Hand osteoarthritis improves with prednisolone

The results of the low-dose prednisolone in patients with hand osteoarthritis (HOPE) study presented at EULAR 2019 show that low-dose prednisolone significantly improves pain and function in patients with painful hand osteoarthritis.

Treatments are currently limited to topical and oral non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain. However, studies have shown that synovial inflammation is often present in hand osteoarthritis and it is this inflammation that is a main determinant of pain and radiographic disease progression, identifying synovitis as a possible target of treatment.

While prednisolone has been used in other rheumatic diseases such as rheumatoid arthritis, polymyalgia, lupus and vasculitis for a long time it is currently not recommended in patients with hand osteoarthritis due to a previous lack of evidence. 

The results presented at EULAR demonstrate that prednisolone (10mg) provides a significant improvement in pain with an average -16.5 point difference in VAS finger pain (95% CI; -26.1 to -6.9) and a -3.5 point difference in AUSCAN pain (95%CI; -4.9 to -2.1, p<0.001). In addition, 72 per cent vs 33 per cent of patients treated with prednisolone and placebo respectively were classified as responders using the OMERACT-OARSI responder criteria. Prednisolone was shown to significantly improve function with an adjusted mean between-group difference of -3.7 points in AUSCAN function (p=0.01) and -2.1 points in FIHOA (p=0.03). Significant differences were also shown in SF-36 physical component scale and the VAS patient global assessment. A significant reduction in synovitis was also demonstrated using ultrasound.

The study was a randomised, double-blind, placebo-controlled trial of 92 patients with painful hand osteoarthritis (fulfilling American College of Rheumatology criteria) and signs of synovial inflammation. Eligible patients were randomised to receive prednisolone 10mg daily for six weeks or placebo, followed by a two-week tapering scheme and six weeks without study medication.

After tapering, all between group differences disappeared, and adverse events were mostly mild and comparable between groups.