Low-dose Prednisolone in Hand Osteoarthritis

A study observed improved symptoms and signs of inflammation in patients with pain osteoarthritis (OA) of the hand who took low-dose oral prednisolone compared to placebo. The findings from the HOPE trial were presented during a plenary session at the American College of Rheumatology (ACR)/Empowering Rheumatology Professionals Annual Meeting.

The trial was a randomized, double-blind study that included patients with painful hand OA who met ACR criteria and presented signs of synovial inflammation. Patients were excluded based on the following criteria: chronic inflammatory rheumatic diseases, psoriasis, using immune modulating drugs within 90 days before baseline, and predominant thumb base pain. Patients were randomized to receive either prednisolone 10 mg daily or placebo for six weeks and then underwent a two-week tapering scheme and six weeks with no study medication. Evaluations were performed at two, four, six, eight, and 14 weeks. The main outcome was visual analog scale (VAS) finger pain at six weeks; additional outcomes included fulfilment of OMERACT-OARSI responder criteria, Australian/Canadian Hand OA Index (AUSCAN) pain/function, Functional Index for Hand OA (FIHOA), VAS patient global assessment, Short-Form 36 and grip strength.

Of 92 patients (mean [SD] age, 63.9 [8.8] years; 79% were female) randomized—46 I the prednisolone group and 46 in the placebo group—42 patients in each group finished the trial. The prednisolone group had a better mean six-week change in VAS finger pain (–21.5) compared to the placebo group (–5.2); the mean between-group difference was –16.5. More patients in the prednisolone group than the placebo group met OARSI responder criteria at six weeks (n=33, 72% vs. n=15, 33%, odds ratio=5.3; 95% CI, 2.0 to 13.6, P=0.001). Prednisolone had superior outcomes compared to placebo in the majority of the secondary outcomes. Six-week ultrasound synovitis was significantly improved in the prednisolone group compared to the placebo group, but PDS did not significantly differ. Between-group differences resolved after tapering. The groups had similar rates of adverse events, most of which were mild.