Key Takeaways

A small new study shows thatmethotrexate, a medication that’s currently used to treatrheumatoid arthritis (RA) andpsoriasis, could also help reduce symptoms of hand OA, such aspain and stiffness.

“At the moment, if a person goes to the doctor with hand OA, treatments are very limited and do not work well,” study authorFlavia Cicuttini, PhD, a professor and the head of the musculoskeletal unit at Monash University and the rheumatology department at Alfred Hospital, both in Melbourne, Australia, told Verywell. “Often patients are told there is nothing much doctors can offer them.”

Symptoms of Hand OA

How Effective Was Methotrexate?

For the study, 50 patients were given a standard methotrexate dose of 20 milligrams orally once a week, and 47 received a placebo.

The researchers followed the patients for six months. During the first month, the participants’ pain improved in both the placebo and methotrexate groups. However, as time went on, Cicuttini said that while the methotrexate group continued to have less pain, the placebo group did not.

“In the methotrexate group, there was improvement at three months and even more so at six months,” said Cicuttini. “Across the full six months, the improvement in pain in the methotrexate group was twice as much as in the control group.”

Cicuttini hopes the results of the study will encourage providers to consider prescribing methotrexate to patients with significant hand OA symptoms.

How Methotrexate Treats Arthritis

What Does Hand OA Feel Like?

Hand OA is common, especially as peopleget older.

Samantha Muhlrad, MD, MS, chief of Hand Surgery at Stony Brook Medicine in New York, told Verywell that hand OA occurs when a person develops thinning of the smooth cartilage where the joints meet one another, which can lead to painful throbbing.

Muhlrad, who was not involved in the study, explained that the current treatments for osteoarthritis only target symptoms—none can slow or stop the progression of the disease. The recent study did not show methotrexate was any different. Evidence just suggests it can also help with hand pain symptoms.

“It’s exciting because methotrexate is generally used to treat rheumatoid arthritis or other types of inflammatory arthritis, but not osteoarthritis,” said Muhlrad. “We’re starting to see it could be effective for that.”

Why Is Hand OA Hard to Treat?

Cicuttini said that one reason it’s been so hard to find effective treatments for OA is that experts did not understand the causes of the condition until recently.

“We are taught in medical school, and even in specialties such as rheumatology, that osteoarthritis is a degenerative condition that is not inflammatory and that treatments are limited,” said Cicuttini.

However, Cicuttini said that recent research has shown that there is inflammation in people with hand OA, even if their blood tests are normal. That inflammation is also associated with pain and significant joint damage.

Jonathan Samuels, MD, a rheumatologist at NYU Langone Health, told Verywell that another reason why finding OA treatment has been challenging is that, unlike other types of arthritis, there are no disease-modifying treatments that are designed for hand OA.

The symptoms of hand OA can also vary widely from person to person. For example, Samuels said some patients will have no pain while others will have severe pain “and can’t even open a doorknob, use a pencil, or type on the keyboard without discomfort.”

Not only do symptoms vary from patient to patient, but even within the same patient. Samuels said that the disease can “fluctuate in one single patient from time to time, so that’s a challenge.”

Treatments for Hand OA

Is It Possible to Get Methotrexate for Hand OA Right Now?

Although methotrexate is not used to treat osteoarthritis or hand OA, some rheumatologists have been prescribing the drug off-label (which means prescribing it for a purpose other than what the FDA approved it for.)

“In a survey we did before starting our study, we found that many rheumatologists were using methotrexate for hand OA as there was little else to offer patients,” said Cicuttini.

Patients will need to discuss the option with their provider and consider their symptoms, disease progression, and other health considerations.

“As a hand surgeon, I would prefer to try cortisone injections and less oral medications to start, said Muhlrad. “But I do think patients could speak with a rheumatologist about it, and they may be candidates, even if their diagnosis is osteoarthritis.”

Muhlrad also said there are potential risks associated with methotrexate use, includingadverse effectssuch as gastrointestinal issues, nausea, vomiting, loss of appetite, and more serious risks like liver toxicity and low blood count.

While the study did show the possible benefits of methotrexate for people with hand OA, more research is needed to understand this relationship, along with the potential need for approval from the FDA.

“The FDA would have to approve it for that use, which may require more studies,” said Muhlrad. “Even if it is approved as a labeled indication, whether or not individual insurance companies would cover it would be another question.”

What to Know About Finger Osteoarthritis

How to Deal With Hand OA Symptoms

Hand OA is not curable. However, there are some expert-recommended tips for coping with the symptoms:

What This Means For YouResearch has shown that methotrexate can be used off-label to help with symptoms of hand osteoarthritis, but since it’s not FDA-approved for this purpose, you’ll have to talk with your provider about whether it could be an option for you.

What This Means For You

Research has shown that methotrexate can be used off-label to help with symptoms of hand osteoarthritis, but since it’s not FDA-approved for this purpose, you’ll have to talk with your provider about whether it could be an option for you.

3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Osteoarthritis (OA).Arthritis Foundation.Osteoarthritis of the hands.Wang Y, Jones G, Keen HI, et al.Methotrexate to treat hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial.Lancet. Published online October 12, 2023. doi:10.1016/S0140-6736(23)01572-6

3 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Osteoarthritis (OA).Arthritis Foundation.Osteoarthritis of the hands.Wang Y, Jones G, Keen HI, et al.Methotrexate to treat hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial.Lancet. Published online October 12, 2023. doi:10.1016/S0140-6736(23)01572-6

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Centers for Disease Control and Prevention.Osteoarthritis (OA).Arthritis Foundation.Osteoarthritis of the hands.Wang Y, Jones G, Keen HI, et al.Methotrexate to treat hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial.Lancet. Published online October 12, 2023. doi:10.1016/S0140-6736(23)01572-6

Centers for Disease Control and Prevention.Osteoarthritis (OA).

Arthritis Foundation.Osteoarthritis of the hands.

Wang Y, Jones G, Keen HI, et al.Methotrexate to treat hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial.Lancet. Published online October 12, 2023. doi:10.1016/S0140-6736(23)01572-6

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