A randomized, double-blind clinical trial by researchers at Hospital for Special Surgery has revealed that corticosteroids are more effective than the more expensive treatment, hylan G-F 20 (Synvisc One, Genzyme Biosurgery), in providing pain relief to patients with thumb arthritis. The study also showed that both of these commonly used treatments provided clinically meaningful pain relief, but so did a placebo injection.
"On average, each of the therapies resulted in clinically meaningful improvement in pain," said Lisa Mandl, M.D., MPH, a rheumatologist at Hospital for Special Surgery, in New York City, who led the study. "What this study suggests is that a number of different injectable treatments might be effective for patients who have pain in their thumb and that the one that appeared to be the most effective was corticosteroids." The study will be reported at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals, to be held Nov. 9-14, in Washington D.C.
The new study is the first large randomized clinical trial in patients with carpometacarpal (CMC) osteoarthritis (thumb arthritis). The study compared a placebo, an injection of a local anesthetic called bupivacaine, with two commonly used injectable treatments: a corticosteroid called triamcinolone acentoide and hylan G-F 20, which is made from a natural substance that lubricates and decreases inflammation in the joints. CMC osteoarthritis, caused by regular wear and tear, is common in individuals over 60. It occurs in 80% of women who are 80 years of age or older.
The researchers enrolled 200 patients with thumb arthritis and randomized them to receive bupivacaine, hylan G-F 20, or triamcinolone. The average age of patients in the study was 66.5 and roughly 70% were female. Over the 26-week study, pain, as measured by the Visual Analogue Scale (VAS), showed a statistically and clinically significant improvement in all
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Hospital for Special Surgery