A 6-week course of prednisolone does not impact serum biomarkers related to tissue turnover and inflammation in patients with hand osteoarthritis (OA), suggesting that prednisolone may not directly impact the disease process, but may alleviate disease-related symptoms, according to findings published in Rheumatology (Oxford).

Researchers conducted a randomized, double-blind, placebo-controlled trial that compared serum biomarkers in 40 patients with symptomatic hand OA who received prednisolone 10 mg for 6 weeks with 38 control patients who received placebo 10 mg for 6 weeks. The patients received a tapered dosage for an additional 2 weeks until discontinuation. Follow-up lasted 14 weeks.

The researchers collected serum samples at baseline, 6 weeks, and 14 weeks. They measured biomarkers indicative of cartilage turnover, bone turnover (C1M), connective tissue turnover and inflammation (CRPM, VICM, and hsCRP).


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They also measured disease characteristics, including pain on the visual analog scale, synovial thickening and sum scores as denoted by ultrasonography, and the presence of erosive OA as defined by a patient having 1 finger joint in the Verbruggen-Veys erosive or remodeling phase. Of the 78 study patients, 71% had erosive OA.

After 6 weeks, the researchers did not observe any significant changes or differences in serum biomarkers between the prednisolone and placebo groups. Serum biomarkers did not correlate with pain levels or synovial thickening. Factors such as age, sex, or body mass index did not influence the results.

One notable association was that patients with erosive hand OA had higher serum levels of C1M (geometric mean ratio, 1.24; 95% CI, 1.03-1.49) and hsCRP (mean ratio, 1.91; 95% CI, 1.19-3.06) than the patients with non-erosive OA.

Levels of VICM increased slightly in the prednisolone group after 6 weeks compared with the placebo group. Patients who responded to prednisolone treatment demonstrated lower baseline levels of CRPM compared with non-responders. OMERACT-OARSI criteria determined patient response to prednisolone treatment.

Limitations of the study include the small sample size and a possible lack of inclusion of all relevant biomarkers.

“None of the markers of cartilage, connective tissue, or inflammation were affected by treatment with prednisolone, only VICM levels increased slightly,” the study authors conclude. They add, “This may indicate that a short course of prednisolone has a limited direct effect on tissue remodeling, and acts solely as a symptom modifying drug.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

van de Stadt LA, Kroon FPB, Thudium CF, Bay-Jensen AC, Kloppenburg M. Serum biomarkers in prednisolone treated hand osteoarthritis patients. Rheumatology (Oxford). Published online August 10, 2022. doi:10.1093/rheumatology/keac442