Methotrexate in patients with hand osteoarthritis refractory to analgesics : a randomized, double-blind, placebo-controlled trial

Abstract : Objectives: No studies have assessed the effect of methotrexate (MTX) in osteoarthritis of the hand (HOA). The purpose of our study was to examine the effect of MTX on pain and structural progression in symptomatic erosive HOA (EHOA).
Methods: This 1-year prospective, monocentric, randomized, double-blind, placebo-controlled study (NCT1968405) followed patients with symptomatic EHOA. Patients were randomized into two groups: 10 mg MTX per week or placebo. The primary endpoint was pain assessment at 3 months, and the secondary endpoints were clinical features (visual analogue scale "VAS" pain), radiographic features (anatomical radiographic score and Gent University Score System), and magnetic resonance imaging (MRI) at 12 months.
Results: Sixty-four patients with HOA were randomized to either the placebo or MTX group. At 3 months, there was no significant difference in the mean decrease in VAS pain score (mm) (MTX: 17.5 (28.4) vs placebo: 8.4 (25.2); p=0.2). Erosive joints progressed significantly more to a remodeling phase in MTX group than in placebo group (27% vs 15%) (p=0.03). Joints with joint space loss appeared to be less eroding in MTX group than in placebo group (8% vs 29%; p=0.2). The level of IL6 (p<0.0001) and presence of synovitis on MRI (p=0.02) at baseline were found to be predictive factors for erosive structural evolution of non-erosive joints.
Conclusion: MTX did not effectively relieve pain after 3 months in EHOA. However, MTX significantly reduced the progression of joint damage compared to placebo. The presence of systemic and local inflammation at baseline was a predictor of erosive progression.
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Master Thesis
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Stéphanie Ferrero. Methotrexate in patients with hand osteoarthritis refractory to analgesics : a randomized, double-blind, placebo-controlled trial. Human health and pathology. 2019. ⟨dumas-02181030⟩

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