Study Finds Methotrexate Helps Ease Hand Osteoarthritis Pain

Methotrexate is an old drug with some seemingly new tricks. For years it has been used to treat rheumatoid arthritis, psoriasis and certain cancers as it can slow the immune response and growth of certain cells. However, methotrexate might be the next go-to remedy for hand osteoarthritis, according to a study published in the journal The Lancet.

In this small study, Monash University and Alfred Health researchers (Australia) recruited 97 community members between the ages of 40 and 75 with MRI confirmed hand osteoarthritis in at least one digit. Participants did not have another form of arthritis, cancer or hepatitis B.

Seventy percent of participants were women. Participants were randomly split into two groups with the first receiving methotrexate 20 mg orally once a week for six months, while the other half of participants got a placebo. Both groups supplemented with folic acid to offset side effects of methotrexate.

After analyzing the data, researchers found the treatment protocol had a moderate but meaningful effect on reducing hand osteoarthritis pain involving synovitis (inflamed joint lining). Treatment participants had a reportable decrease in pain at the three-month and six-month marks, while the pain levels of placebo participants remained the same. Pain improvement was doubled among the treatment participants compared to the placebo group.

“Osteoarthritis is a painful, debilitating condition, but it can be particularly problematic if it affects the hands, as we rely on our hands for so many of our daily activities,” says Bernard Kaminetsky, MD, medical director, MDVIP. “Currently, treatment choices for hand OA are limited, so it’s important that we continue finding ways to ease the pain associated with hand OA.”

What is Arthritis?

Arthritis is an umbrella term to describe more than 100 conditions that involve swollen joints. The common form, osteoarthritis or OA, is a degenerative condition that affects the entire joint. It involves the breakdown of the cartilage -- the smooth, protective tissue at the end of bones that prevents bones from rubbing together, inflaming the lining of the joint (or synovitis), causing pain and stiffness. The best way to think of it is wear and tear on the joints. OA can occur in any joint, but it’s most often experienced in the knees, hips, spine, big toes and hands.

What is Hand Osteoarthritis?

Hand OA can affect any of the joints formed by the 29 bones in the hands and wrists. The Arthritis Foundation reports that hand OA causes pain and stiffness to the: 
 

• Base of the thumb, where the thumb and wrist join.
• Joint closest to the fingertip 
• Middle joint of a finger

The Arthritis Foundation had identified risk factors that are involved in hand OA, such as being:
 

• Older – hand OA can develop at any age, but usually signs and symptoms begin appearing after age 50.
• White – white people have a higher incidence of hand OA, whereas, African Americans have a higher incidence of knee and hip OA.
• Female – about 50 percent of women and 25 percent men have hand OA by the time they're 85.
• Overweight/Obese – additional weight places additional strain on joints and triggers inflammation, raising the risk for hand OA.
• Genetically predisposed – genes can play a role in hand OA, particularly if you’re younger than 50 when your condition arises.   
• Injured or have joint issues – issues such as hand fractures, dislocations, overuse syndromes, and infections, regardless of how well they’re treated, can led to hand OA.

Hand OA treatments include:

• Lifestyle modifications like eating a Mediterranean-style diet to help control inflammation.
• Braces and splints to lower joint strain.
• Hand exercises to help maintain joint flexibility and range of motion.
• Hot and cold therapy to ease pain.
• Over-the-counter pain relievers like acetaminophen, NSAIDS and topical treatments
• Prescription medications such as corticosteroids.
• Surgery to remove damaged cartilage, fuse bone together, replace joints.

What is Methotrexate?

Methotrexate is an immunosuppressant. It disables parts of the immune system activity, decreasing its activity, which helps reduce inflammation. However, osteoarthritis-related inflammation doesn’t seem to be linked to the immune system, which is why it hasn’t been prescribed for hand OA. But may slow the progression of joint damage and help facilitate bone remodeling, according to research presented at the 2019 American College of Rheumatology meeting.

“As of now, methotrexate is not a standard treatment for hand osteoarthritis, however, you can raise the conversation with your primary care physician,” says Kaminetsky.

Don’t have a primary care physician? Consider joining an MDVIP-affiliated practice. As part of the MDVIP Wellness Program, your doctor can help you live a bone- and joint-healthy style. Find an MDVIP affiliate near you and begin your partnership in health »