Osteoarthritis Hand, Osteoarthritis Wrist
Conditions
Brief summary
The purpose of this research is to compare low-dose radiotherapy to corticosteroid injection for treatment of hand/wrist osteoarthritis.
Interventions
DRUGCorticosteroid injection (CSI)
A maximum of 3 joints will be treated with standard a standard combination of methylprednisolone and lidocaine: * 1st Carpometacarpal (CMC) joint - 20 mg methylprednisolone/0.5 mL 1% lidocaine\* * Radiocarpal (RC) joint - 40 mg methylprednisolone/1 mL 1% lidocaine\* * Scaphotrapeziotrapezoidal (STT) joint - 20 mg methylprednisolone/0.5 mL 1% lidocaine\* * Metacarpophalangeal (MCP) joint - 20 mg methylprednisolone/0.5 mL 1% lidocaine * Interphalangeal (IP) joint - 10 mg methylprednisolone/0.25 mL 1% lidocaine
RADIATIONLow-dose radiotherapy (LDRT)
Subjects will be treated with low-dose radiotherapy of 300cGy in 6 fractions, 2-3 times per week on non-consecutive days. Non-responders to the initial LDRT treatment will receive a second treatment course of 300cGy in 6 fractions to be given 2-3 times per week on non-consecutive days.
Sponsors
Mayo Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient at Mayo Clinic, Rochester, MN * Age 50 years or older * Mild, moderate, or severe hand OA (Kellgren and Lawrence classification grade 2, 3, or 4) on hand radiographs within the last 24 months * Hand OA pain with a minimum VAS score relating to hand pain of ≥40 (on a 100-point scale) when using the affected hand * Ability to complete study questionnaires
Exclusion criteria
* History of previous surgery to the affected hand(s) * Autoimmune joint disease such as rheumatoid arthritis or psoriatic arthritis * Active confounding hand condition such as stenosing tenosynovitis or Dupuytren's contracture * Recent injury (within last 1 month) to the affected hand causing current pain * History of crystalline arthritis (gout or pseudogout) flare in the affected hand(s) * Active use of opioid pain medication(s) or oral steroids within the last 3 months * Fibromyalgia or central sensitization syndrome * Hand CSI or other hand injection within the past 3 months * History of hand LDRT within the past 3 months * Poorly controlled diabetes (HbA1c \> 10%) * Active infection * Current pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Visual Analog Scale (VAS) score | Baseline, monthly for 6 months post-intervention, 9 months post-intervention, 12 months post-intervention | Pain values reported by participants will be assessed using the 100-mm Visual Analogue Scale (VAS). The VAS line will be 100 mm long with no intermediate delineations. Each end will be marked with "no pain" on the left, and "worst possible pain" on the right. Participants will identify their pain level by indicating a point on the line between each end. That point will be measured from the "No pain" end, and the number of millimeters will be reported as the pain score. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Cochin Hand Function Scale scores | Baseline, monthly for 6 months post-intervention, 9 months post-intervention, 12 months post-intervention | The Cochin Hand Function Scale (CHFS) uses an 18-item, 5-point Likert scale (0 to 5) for scoring, where higher scores indicate greater difficulty with hand function. Scores range from 0 (no difficulty) to 90 (impossible to complete) by summing the ratings for all 18 items. This scale measures the ability to perform daily activities related to the hand, such as kitchen tasks, dressing, and hygiene. |
| Change in analgesic medication use | Baseline, monthly for 6 months post-intervention, 9 months post-intervention, 12 months post-intervention | Change in analgesic medication use will be assessed using the Qualitative Analgesic Questionnaire \[QAC\]. The QAC is a 3 question self-report survey tracking current use of pain medications. |
| Patient experience, as measured by Was It Worth It questionnaire | 6 months and 12 months post-intervention | The Was It Worth It questionnaire is a 4-question survey consisting of yes/no questions regarding the treatment experience. The greater number of questions with a 'yes' response indicate a higher level of patient satisfaction. |
Countries
United States
Contacts
CONTACTTochukwu Iyke-Nzeocha
CONTACTMelissa Wang, M.A., CCRP
PRINCIPAL_INVESTIGATORTerin Sytsma, MD
Mayo Clinic
Outcome results
None listed