This Common Drug Could Be the First Effective Treatment for Hand Osteoarthritis
Fact checked by Nick Blackmer
Key Takeaways
A recent study found that methotrexate, a drug used to treat rheumatoid arthritis and psoriasis, may also help with the symptoms of hand osteoarthritis.
The drug is not approved by the Food and Drug Administration (FDA) for hand osteoarthritis, but experts say that patients can ask their providers if they’d be able to take the drug off-label.
Patients with hand osteoarthritis can also try topical and oral nonsteroidal anti-inflammatory drugs, splints or braces, warm or cold compresses, and hand exercises to treat symptoms.
Hand osteoarthritis (OA) is a painful and disabling joint condition that can seriously affect a person’s ability to do daily activities, such as eating and dressing. Hand OA is common, and about half of all women and one-quarter of all men will have symptoms by the time they’re 85 years old.
While there are some treatments for hand OA, they are limited and often don’t work.
A small new study shows that methotrexate, a medication that’s currently used to treat rheumatoid arthritis (RA) and psoriasis, could also help reduce symptoms of hand OA, such as pain and stiffness.
“At the moment, if a person goes to the doctor with hand OA, treatments are very limited and do not work well,” study author Flavia Cicuttini, PhD, a professor and the head of the musculoskeletal unit at Monash University and the rheumatology department at Alfred Hospital, both in Melbourne, Australia, told Verywell. “Often patients are told there is nothing much doctors can offer them.”
She said her team’s findings support a potential role for methotrexate in the management of hand osteoarthritis and inflammation and should be considered a safe treatment option by clinicians.
Related: Symptoms of Hand OA
How Effective Was Methotrexate?
The study included 97 adults with hand OA. The researchers confirmed that the participants had osteoarthritis by taking X-rays and using magnetic resonance imaging (MRI) scans to check for inflammation.
For the study, 50 patients were given a standard methotrexate dose of 20 milligrams orally once a week, and 47 received a placebo.
The researchers followed the patients for six months. During the first month, the participants’ pain improved in both the placebo and methotrexate groups. However, as time went on, Cicuttini said that while the methotrexate group continued to have less pain, the placebo group did not.
“In the methotrexate group, there was improvement at three months and even more so at six months,” said Cicuttini. “Across the full six months, the improvement in pain in the methotrexate group was twice as much as in the control group.”
Cicuttini hopes the results of the study will encourage providers to consider prescribing methotrexate to patients with significant hand OA symptoms.
Related: How Methotrexate Treats Arthritis
What Does Hand OA Feel Like?
Hand OA is common, especially as people get older.
Samantha Muhlrad, MD, MS, chief of Hand Surgery at Stony Brook Medicine in New York, told Verywell that hand OA occurs when a person develops thinning of the smooth cartilage where the joints meet one another, which can lead to painful throbbing.
“A patient can experience stiffness, sometimes deformity, pain, and knobby knuckles,” she said. “As the disease progresses, patients sometimes have difficulty moving their joints at all.”
Muhlrad, who was not involved in the study, explained that the current treatments for osteoarthritis only target symptoms—none can slow or stop the progression of the disease. The recent study did not show methotrexate was any different. Evidence just suggests it can also help with hand pain symptoms.
“It’s exciting because methotrexate is generally used to treat rheumatoid arthritis or other types of inflammatory arthritis, but not osteoarthritis,” said Muhlrad. “We’re starting to see it could be effective for that.”
Related: What Are the Most Common Symptoms of OA?
Why Is Hand OA Hard to Treat?
Cicuttini said that one reason it’s been so hard to find effective treatments for OA is that experts did not understand the causes of the condition until recently.
“We are taught in medical school, and even in specialties such as rheumatology, that osteoarthritis is a degenerative condition that is not inflammatory and that treatments are limited,” said Cicuttini.
However, Cicuttini said that recent research has shown that there is inflammation in people with hand OA, even if their blood tests are normal. That inflammation is also associated with pain and significant joint damage.
Jonathan Samuels, MD, a rheumatologist at NYU Langone Health, told Verywell that another reason why finding OA treatment has been challenging is that, unlike other types of arthritis, there are no disease-modifying treatments that are designed for hand OA.
The symptoms of hand OA can also vary widely from person to person. For example, Samuels said some patients will have no pain while others will have severe pain “and can’t even open a doorknob, use a pencil, or type on the keyboard without discomfort.”
Not only do symptoms vary from patient to patient, but even within the same patient. Samuels said that the disease can “fluctuate in one single patient from time to time, so that’s a challenge.”
Related: Treatments for Hand OA
Is It Possible to Get Methotrexate for Hand OA Right Now?
Although methotrexate is not used to treat osteoarthritis or hand OA, some rheumatologists have been prescribing the drug off-label (which means prescribing it for a purpose other than what the FDA approved it for.)
“In a survey we did before starting our study, we found that many rheumatologists were using methotrexate for hand OA as there was little else to offer patients,” said Cicuttini.
Patients will need to discuss the option with their provider and consider their symptoms, disease progression, and other health considerations.
“As a hand surgeon, I would prefer to try cortisone injections and less oral medications to start, said Muhlrad. “But I do think patients could speak with a rheumatologist about it, and they may be candidates, even if their diagnosis is osteoarthritis.”
Muhlrad also said there are potential risks associated with methotrexate use, including adverse effects such as gastrointestinal issues, nausea, vomiting, loss of appetite, and more serious risks like liver toxicity and low blood count.
While the study did show the possible benefits of methotrexate for people with hand OA, more research is needed to understand this relationship, along with the potential need for approval from the FDA.
“The FDA would have to approve it for that use, which may require more studies,” said Muhlrad. “Even if it is approved as a labeled indication, whether or not individual insurance companies would cover it would be another question.”
Related: What to Know About Finger Osteoarthritis
How to Deal With Hand OA Symptoms
Hand OA is not curable. However, there are some expert-recommended tips for coping with the symptoms:
Take topical and oral non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen to decrease pain, swelling, and inflammation.
Wear braces or splints that provide structured support to your hands and fingers, especially the thumbs.
Get corticosteroid injections or oral tablets to help with pain and swelling.
Apply warm or cool compresses to ease swelling, pain, and stiffness.
Do hand exercises such as making a gentle fist, lightly bending each finger, placing your hand flat on the table, and lifting each finger off the table one by one to increase the range of motion in your hands.
What This Means For You
Research has shown that methotrexate can be used off-label to help with symptoms of hand osteoarthritis, but since it’s not FDA-approved for this purpose, you’ll have to talk with your provider about whether it could be an option for you.
Read Next: Useful Gadgets for People with Hand OA
Read the original article on Verywell Health.
