Response of symptoms and synovitis to intra-muscular methylprednisolone in osteoarthritis of the hand: an ultrasonographic study

OBJECTIVE: To examine the relationship between ultrasound (US)-detected synovial pathology in hand OA and the clinical response to parenteral corticosteroids. METHODS: People with symptomatic OA of the hand completed questionnaires [visual analogue scale (VAS) pain, Australian Canadian Osteoarthritis Hand Index and VAS global] and underwent an US examination of both hands prior to receiving an i.m. dose of methylprednisolone. Four- and twelve-week assessments were performed to assess therapeutic response. RESULTS: Thirty-six subjects with established OA were enrolled. Twenty-four (67%) subjects met the primary end-point of a 20% reduction in VAS pain, 25 (69.4%) met the Osteoarthritis Research Society International response criteria at 4 weeks. Overall in the group, there was a reduction in levels of pain in the most painful joint, pain in all joints and in global disease activity at 4 weeks (P < 0.001, P < 0.001 and P < 0.001, respectively). Reduction in symptoms was not associated with a statistically significant reduction in US-detected synovial hypertrophy or power Doppler signal. CONCLUSIONS: In this observational study, parenteral corticosteroids were associated with a statistically significant reduction in symptoms, but no statistically significant reduction in US-detected synovial inflammation. The latter finding may, however, reflect the relatively low levels of synovial inflammation detected ultrasonagraphically in hand joints.