The paper also calls for more clinical trials to establish whether the effects of 20 mg of methotrexate once weekly extend beyond six months and whether it improves structural outcomes in individuals with hand OA and synovitis over longer periods.
To that end, Dr. Cicuttini says she will soon start a new study of methotrexate in patients with hand OA. The recently published six-month study showed a reduction in pain, but because methotrexate is a slow-acting agent, the forthcoming 12-month study will follow approximately 150 similar patients. The goal is to figure out which patients continue to benefit from it.
Although Dr. Conaghan says he would hold off prescribing methotrexate for hand OA pending further positive research results, Dr. Cicuttini says rheumatologists can discuss the drug with some patients, considering their individual disease and treatment options.
Deborah Levenson is a writer and editor based in College Park, Md.
References
- Wang Y, Jones G, Keen HI, et al. Methotrexate to treat hand osteoarthritis with synovitis (METHODS): An Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial. Lancet. 2023 Nov;402(10414):1764–1772.
- Osteoarthritis of the hands. Arthritis Foundation. 2021 Oct 14. https://www.arthritis.org/diseases/more-about/osteoarthritis-of-the-hands.
- Ferrero S, Wittoek R, Allado E, et al. Methotrexate treatment in hand osteoarthritis refractory to usual treatments: A randomised, double-blind, placebo-controlled trial. Semin Arthritis Rheum. 2021 Aug;51(4):831–838.
