack of data supporting a disease-modifying impact to date, caution must be used when interpreting the findings of oral corticosteroids.

One experiment found an impact of intra-articular corticosteroids on reducing discomfort during mobility in interphalangeal OA, whereas intra-articular corticosteroids had no discernible effect on clinical outcomes in carpometacarpal OA. The function of oral or intra-articular corticosteroids in the treatment of hand OA requires more investigation.

Reference:

Estee, M. M., Cicuttini, F. M., Page, M. J., Butala, A. D., Wluka, A. E., Hussain, S. M., & Wang, Y. (2022). Efficacy of corticosteroids for hand osteoarthritis - a systematic review and meta-analysis of randomized controlled trials. In BMC Musculoskeletal Disorders (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12891-022-05619-9