I personally find hand OA, and particularly erosive hand OA, to be the most disappointing condition we treat. Patients have pain and disability sometimes equal to RA and to date, we can do very little to help them apart from analgesics.
On the final day of EULAR, there was a session on hand OA including 2 RCTs evaluating potential therapies. For the subset of patients with EHOA, there have been pilot studies on biologics including anakinra, adalimumab and infliximab with mixed results, although more detail was not discussed.
A randomized trial from Korea looked at the efficacy and safety of GCSB-5, a mixture of six purified Oriental herb extracts, which showed a modest improvement in pain scores. Unlikely to be a significant addition to our treatment protocols, in my opinion.
An RCT of HCQ from The Netherlands studied 202 patients with primary hand OA treated with HCQ 400mg per day vs placebo for 24 weeks. The primary outcome was VAS pain score. In a nutshell, it was a negative trial with no difference in pain scores between groups. The authors suggested it should not be used in primary hand OA but more studies are needed in other subsets.
This would fit with my clinical experience. I have prescribed Plaquenil on several occasions for those very symptomatic patients who can hardly believe there is nothing I can offer to them. It has not been effective despite my hopes for maybe even a placebo effect.
I think it is time to stop beating this dead horse and focus on the development of something completely new that will be a DMOAD. Hopefully not too much to ask for in an era where we have so many exciting options for inflammatory arthritis!
Arrivederci from Roma.
Dr. Shelley Dunne is a graduate of Memorial University of Newfoundland School of Medicine. She completed her training in Internal Medicine and a fellowship in Rheumatology at the University of Toronto. She has been in private practice since 1998 and is currently a consulting rheumatologist at the Toronto East General Hospital.View Full Bio