TREATMENT of hand osteoarthritis and synovitis with methotrexate has revealed a moderate, but clinically meaningful, effect on reducing pain. Researchers from Monash University, Clayton, Victoria, Australia, found that 20 mg weekly methotrexate delivered orally over 6 months reduced pain and stiffness in patients with symptomatic hand osteoarthritis.
This study was a multisite, parallel-group, double-blind, randomised, placebo-controlled trial, involving participants aged 40–75 years. Participants were randomly assigned to receive methotrexate 20 mg or an identical placebo orally once weekly for 6 months. Primary outcome in the study was pain reduction, measured with a 100 mm visual analogue scale.
Lead author, Flavia Cicuttini, Monash University, described their findings: “Pain levels stayed the same in the placebo group, but continued to decrease in the methotrexate group at 3- and 6 months.” Cicuttini stressed: “The pain improvement in the methotrexate group was twice as much as in the placebo group.”
Between 2017–2021, 97 participants were assigned methotrexate (n=50) and placebo (n=47); 68 female and 29 male. Overall, 42 of the methotrexate group and 40 of the placebo cohort provided primary outcome data. Mean change in pain at 6 months was -15.2 mm (standard deviation: 24.0) in the methotrexate group, and -7.7mm (standard deviation: 25.3) in the placebo, with a mean difference of -9.9 (95% confidence interval: -19.3 to -0.6; p=0.037) and an effect size of 0.45 (0.03-0.87). Adverse events occurred in 31 of participants in the methotrexate group and 28 in the placebo group.
The authors concluded that treatment of hand osteoarthritis and synovitis had a moderate but clinically meaningful effect on pain reduction, providing proof that methotrexate has a role in managing osteoarthritis with an inflammatory phenotype. This research carries great meaning when it is considered that close to half of females and one-in-four males, will experience symptoms from hand osteoarthritis before they turn 85. Cicuttini discussed the next steps for this research: “Further trials are needed to establish whether the effect of methotrexate extends beyond 6 months.” The authors plan to apply their work specifically to females who develop osteoarthritis around menopause, who often experience severe pain and joint damage.
