Injections ‘no better than placebo’ for hand osteoarthritis: Study

Intra-articular therapies for the treatment of hand osteoarthritis are ineffective, research published this month suggests.
 
The authors of a new systemic study published in RMD Open – part of BMJ – filtered the results of randomised trials involving pharmacological interventions for people with the condition.
 
Sixty trials running up until 26 December 2021 with a total 5246 participants were included for data analysis. 
 
The researchers’ main aim was to explore the impact of pharmacological interventions for hand osteoarthritis pain.
 
Non-steroidal anti-inflammatories (NSAIDs) and glucocorticoids are ‘apparently effective’ in treating the condition, the University of Copenhagen researchers concluded.
 
The analysis also suggests steroid tablets have more impact than standard painkillers.
 
‘Oral glucocorticoids were consistently effective across analyses for pain and were effective in function, patient global assessment, and health-related quality of life,’ they wrote.
 
However, the authors say their review casts doubt on the efficacy of other interventions, describing the clinical impact of topical NSAIDs as ‘questionable’.
 
‘Current intra-articular therapies are ineffective for thumb osteoarthritis,’ they also concluded.
 
‘These findings raise questions about the evidence supporting the current treatment recommendation for intra-articular therapies and emphasise the need for future large-scale trials with rigorous methodology to establish the efficacy of promising interventions such as topical NSAIDs.
 
‘Many pharmacological treatments for hand osteoarthritis pain are available, of which most have no proven efficacy.’
 
The authors note only treatment withdrawals due to side effects were assessed, and not long-term safety.
 
They also acknowledged other potential limitations of the research, including that around 85% of the trial participants were women, with the mean age of those assessed standing at 62.
 
The majority of participants were of white ethnicity, another factor authors said could limit the application of the results.
 
They also noted the varying quality of studies included in the analysis, with 48 of the 60 trials assessed having a ‘high risk of bias’. 
 
‘The strengths of our study include our rigorous search strategy, which minimised the risk of missing eligible studies, and an active and extensive search that identified unpublished trial data and trials not previously included in systematic reviews,’ they stated.
 
‘Nevertheless, we cannot completely rule out publication bias, so our results must be interpreted cautiously.’
 
According to research cited in the article, hand osteoarthritis affects 15.9% of women and 8.2% of men aged between 40–84 years.
 
See the Handbook of Non-Drug Interventions (HANDI) for more information on the reduction of hand osteoarthritis pain on the RACGP website.
 
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non-steroidal anti-inflammatories NSAIDs osteoarthritis