Research in context
Evidence before this study
Hand osteoarthritis is a prevalent joint condition that causes pain, functional disability, and decreased quality of life. The clinical course of hand osteoarthritis often fluctuates, with transient flare-ups of the disease accompanied by more pain and joint inflammation. Previous evidence indicates that local joint inflammation is involved in the disease progression of osteoarthritis. A 2018 systematic literature review to update the European League for Rheumatology recommendations on the treatment of hand osteoarthritis searched MEDLINE (via PubMed), Embase, and the Cochrane CENTRAL databases for work published before June 6, 2017, and the review identified two studies of oral prednisolone. Previous trials of glucocorticoids in hand osteoarthritis were inconclusive. A trial investigating the efficacy of 5 mg prednisone daily for 4 weeks found that prednisone was not superior to placebo in reducing pain. A trial of a combined prednisolone and dipyridamole showed improvements in pain with this preparation compared with placebo but at the cost of more adverse events, particularly headaches, a known side-effect of dipyridamole. We did an updated search in PubMed for work published before March 16, 2019, and we found no new trials. We hypothesised that glucocorticoids could suppress this local inflammation and, as a result, improve signs and symptoms of hand osteoarthritis.
Added value of this study
By contrast with previous trials of glucocorticoids in hand osteoarthritis, our study investigated a potent prednisolone dosage of 10 mg daily. By specifically including patients with pain and local joint inflammation, the trial focused on patients who are most in need of treatment. In this randomised, double-blind placebo-controlled trial, we found that 6 weeks of treatment with 10 mg prednisolone daily substantially improved pain and function and imaging markers of inflammation. The large beneficial effect size exceeded that of all available therapeutic options for hand osteoarthritis, and our findings indicated that local inflammation in hand osteoarthritis can be modulated.
Implications of all the available evidence
Our study provides evidence that patients experiencing a flare-up of hand osteoarthritis can be effectively and safely treated with a 6-week course of 10 mg daily prednisolone. These findings provide clinicians with a new treatment option for a disease that that has very few therapeutic options. Finally, our study supports inflammation as a treatment target in hand osteoarthritis, which is a notable step towards targeted treatment in hand osteoarthritis, with the eventual goal of finding a treatment that can modify its disease course.