Lancet

Methotrexate beneficial in hand osteoarthritis with synovitis

November 10, 2023

For patients with hand osteoarthritis and synovitis, methotrexate offers a viable treatment option for moderate pain reduction within 6 months, with no increase in adverse events, according to findings from an Australian RCT.

• The study included 97 participants ages 40 to 75 with hand osteoarthritis (Kellgren and Lawrence grade ≥2 in at least one joint) and MRI-detected synovitis of grade 1 or more who were recruited from Melbourne, Hobart, Adelaide, and Perth, Australia. 
• Participants were randomly assigned to receive methotrexate 20 mg (50 patients) or identical placebo (47 patients) once weekly for 6 months.
• The primary outcome was pain reduction in the study hand at 6 months; 84% of the participants in methotrexate group and 85% in the placebo group provided primary outcome data.
• The mean change in visual analogue scale pain at 6 months was −15.2 mm in the methotrexate group and −7.7 mm in the placebo group, with a mean between-group difference of −9.9 and effect size of 0.45.
• Adverse events occurred in 62% of the methotrexate and 60% of placebo group participants.

Source:

Wang Y, et al. (2023, October 12). Lancet. Methotrexate to treat hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial. https://pubmed.ncbi.nlm.nih.gov/37839420/