Oral NSAIDs and Glucocorticoids Effective Against Hand Osteoarthritis: BMJ

A comprehensive analysis published in the British Medical Journal highlights the effectiveness of oral NSAIDs and glucocorticoids as pharmacological interventions for hand osteoarthritis (OA). While other treatments such as intra-articular therapies and topical NSAIDs showed some promise, they did not outperform placebos.

The research involved an extensive review of 72 trials with 7609 participants, aimed to assess the comparative benefits of these treatments. The study was conducted until December 26, 2021, systematically combed through databases, including Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials. It encompassed randomized trials of pharmacological interventions designed for individuals with hand OA.

The findings revealed that oral non-steroidal anti-inflammatory drugs (NSAIDs) and oral glucocorticoids exhibited notable efficacy in the treatment of hand OA. When compared to a placebo, oral NSAIDs displayed an effect size of -0.18, with a 95% credible interval of -0.36 to 0.02. Oral glucocorticoids, on the other hand, had a more substantial effect size of -0.54, within a range of -0.83 to -0.24. These results held true even when analyzing trials without a high risk of bias.

Intra-articular hyaluronate, intra-articular glucocorticoids, hydroxychloroquine, and topical NSAIDs also underwent scrutiny. Their effect sizes were 0.22, 0.25, -0.01, and -0.14, respectively, when compared to a placebo. This data suggests that while intra-articular therapies and topical NSAIDs showed some effectiveness, they did not surpass the placebo's impact.

Interestingly, when directly comparing oral NSAIDs and oral glucocorticoids, the latter proved superior, with an effect size of 0.36.

However, the study's results were consistent across the board when researchers analyzed thumb and finger OA separately. In both cases, no intervention demonstrated superiority over a placebo.

These findings are particularly significant for individuals suffering from hand OA, as they offer evidence-based guidance on which pharmacological interventions may provide the most relief.

Reference:

Døssing, A., Nielsen, S. M., Kroon, F. P., Balsby, I. M., Tarp, S., Kloppenburg, M., Stamp, L., Altman, R. D., Henriksen, M., Boesen, M., Bliddal, H., Berg, S., & Christensen, R. (2023). Comparative effectiveness of pharmacological interventions for hand osteoarthritis: a systematic review and network meta-analysis of randomised trials. In RMD Open (Vol. 9, Issue 3, p. e003030). BMJ. https://doi.org/10.1136/rmdopen-2023-003030