HealthDay News –  Spironolactone, a potent aldosterone blocker, is known to have antiinflammatory properties. It has been suggested as a potential therapeutic option for patients with knee osteoarthritis (OA).  In a new parallel-group, randomized, placebo-controlled, double-blind, proof-of-concept trial of older adults, researchers assessed whether spironolactone treatment would result in symptom and quality-of-life improvements. The results were recently published in Arthritis Care & Research.

Marion E.T. McMurdo, MBChB, MD, from Ninewells Hospital and Medical School in Dundee, U.K., and colleagues conducted a randomized trial involving individuals aged ≥70 years with symptomatic knee OA. Eighty-six participants were randomized to 12 weeks of 25 mg daily oral spironolactone or placebo.

The researchers observed no significant improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score between the groups (P = .19). Furthermore, no improvements were seen in WOMAC stiffness score (P = .58), WOMAC physical function score (P = .98), or EuroQol 5-domain 3L score (P = .34). 

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The groups did not differ significantly in terms of cortisol, matrix metalloproteinase 3, and urinary C-telopeptide of type II collagen. The spironolactone group had more minor adverse events (47 vs 32), but there was no increase in death or hospitalization.

“Spironolactone did not improve symptoms, physical function, or health-related quality of life in older people with knee OA,” the authors write.

Summary and Clinical Applicability

Spironolactone was not shown to improve WOMAC pain scores at 12 weeks post-treatment as compared to placebo in this double-blind study of older patients with knee OA.

Limitations and Disclosures

This study did not specifically assess efficacy of spironolactone according to OA disease phenotype, including degrees of joint inflammation. Stratification of patients according to degree of chronic inflammation or presence of chronic synovitis may yield data on particular groups of patients who may have favorable responses to spironolactone.

It should also be noted that 47 adverse events occurred in the spironolactone treatment group as compared to 32 in the placebo group.

Supported by Arthritis Research UK.

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Mcmurdo ME, Sumukadas D, Donnan PT, et al. Spironolactone for People Age 70 Years and Older With Osteoarthritic Knee Pain: A Proof-of-Concept Trial. Arthritis Care Res (Hoboken). 2016;68(5):716-21.