Objective: Hand pain with stiffness is a common clinical presentation to early arthritis clinics, with outcome varying from resolution to the development of rheumatoid arthritis. This study assessed the response and predictors of response to intramuscular methylprednisolone (IM MP) and hydroxychloroquine (HCQ) using a standardised treatment protocol.
Methods: Patients with inflammatory hand pain (IHP), defined as predominant hand pain and morning stiffness of at least 30 minutes duration, received a standardised assessment prior to receiving IM MP. Response (primary outcome) at 4 weeks was a patient perceived 50% improvement in symptoms; responders who relapsed received repeat IM MP and HCQ.
Results: 102 patients recruited; 21% RF positive, 23% clinical synovitis, 25% raised CRP, 55% Ultrasound- detected synovitis. 73% responded, with associated significant reductions in morning stiffness, HAQ, painful and tender joint counts, and patient VAS¡¯s (p¡Ü0.006 for all). US-detected synovitis (p<0.001) and RF (p=0.04), but not clinical synovitis (p=0.74), were significantly associated with response to IM MP. 86% who remained on HCQ long-term reported a benefit.
Conclusions: Patients with IHP have significant improvement of symptoms and function following IM MP. Further placebo controlled trials are required to assess the role of IM MP and ultrasonography in managing this patient group.
- Hand pain