Joint injections ‘ineffective’ for hand osteoarthritis

Joint injections are ineffective for relieving the symptoms of hand osteoarthritis and evidence about the effectiveness of topical creams and gels is uncertain, researchers say today.

A pooled data analysis of the available evidence found painkiller tablets and steroid pills work, with the latter the most effective.

The researchers, from Denmark, Netherlands, Norway, New Zealand and the USA, say their findings should prompt a review of the evidence that support recommendations on joint injections for hand osteoarthritis, which affects about one in six women and one in 12 men over the age of 40.

Writing in RMD Open, they describe analysing 72 trials that involved 7,609 participants and 29 pharmacological interventions over an average of three months. Most of the trial participants were women, with an average age of 62. Most were white.

Out of the 72 trials, 60, with 5,246 participants, looked specifically at pain and were included in a pooled data analysis.

The results showed non-steroidal anti-inflammatories (NSAIDs) and steroid tablets were better than placebo, with steroid tablets slightly more effective than standard painkillers.

Topical cream and gel effectiveness was unclear but joint injections of hyaluronate or steroids and hydroxychloroquine tablets were no better than placebo, they said.

NSAID and steroid tablets reduced pain and improved physical function, but while the analysis points to their safety the researchers only assessed treatment withdrawals due to side effects and not long-term safety.

The researchers acknowledge the narrowness of participants and added that the quality of the included studies varied, with two thirds (48) at high risk of bias.

The findings on joint injections mirror those of previous pooled data analyses, they contradict the recommendations of existing clinical guidelines, they add.

“These findings raise questions about the evidence supporting the current treatment recommendation for intra-articular therapies and emphasise the need for future large-scale trials with rigorous methodology to establish the efficacy of promising interventions such as topical NSAIDs,” they write.

“Many pharmacological treatments for hand [osteoarthritis] OA pain are available, of which most have no proven efficacy. For hand OA, oral NSAIDs and oral glucocorticoids appear effective, whereas the efficacy of topical NSAIDs remains questionable. Current intra-articular therapies are ineffective for thumb osteoarthritis.”

Døssing A, Nielsen SM, Kroon FBP et al. Comparative effectiveness of pharmacological interventions for hand osteoarthritis: a systematic review and network meta-analysis of randomised trials. RMD Research 29 September 2023; doi: 10.1136/rmdopen-2023-003030


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