Effects of Methotrexate in Symptomatic Erosive Hand OA

In a randomized study presented at the American College of Rheumatology/Empowering Rheumatology Professionals Annual Meeting, the use of methotrexate compared to placebo was explored in patients with symptomatic erosive osteoarthritis of the hand (EHOA). Specifically, the researchers explored how methotrexate affects pain and structural disease progression.

Symptomatic EHOA patients were randomized to receive 10 mg methotrexate per week or placebo. The main outcome was three-month pain assessment; other outcomes included clinical features (visual analog scale [VAS] pain), radiographic features (Verbruggen anatomical radiographic score and Gent University Score System), and MRI at 12 months.

Final analysis included 64 patients. Three-month VAS pain score did not significantly differ between the groups (methotrexate: 17.5 vs. placebo: 8.4, P=0.2). The rate of erosive joint progression to a remodeling phase was higher in the methotrexate group than the placebo group (27% vs. 15%, P=0.03). The methotrexate group had a lower rate of eroding in joints with joint space (8% vs. 29%, P=0.2). Baseline interleukin-6 level (P<0.0001) and synovitis findings on MRI (P=0.02) at baseline predicted erosive structural evolution of non-erosive joints.

The authors concluded that methotrexate was not superior to placebo in terms of pain and function evolution in patients with EHOA at three and 12 months, but methotrexate was associated with reduced progression of joint damage and may promote bone remodeling.