6 months of 20 mg Methotrexate can improve significant early hand OA by 25%.
Wang, Yuanyuan, et al.
Methotrexate to treat hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial.
The Lancet 402.10414 (2023): 1764-177
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01572-6/fulltext
- pain at least 4/10 and involving thumb and phalanges and imaging evidence of active synovitis
- 1/2 were on NSAIDs
- started with 1 month methotrexate 10 mg then 20 mg thereafter
- Folic acid 5 mg/day
Results:
- prior studies using 10 mg and 3 months did not show results but this does.
- Have to start early to have any effect (same for Rheumatoid arthritis though)
- White blood counts and liver functions need monitoring but lower WBC counts were just as common in placebo group (still, need to stop methotrexate).
Comment- were told no treatments for OA hands but studies never went long enough. Getting pain under 4/10 is low enough to ignore some of time…