A medication well known to people who suffer from psoriasis would alleviate pain related to osteoarthritis of the hand, suggests a study published in The Lancet. However, beware of unwanted effects…
THE methotrexatea medicine indicated in the treatment psoriasis, psoriatic arthritis and some rheumatoid arthritiswould also be effective against the symptoms of osteoarthritis of the hand and of synovitis (inflammation of the membrane lining the inside of the joint capsule), suggest Australian researchers in a study published on October 12, 2023 (The Lancet). To achieve this result, they carried out a double-blind, randomized, placebo-controlled trial on 202 participants aged 40 to 75 suffering from hand osteoarthritis and synovitis detected by MRI (70% women, 30% men). For 6 months, participants received either 20 mg methotrexateor an identical placebo orally once a week.
Pain halved…
At the end of 6 months, the intensity of the pain (measured with a 100mm visual analogue scale) had become half as much in patients who received methotrexate than in patients who received a placebo (respectively a reduction in pain of -15.2 mm with methotrexate and -7.7 mm with the placebo). “Treatment of hand osteoarthritis and synovitis with 20 mg methotrexate for 6 months had a moderate effect but potentially clinically significant on the pain reductionproviding evidence that methotrexate may play a role in the management of hand osteoarthritis with an inflammatory phenotype (…) Especially since hand osteoarthritis is a disabling pathology for which there are few effective therapies“, conclude the authors of the study.
…but a few too many side effects
However, methotrexate (Imeth®, Novatrex® and generics, all on prescription) can be dangerous and must be subject to precautions for use. For example, in the Australian trial, adverse events occurred in 62% of participants in the methotrexate group and 60% of participants in the placebo group. Overdoses (several times a week) and drug interactions are frequent, alerts theMedicines Agency (ANSM) which reminds that this medicine should only be administeredonly once a week and that it is important to be careful when taken with other prescription or over-the-counter medications (including nonsteroidal anti-inflammatory drugs [ibuprofène, kétoprofène, aspirine, etc]), proton pump inhibitors [oméprazole, pantoprazole, etc]) without the advice of a doctor or pharmacist. An overdose can manifest itself in particular by fever, sore throatmouth ulcers, diarrhea, vomiting, rash, bleeding or unusual weakness.