Inflammation is often present in the hand joints of patients with hand osteoarthritis (OA), particularly in those with erosive disease, and is linked with pain and disease progression. Targeting this inflammation with a short course of glucocorticoid therapy could offer pain relief, according to the results of the Hand Osteoarthritis Prednisolone Efficacy (HOPE) study.

The study specifically included patients with a flare of painful hand OA and signs of active synovial inflammation, in order to target those patients who would benefit most from the anti-inflammatory treatment. “More liberal patient inclusion criteria might have been a reason that previous trials (of other anti-inflammatory drugs) in hand OA produced negative results,” suggests corresponding author Féline Kroon.

Compared with placebo, 6 weeks of treatment with oral prednisolone 10 mg daily substantially reduced finger pain (as measured on a 100 mm visual analogue scale) and function (measured by AUSCAN function score and FIHOA score). Signs of inflammation, determined by MRI and ultrasonography, were also decreased. “The effects on pain and function we found in this trial exceeded those of all currently available treatment options,” notes Kroon. Notably, symptoms returned to pre-treatment levels after the prednisolone was tapered over 2 weeks.

“The results of our study provide clinicians with a new short-term treatment option for patients with hand OA who report a flare-up of their disease,” Kroon says. Whether continued treatment would have provided additional benefit or could eventually modify the disease course remains to be determined. In light of the potential complications of prolonged glucocorticoid therapy, further studies are needed to determine the optimal dosage and duration of treatment for inflammatory hand OA.