Highlights from

EULAR 2019

European Congress of Rheumatology

Madrid 12-15 June 2019

Low-dose prednisolone reduces localised inflammatory response and painful hand OA

The HOPE study showed that, in patients with painful hand osteoarthritis (OA), short-term treatment with prednisolone improved symptoms of pain and function, as well as imaging markers of inflammation.

Hand OA is a common chronic joint disease, causing pain and limitation of mobility in affected joints. There is a need for more effective therapeutic treatments, because of high disease-burden. Studies have shown that synovial inflammation is often present in hand OA and that it is the main determinant of pain and radiographic disease progression.

Dr Féline Kroon (Leiden University Medical Centre, the Netherlands) et al. investigated the efficacy and safety of short-term, low-dose prednisolone in patients with hand OA. The randomised, double-blind, placebo-controlled HOPE trial included 92 patients with painful hand OA (according to ACR criteria) and signs of synovial inflammation. Eligible patients were randomised to either prednisolone (10 mg daily for 6 weeks) or placebo, followed by a 2-week tapering regime and 6 weeks without study medication. Outcomes were assessed at 2, 4, 6, 8, and 14 weeks. The primary outcome of the study was the visual analog scale (VAS) finger pain at week 6 in the intention-to-treat-analysis. Key secondary outcomes included fulfilment of OMERACT-OARSI responder criteria, pain/function (AUSCAN/FIHOA), VAS patient global assessment, quality of life (Short-Form 36), and grip strength. Imaging endpoints included ultrasound synovitis and positive power Doppler signal (PDS).

Results show that the mean change from baseline to week 6 in VAS finger pain was greater for patients on prednisolone compared with the placebo group (-21.5 vs -5.2; mean intergroup difference -16.5; 95% CI -26.1 to -6.9; P=0.001). At week 6, 33 patients (72%) in the prednisolone, and 15 (33%) in the placebo group fulfilled OARSI responder criteria (OR 5.3; 95% CI 2.0-3.6; P=0.001). Prednisolone was superior to placebo in most other secondary clinical endpoints (see Table). Ultrasound synovitis improved at week 6 in the prednisolone compared to the placebo group. No difference was observed in PDS. Intergroup differences disappeared after tapering off the medication. Adverse events, in both groups, were mostly mild.

Dr Kroon and colleagues concluded that 6-week treatment with low-dose oral prednisolone improved symptoms in patients with painful hand OA and signs of inflammation. This trial provides evidence that local inflammation can be targeted and treated in hand OA.

Table: Change from baseline to week 6 in selected secondary endpoints

Table HOPE study

  1. Kroon F, et al. OP0180. EULAR 2019

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