Adalimumab was not superior to placebo for relieving pain in patients with osteoarthritis of the hands.
Osteoarthritis is a condition that makes a person’s joints stiff and painful, particularly in the morning. It is caused by thinning of the cartilage within the joints, which allows the bones to rub against each other. It is the most common of all the different types of arthritis, increasing as people get older. Osteoarthritis of the hands is very common and typically affects middle-aged women and the elderly. A large number of people with hand osteoarthritis experience high levels of pain and disability despite treatment with drugs or exercise or physiotherapy programmes (these are sometimes called refractory patients). It is thought that this may be caused by erosions in the joints, or possibly underlying inflammation. Biologic drugs such as adalimumab are used in many autoimmune diseases such as rheumatoid arthritis where they act to reduce inflammation in the joints. Adalimumab targets TNF (tumour necrosis factor), a cytokine molecule that is involved in inflammation and the breakdown of cartilage.
WHAT DID THE AUTHORS HOPE TO FIND?
There are not very many treatments available for people with refractory osteoarthritis in their hands. The authors hoped to see whether adalimumab could have an effect in these patients and help to relieve their pain. They also wanted to know whether it could reduce swelling and stiffness, and make it easier for patients to use their hands.
WHO WAS STUDIED?
The study included 85 patients with osteoarthritis in their hands that had not got better with previous treatment with pain killers or non-steroidal anti-inflammatory drugs (NSAIDs). All patients were aged between 40 and 80 and had suffered from osteoarthritis in at least three joints in their hands for more than 3 months with no relief from pain killers or NSAIDs.
HOW WAS THE STUDY CONDUCTED?
This was a randomised, placebo-controlled trial, which means that patients were assigned by chance to one of two treatment groups to receive either adalimumab (the active medicine) or placebo (a dummy that has no active medicine in it). Using chance in this way means that the groups will be similar and will allow the variable or treatment under investigation to be compared objectively. During the treatment neither patients nor their doctors knew which group they were in. The study took place at 16 hospitals across France over 26 weeks.
WHAT WERE THE MAIN FINDINGS OF THE STUDY?
The study found no difference between adalimumab and placebo for relieving pain and improving function in patients with hand osteoarthritis, although there was a slightly better improvement in the number of swollen joints in the adalimumab group, but the difference was very small. This suggests that TNF is not the right target in order to improve symptoms in hand osteoarthritis.
ARE THESE FINDINGS NEW?
There have been other similar small trials of adalimumab in patients with inflammatory hand osteoarthritis, but this is the first time that pain relief has been considered as the main objective.
HOW RELIABLE ARE THE FINDINGS?
There are several limitations in the study. Patients received only two injections, which could be too few to see an effect or draw meaningful comparisons, although in inflammatory conditions a quick response is usually seen after treatment with biologic drugs. The study looked for a 50% improvement in pain, which might have been too high – a lower level of improvement might have been achieved.
WHAT DOES THIS MEAN FOR ME?
If you have hand osteoarthritis that does not respond to traditional pain killers, NSAIDs or exercise and physiotherapy you may feel that your disease is neglected or that nothing can be done for you. Although the results of this trial were not positive, there are other studies underway to try to find treatments that can relieve the pain and disability caused by hand osteoarthritis, and it is hoped that there will be more options for you in the future.
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Date prepared: September 2015
Summary based on research article published on: 9th May 2014
From: Chevalier, X. et al. Adalimumab in patients with hand osteoarthritis refractory to analgesics and NSAIDs: a randomised, multicentre, double-blind, placebo-controlled trial. Ann Rheum Dis 2015;74: 1697–1705. doi:10.1136/annrheumdis-2014-205348LaySummary
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