PICASSO
Treatment of painful inflammatory carpometacarpal-1 osteoarthritis with intra-articular steroids, saline or occupational therapy
Project Manager
ABOUT THE PROJECT
Osteoarthritis of the root joint of the thumb (CMC-1) can cause pain and poor hand function. The treatment options for this patient group are unfortunately limited. All patients should be offered non-medicinal measures such as hand exercise, but only a few receive this type of treatment. There is also limited knowledge about the effect cortisone has for this patient group.
The main aim of the project is to see if cortisone injections are better than saline injections, and if non-drug treatment is as good as cortisone.
The study will have direct consequences for current treatment where, by comparing different treatment alternatives, one will contribute knowledge about which alternatives are both effective and safe.
WHO CAN JOIN?
Recruitment is ongoing.
Adults diagnosed with osteoarthritis in the root joint of the thumb will be eligible for inclusion in the study. The patients will be recruited from six hospitals from all four health regions in Norway.
WHAT DOES THE STUDY INCLUDE?
The study is carried out in two phases:
Phase 1 is a randomized controlled trial with a duration of 6 months. The patients who participate will be randomized into three different groups, where group 1 receives a cortisone injection in the CMC-1 joint, group 2 receives a saline injection (placebo) in the CMC-1 joint, and group 3 receives non-drug treatment with hand exercises and a support splint. Those who receive an injection can repeat it after 3 months, but will not know whether they are receiving cortisone or saline. The main aim of the study is to look at changes in pain after 4 weeks. Sub-goals are to look at changes in pain and hand function after three months and two years, and MRI-defined inflammation after 4 weeks and degree of osteoarthritis and subluxation after 2 years.
Phase 2 is an open study lasting 18 months. Here, all participating patients can receive a cortisone injection if the treating rheumatologist deems it appropriate. Here, the researchers will also study whether repeated injections can have a harmful effect on the joint.