Methotrexate Shows Promise for Hand Arthritis

Methotrexate—an affordable, established drug for rheumatoid arthritis—may also be helpful for patients suffering from osteoarthritis (OA) of the hand, a recent study reports.¹

Treatment of hand OA and inflammation with 20 mg of methotrexate for six months had a moderate, but potentially clinically meaningful, effect on reducing pain and stiffness in patients with symptomatic hand OA, Australian researchers write in The Lancet. They add that their study is proof of concept that methotrexate may have a role in the management of hand osteoarthritis with an inflammatory phenotype.

Hand OA makes daily activities, such as dressing and eating, difficult and reduces quality of life. According to the Arthritis Foundation, the condition is common among older adults, and even more so in women, with symptoms typically starting around the time of menopause. About half of all women and one-quarter of all men will experience the stiffness and pain of hand OA by age 85.² About half of these patients have inflamed joints, associated with significant damage.

“At the moment, if a person goes to the doctor with hand osteoarthritis, treatments are very limited and do not work well. Often patients are told there is nothing much to offer them,” says senior author Flavia Cicuttini, PhD, MSc, head of the Musculoskeletal Research Unit at Monash University and head of rheumatology at The Alfred Hospital, Melbourne, Australia. “The results of our study support a potential role for methotrexate in the management of hand osteoarthritis and inflammation.”

The Reason for Research

Hand OA was previously seen as a primarily degenerative condition, not an inflammatory one. This old thinking limited treatments to pain relief with paracetamol or such medications as naproxen or celecoxib, says Dr. Cicuttini. However, research involving imaging has since found inflammation in patients with hand OA, despite normal blood tests, she notes in an interview. “This inflammation is associated with pain and very significant joint damage. For these reasons, and the huge unmet need, there have been many trials to see if the anti-tumor necrosis factors (TNF) and other biological agents work. While very effective in conditions such as rheumatoid arthritis, they are also very expensive and have not worked [for hand OA],” she says.

Dr. Cicuttini and her co-authors “decided to test methotrexate because we know it is effective in inflammatory arthritis. Its mode of action is broader than the more selective anti-TNF agents which have revolutionized the management of rheumatoid arthritis and other inflammatory conditions.”