NEW YORK — Injections of high molecular weight hyaluronan were as effective as corticosteroids in alleviating pain associated with arthritis of the trapeziometacarpal joint, Shalom Stahl, M.D., reported at the annual meeting of the American Society for Surgery of the Hand.
Trapeziometacarpal joint arthritis is a disabling condition that presents with pain at the base of the thumb, causing impairment of hand function. Early disease is usually treated conservatively with splints, rest, and nonsteroidal anti-inflammatory drugs.
Occasionally, intraarticular injections of corticosteroids also are given, but this treatment has unpredictable efficacy and the potential for adverse events, such as infection and subcutaneous fat degeneration, that can cause additional disability, Dr. Stahl said.
High molecular weight hyaluronan (Orthovisc) is indicated for the relief of pain in knee osteoarthritis.
It is intended to restore the viscoelastic properties of the joint lining in patients who are in the early stages of osteoarthritis, said Dr. Stahl of the hand surgery unit, Rambam Medical Center, Haifa, Israel.
A total of 52 patients with grade 2 trapeziometacarpal joint arthritis were prospectively randomized to injections of 40 mg methylprednisolone acetate or 15 mg hyaluronate.
Patients were evaluated for pain severity, pinch and grip strength, and function before injection and 1, 3, and 6 months later.
Both groups experienced similar degrees of pain reduction. In the corticosteroid group, pain evaluated on a visual analog scale fell from a mean of 4.5 to 2.8; in the hyaluronate group, it decreased from 4.2 to 2.3.
Grip strength improved significantly throughout the 6-month follow-up period in the corticosteroid group but only at the 6-month point in the hyaluronate group.
Pinch strength, considered a proxy for functional improvement, improved at 6 months in the hyaluronate group but not in the corticosteroid group.
“Additionally, a significant improvement in the three-point pinch, lateral pinch, and physical performance test has been observed in the Orthovisc group starting at 3 months' follow-up,” Dr. Stahl said.
“We believe that sodium hyaluronate actually works on the basic process of the degenerative arthritic changes, whereas the corticosteroid addresses only the inflammatory component,”Dr. Stahl said.