Methotrexate effective against osteoarthritis: Study

It is a ‘disabling’ condition which impacts more than two million Australians, and until now, there have been few effective treatment options for those with hand osteoarthritis.
 
But pain relief is in sight for patients, after researchers from Monash University and Alfred Health found methotrexate can reduce symptoms.
 
Published in The Lancet, the study recruited participants with hand osteoarthritis and MRI-detected inflammation from Melbourne, Hobart, Adelaide, and Perth.
 
The randomised, double-blind trial saw 50 participants take a weekly dose of methotrexate, while 47 were given a placebo over a six-month period.
 
Patients were regularly asked to report their pain on the Visual Analogue Scale (VAS) throughout, with the methotrexate group reporting a mean reduction of 15.2, while the placebo group reported a reduction of 7.7.
 
Researchers concluded a 20 mg weekly oral dose over six months had a ‘moderate but potentially clinically meaningful’ effect on reducing pain.
 
Senior author Professor Flavia Cicuttini said both the placebo group and methotrexate groups’ pain improved in the first month.
 
‘However, pain levels stayed the same in the placebo group but continued to decrease in the methotrexate group at three and six months,’ she said.
 
‘Based on these results, use of methotrexate can be considered in the management of hand osteoarthritis with an inflammatory pattern.
 
‘This provides clinicians with a treatment option for this group, which tends to get more joint damage.’
 
According to the Australian Institute of Health and Welfare, 22% of people over the age of 45 have osteoarthritis, and it accounts for 2.4% of the country’s total disease burden.
 
About half of all women and one quarter of all men will experience symptoms from hand osteoarthritis by the time they turn 85.
 
Professor Dimity Pond, a GP with a special interest in aged care, described the condition as ‘very common and very debilitating’, and told newsGP she is surprised by the research.
 
‘Methotrexate has been used for decades for a range of conditions, including conditions such as rheumatoid arthritis and psoriatic arthritis. It is very effective in those conditions which have an inflammatory component,’ she said.
 
‘However, not all osteoarthritis has an inflammatory component, so I haven’t personally considered it for osteoarthritis.’
 
Osteoarthritis continues to rise globally, with a recent study finding cases increased from 247.51 million in 1990 to 527.81 million in 2019.
 
In Australasia, that increase was slightly higher at 116%.
 
Professor Pond said she would now like to see more research into the medication, and into hand osteoarthritis more broadly.
 
‘Methotrexate does depress the immune system so care needs to be taken with vaccinations if you are taking it, and it can cause damage to the liver so regular blood tests are needed,’ she said.
 
‘From a female GP’s point of view, it is diseases like this that affect women more than men that are often neglected in research.’
 
Professor Cicuttini said she plans to conduct an extension trial to investigate whether women who develop hand osteoarthritis around menopause, and often have severe pain and joint damage, may benefit.
 
‘Further trials are needed to establish whether the effect of methotrexate extends beyond six months, for how long we need to treat patients, and whether methotrexate reduces joint damage in patients with hand osteoarthritis and associated inflammation,’ she said.
 
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aged care osteoarthritis pain management