Doctor, I have osteoarthritis in my hands. Are steroids helpful for this condition?

Corticosteroids pills may improve hand pain and function for people with osteoarthritis, but the improvement is small to moderate and only lasts a few weeks. Due to the adverse effects of taking corticosteroid pills, this treatment is likely not the best choice for most people with this type of hand arthritis.

What is the evidence?

SUMMARY OF FINDINGS

Corticosteroids vs placebo or another treatment

Group and Outcome	No. of studies	Effect	Quality of Evidence
Short-term pain (4 to 6 weeks)
Oral	3	moderate reduction in pain compared to placebo	2 out of 3 studies low risk of bias*
Injection	5 out of 10	no effect on pain	1 out of 5 studies low risk of bias
Short-term function (4 to 6 weeks)
Oral	3	small improvement in function compared to placebo	2 out of 3 studies low risk of bias
Injection	2 out of 6	no effect on function	0 out of 2 studies low risk of bias
Intermediate pain (12 to 14 weeks)
Oral	2 out of 3	no effect on pain	2 out of 2 studies low risk of bias
Injection	3 out of 6	no effect on pain	1 out of 3 studies low risk of bias

*low risk of bias = low risk that the study has method or design errors that would affect the accuracy of the results

What kind of study was this?

This was a systematic review of 13 randomized controlled trials published up to October 2021.

Who? This review included 780 adults (average age 58; proportion of women ranged from 73 to 100%) with osteoarthritis in the joints of their fingers or thumb. People with other types of arthritis such as rheumatoid arthritis were excluded.

What? The reviewers included studies that compared corticosteroids with placebo or another treatment for osteoarthritis in the hand.

Corticosteroids	vs	<Placebo/Usual care/another treatment>
Oral Corticosteroids: prednisolone pills (doses ranging from 3 to 10 mg for 4 to 6 weeks) taken by mouth (3 studies) Intra-articular Corticosteroids: triamcinolone, methylprednisolone, or betamethasone (or combination of one of these steroids plus lidocaine) injections (single injection or injections once a week for 1 to 3 weeks) into the painful joint (9 studies) Follow-up of patients after treatment ranged from 1 to 12 months.		Placebo: A pill/needle/lotion containing an inactive substance that has no effect on the outcome. Sometimes, it is referred to as a "sugar pill." Another treatment: injections of platelet-rich plasma, hyaluronic acid, dextrose, lidocaine, or saline (all of the oral corticosteroid studies used placebo as the control group)

Corticosteroids

Oral Corticosteroids: prednisolone pills (doses ranging from 3 to 10 mg for 4 to 6 weeks) taken by mouth (3 studies)

Intra-articular Corticosteroids: triamcinolone, methylprednisolone, or betamethasone (or combination of one of these steroids plus lidocaine) injections (single injection or injections once a week for 1 to 3 weeks) into the painful joint (9 studies)

Follow-up of patients after treatment ranged from 1 to 12 months.

Placebo: A pill/needle/lotion containing an inactive substance that has no effect on the outcome. Sometimes, it is referred to as a "sugar pill."

Another treatment: injections of platelet-rich plasma, hyaluronic acid, dextrose, lidocaine, or saline (all of the oral corticosteroid studies used placebo as the control group)

Why was this research done?

Corticosteroids are medications that reduce inflammation. They can be effective at reducing pain and improving function in the types of arthritis that are caused by the immune system such as rheumatoid arthritis or psoriatic arthritis. Osteoarthritis is not typically caused by inflammation caused by the immune system. Instead, it is a type of "wear and tear" arthritis that occurs when the cushion (cartilage) between the bones in a joint wear down over time and allows the bones to rub together.

The reviewers wanted to know if corticosteroids would reduce pain and improve function in people with osteoarthritis in the hand. They found that corticosteroid pills improved short-term pain and function by a small to moderate amount, but the improvement only lasted a few weeks. There did not appear to be any benefit from the corticosteroid injections. Because the adverse effects of taking corticosteroids can be serious, these drugs are likely not the best choice for people with this type of arthritis. A major concern about this review was the difference in dose and duration of the corticosteroid injections which made combining the results unreliable.

This Evidence Summary is based on the following article:

Estee MM, Cicuttini FM, Page MJ, et al. Efficacy of corticosteroids for hand osteoarthritis - a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2022 Jul 13;23(1):665. doi: 10.1186/s12891-022-05619-9. PubMed

Published: Monday, October 31, 2022

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.

This Evidence Summary was printed from the PAIN+ CPN website on 2024/11/21.

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