BACKGROUND: There is some evidence that corticosteroids may have a beneficial effect in hand osteoarthritis. We examined the efficacy of corticosteroids on symptoms and structural outcomes in hand osteoarthritis.
METHODS: Ovid MEDLINE, Embase and Cochrane Central Register of Controlled Trials were searched from inception to October 2021 for randomized controlled trials investigating the efficacy of corticosteroids in hand osteoarthritis. Two authors independently screened records, extracted data, and assessed risk of bias using the RoB 2 tool. Standardized mean difference (SMD) or mean difference (MD) was calculated, and random-effects meta-analyses were performed.
RESULTS: Of 13 included trials, 3 examined oral corticosteroids and clinical outcomes in any hand joints, 9 examined intra-articular injection of corticosteroids and clinical outcomes at the first carpometacarpal joint and one in the interphalangeal joints. In meta-analysis, oral corticosteroids reduced pain (SMD -0.53, 95% CI -0.79 to -0.28) and improved stiffness (MD -5.03, 95% CI -9.91 to -0.15; Australian Canadian Osteoarthritis Hand Index stiffness subscale) and function (SMD -0.37, 95% CI -0.63 to -0.12) at 4-6 weeks. However, there was no significant persistent effect on pain and function at 3 months which was 6-8 weeks after study medication was stopped. There was no significant effect of intra-articular corticosteroids on pain or function at 4-6 weeks or over 3-12 months in first carpometacarpal osteoarthritis. Two trials evaluated joint structure at 4-6 weeks: one study showed oral corticosteroids reduced synovial thickening, neither showed an effect on synovitis.
CONCLUSIONS: There was low-certainty evidence for a medium effect of oral corticosteroids on pain relief and stiffness improvement and small-to-medium effect on functional improvement at 4-6 weeks, with no significant effect for intra-articular corticosteroids. Corticosteroids had no significant effect on any outcomes over longer term (3-12 months) off treatment. No trials examined the effect of corticosteroids on disease progression. The role of corticosteroids in hand osteoarthritis is limited.
A very common problem that is not often covered in trials.
Oral corticosteroids may help but not much and probably not enough to justify the risks.
This paper presents findings that will be useful in discussions with patients showing that steroids 'might' improve things in the short term but not the medium or long term.
This review looked at 13 articles on steroids in hand OA. It showed that in 245 patients, oral steroids were helpful for 4-6 weeks but the benefit did not extend any longer, and intra-articular steroids were not beneficial even at 4-6 weeks in 550 patients.
Given the absence of effective therapies for hand OA, using low-dose oral GCs has gained popularity given the results of a well-designed RCT recently published. These results offer a note of caution to explore long-term outcomes.
Since 1949 when Hench and colleagues announced the dramatic effects of cortisone on rheumatoid arthritis, PROS and CONS have continued. This meta-analysis shows that step-by-step clarification is needed for the phenotypes of osteoarthritis, the placebos used, the administration routes, and the time given.