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Background: Inflammation is thought to play an important role in hand osteoarthritis (HOA), which is associated with pain and increased limitation of hand function. Objectives: To explore the acceptability of therapy with intramuscular methylprednisolone in HOA among health-care providers (HCPs) and HOA patients. Additionally, the response to a single methylprednisolone injection was investigated. Design: We adopted a mixed-methods design. Methods: In a qualitative study, we asked HCPs and patients for their acceptability of intramuscular methylprednisolone. A prospective observational study was performed afterward in HOA patients who received a single 120-mg intramuscular methylprednisolone injection as part of off-label administration. Average pain, functional impairment, and occurrence of adverse events were assessed at baseline and at 4, 8, and 12 weeks after the injection. Results: Fourteen HCPs and 15 patients participated in the first part of the study. They considered intramuscular methylprednisolone potentially effective, yet expressed concerns about the risk for long-term adverse events. Among the 22 HOA patients who received intramuscular methylprednisolone, 13 patients reported 44 adverse events, with half of them occurring within the first 4 weeks after injection and being classified as nonserious. Mean hand pain decreased the most 4 weeks after injection and this effect persisted till week 12, though less pronounced. Similar results were seen with HOA-related functional impairment, which improved the most at week 4 and to a lesser extent at week 12. Conclusion: We found a good acceptability of intramuscular methylprednisolone treatment among HCPs and HOA patients, as well as a potential to reduce pain and improve hand function with a good safety profile for as long as 12 weeks after a single administration.
Use of methylprednisolone in the muscle for hand osteoarthritis patients: a feasibility study to inform a randomized controlled trial Hand osteoarthritis is very common among adults and older people, and being characterized by high levels of pain, stiffness and decreased function of the hand. Therapeutic options for hand osteoarthritis are limited. Methylprednisolone is sometimes used in clinical practice with good results. However, these results are mainly based on the experience of the physicians and do not rely on properly performed studies. That is why we intend to finally perform such a study. But before starting that, we wanted to see if patients with hand osteoarthritis and healthcare providers would accept the idea of injecting methylprednisolone into the buttocks muscle for the treatment of hand osteoarthritis. That is why we performed interviews with patients and healthcare providers, which brought up six factors to think about when discussing this therapeutic option: how well it works, how safe it is, the overall situation of the patient, how it's given, use of shared decision-making and logistics aspects. Next to this, we examined the effect of methylprednisolone over time on pain and function of the hands, as well as the frequency and nature of side effects. We found a decrease in hand pain and an improvement in hand function persisting for 12 weeks after just one methylprednisolone injection. Half of the patients reported side effects, but they all were non-serious. Eventually, we concluded that the use of methylprednisolone as an injection in the buttocks muscle for the treatment of hand osteoarthritis is accepted by both patients and health-care providers, and could be a safe and helpful therapy. The results will be used in the next study designed to assess the effect and safety of this therapy in a much larger group of patients with hand osteoarthritis.
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Background: A large proportion of patients with angina and no obstructive coronary artery disease (ANOCA) has underlying coronary vasomotor dysfunction (CVDys), which can be diagnosed by a coronary function test (CFT). Coronary tortuosity is a common angiographic finding during the CFT. Yet, no data exist on the association between vasomotor dysfunction and coronary tortuosity. Aim: To investigate the association between CVDys and coronary tortuosity in patients with ANOCA Methods: All consecutive ANOCA patients who underwent clinically indicated CFT between February 2019 and November 2020 were included. CFT included acetylcholine spasm testing to diagnose epicardial or microvascular spasm, and adenosine testing to diagnose microvascular dysfunction (MVD). MVD was defined as an index of microvascular resistance (IMR) ≥ 25 and/or coronary flow reserve (CFR) <2.0. Coronary tortuosity, was scored (no, mild, moderate or severe) based on the angles of the curvatures in the left anterior descending (LAD) artery on angiography. Results: In total, 228 patients were included (86% female, mean age 56 ± 9 years). We found coronary artery spasm in 81% of patients and MVD in 45% of patients (15%: abnormal CFR, 30%: abnormal IMR). There were 73 patients with no tortuosity, 114 with mild tortuosity, 41 with moderate tortuosity, and no patients with severe tortuosity. No differences were found in cardiovascular risk factors or medical history, and the prevalence of CVDys did not differ between the no tortuosity, mild tortuosity and moderate tortuosity group (82, 82, and 85%, respectively). Conclusion: In this study, CVDys was not associated with coronary tortuosity. Future experimental and clinical studies on the complex interplay between coronary tortuosity, wall shear stress, endothelial dysfunction and coronary flow are warranted.
