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Can a fairly common drug relieve osteoarthritis?

Photo of a woman

Researchers are investigating whether a drug used for other diseases can relieve hand osteoarthritis in patients who do not receive enough help from current treatment – ​​information, exercise and painkillers.

Caption: The MERINO study could lead to better treatment for osteoarthritis patients in the future, says project manager, Ida Kristin Bos-Haugen. Photo Nicolas Tourrenc/ Diakonhjemmet Hospital

The study, which has been named MERINO, is led by consultant and researcher, Professor Ida Kristin Bos-Haugen. Alexander Mathiessen is responsible for the practical work of data collection and patient recruitment.

Aggressive hand osteoarthritis

Hand osteoarthritis is affecting more and more people. The pain can be severe and everyday tasks difficult. Buttoning buttons with stiff fingers can become impossible.

Bos-Haugen says that the researchers have deliberately selected patients with clear signs of inflammation. They expect that the drug methotrexate may be effective for this group.

– We hope to be able to provide a clearer answer to whether methotrexate can help patients with severe, so-called erosive hand osteoarthritis. It is a more aggressive form of hand osteoarthritis with more inflammation and greater destruction of the joint.

– This is a group that often has a lot of discomfort and limited effect of painkillers and anti-inflammatory medications, she says.

The strict criteria for including patients have made recruitment more demanding. With all patients now in place in the study, this part is complete.

Follows patients for one year

Researchers use the most recognized method to find out if the intervention works. Randomized controlled trial (RCT), considered the gold standard. Randomized means that the participants are randomly assigned, while controlled means that the results are compared with a group that has not received the intervention.

The MERINO study is an RCT with 163 participants. They are randomly assigned to receive methotrexate or something that looks like the drug but isn't (placebo). No one knows who is in which group until the data is analyzed. This allows researchers to investigate whether differences are actually due to the treatment.  

Once the researchers have followed everyone in the study for a year, they can analyze the results.

Studies show improvement

A new systematic review gives MERINO researchers extra motivation. Researchers have collected and reviewed results from six randomized trials, with a total of 602 participants. The results suggest that methotrexate may have a pain-relieving effect in osteoarthritis.

The researchers found pain relief from methotrexate in both knee and hand osteoarthritis. They also found improved function in patients with knee osteoarthritis.

– The findings are promising. At the same time, we need more studies that can confirm these findings. We also need studies that also investigate effects on disease progression measured on X-ray. This is precisely what MERINO is designed to investigate, explains Bos-Haugen.

For better treatment

Methotrexate is a type of chemotherapy drug that is given in higher doses for cancer to prevent uncontrolled cell division. The drug can cause side effects, even though it is given in much lower doses here. Researchers therefore need to be sure before they can recommend this treatment for hand osteoarthritis.

MERINO is the first study that targets only patients with erosive, more severe, hand osteoarthritis.

The researchers are now looking forward to analyzing the material.

“Our ambition is that the results from MERINO will have an impact on patients. If we are successful, we can gain knowledge that can provide better treatment for many patients in the future,” says Bos-Haugen.

Read more about MERINO: www.remedy-senter.no/project/merino 
Read the meta-analysis: www.pubmed.ncbi.nlm.nih.gov/40203990/ 


FACTS: The MERINO study

  • What the study investigates:
    Can methotrexate help patients with severe (erosive) hand osteoarthritis?
  • Study design
    Randomized controlled trial (RCT), with 163 participants.
  • Why the study is important
    No previous studies have included patients with erosive hand osteoarthritis to investigate the effects of methotrexate.
  • Status
    Recruitment is complete. Participants will now be followed for one year before analyses begin.
  • Who is behind
    Diakonhjemmet Hospital, the REMEDY center?
    Professor Ida K. Bos-Haugen, researcher and senior consultant in rheumatology
    Alexander Mathiessen, physician (PhD), is responsible for data collection during the study period.
  • Funding
    The study is funded by South-Eastern Health.
  • Methotrexate
    A drug that reduces inflammation in rheumatic diseases, such as rheumatoid arthritis, gout.
  • Words explained
    • Osteoarthritis: Pain and stiffness in joints.
    • RCT: Study in which participants are randomly assigned to treatment or placebo.
    • Systematic review: Collects and evaluates results from multiple studies.

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