Hand pain research

Hand osteoarthritis is a common disabling condition that causes significant pain and impaired hand function. Even simple life tasks such as buttoning clothing can become unmanageable.

Currently there is no treatment that slows the progression of hand osteoarthritis, so we undertake clinical trials to build an evidence-base that supports the identification of effective therapies.

Randomised controlled trials are the most rigorous type of clinical trials, that demonstrate effect by allowing comparison with a neutral (control) group that do not receive the drug or therapy being investigated.

METHODS: A randomised controlled trial of methotrexate to treat hand osteoarthritis with synovitis

Joint swelling (synovitis) is found in approximately 50% of people with symptomatic hand osteoarthritis. Joints in hands with synovitis are three and half times more likely to have rapid joint damage than those without synovitis. Therapies targeting synovitis may offer a new approach to treating hand osteoarthritis.

Methotrexate, the first line therapy for rheumatoid arthritis, is a well-established, low-cost drug with a well-described safety profile. It has been shown to improve both synovitis and symptoms in clinical trials of rheumatoid arthritis.

The METHODS study is a randomised clinical trial aiming to investigate the effect of methotrexate on reducing pain and slowing joint structural damage in people with symptomatic hand osteoarthritis and synovitis. If methotrexate is effective, it will offer a new way to treat hand osteoarthritis.

This study is funded by NHMRC. We anticipate completion by December 2022.

Topical corticosteroid for treatment of hand osteoarthritis

There are a range of treatments available for hand osteoarthritis, but their ability to reduce pain is limited. These include topical therapies like creams and lotions, pain relief tablets, and non-drug treatments.

Previous studies have shown a high prevalence of joint swelling (synovitis) in painful hand osteoarthritis, suggesting that inflammation is a potential treatment target to reduce pain in hand osteoarthritis. Corticosteroids are a class of drugs that can reduce inflammation.

Oral corticosteroids are effective for the treatment of patients with painful hand osteoarthritis and signs of inflammation, but corticosteroids taken orally or by injection are associated with significant adverse events.

Topical delivery of corticosteroids is a potential alternative approach to improving outcomes in hand osteoarthritis. They are safe, inexpensive and commonly used for skin conditions.

This study is a randomised clinical trial aiming to investigate the effect of topical corticosteroid (Diprosone OV ointment) on reducing pain and improving function in people with symptomatic hand osteoarthritis.

If Diprosone OV ointment is effective, it will offer a new way to treat hand osteoarthritis.

This study is funded by NHMRC. We anticipate completion by December 2022.