Thumb Osteoarthritis Clinical Trial
— CASITOAOfficial title:
Comparison of the Efficacy of Intra-Articular Corticosteroid Injections Versus Saline Solution for Thumb Osteoarthritis: Multicentric Double-Blind Pragmatic Randomized Pilot Study
Thumb osteoarthritis or trapeziometacarpal osteoarthritis (TMO) is a common and painful form of hand arthritis that limits thumb mobility and hand function, affecting patients' quality of life. Although corticosteroids injections are a typical treatment, their effectiveness has been challenged, and side effects have been reported. Recent studies suggest that saline injections, usually considered inactive, might be a viable treatment option. The primary goal of this study is to compare the effectiveness of saline injections versus corticosteroids injections in reducing TMO-related pain and improving hand function. In this study, 40 people with TMO will be randomly assigned to receive either a corticosteroids or a saline injection, without them or the doctors performing the injection knowing which one was administered (double blind). If saline injections prove more effective, they could provide a less harmful and cheaper therapeutic alternative for TMO patients.
Status | Not yet recruiting |
Enrollment | 40 |
Est. completion date | December 31, 2028 |
Est. primary completion date | December 31, 2027 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - aged =18 years - diagnosis of TMO was confirmed by X-ray - suffering from pain at the base of the thumb - the attending physician deems that an intra-articular corticosteroid injection would be beneficial, rather than opting for other types of intervention such as surgery - can read, understand and respond in French or English. Exclusion Criteria: - having received one or more corticosteroid injections in the last 12 months or surgery on the affected thumb; - suffering from painful thumb caused by a trauma (e.g., fracture, sprain), rheumatoid arthritis, or De Quervain's tendonitis; and - being unable to provide informed consent due to physical or mental incapacity. |
Country | Name | City | State |
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n/a |
Lead Sponsor | Collaborator |
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Université du Québec à Trois-Rivières | Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Centre hospitalier de l'Université de Montréal (CHUM), Les Cliniques MSK, McGill University, Université de Montréal, Université de Sherbrooke |
Altman RD, Devji T, Bhandari M, Fierlinger A, Niazi F, Christensen R. Clinical benefit of intra-articular saline as a comparator in clinical trials of knee osteoarthritis treatments: A systematic review and meta-analysis of randomized trials. Semin Arthritis Rheum. 2016 Oct;46(2):151-159. doi: 10.1016/j.semarthrit.2016.04.003. Epub 2016 Apr 27. — View Citation
Ayub S, Kaur J, Hui M, Espahbodi S, Hall M, Doherty M, Zhang W. Efficacy and safety of multiple intra-articular corticosteroid injections for osteoarthritis-a systematic review and meta-analysis of randomized controlled trials and observational studies. Rheumatology (Oxford). 2021 Apr 6;60(4):1629-1639. doi: 10.1093/rheumatology/keaa808. — View Citation
Dahaghin S, Bierma-Zeinstra SM, Ginai AZ, Pols HA, Hazes JM, Koes BW. Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study). Ann Rheum Dis. 2005 May;64(5):682-7. doi: 10.1136/ard.2004.023564. Epub 2004 Sep 16. Erratum In: Ann Rheum Dis. 2005 Aug;64(8):1248. — View Citation
Hamasaki T, Choiniere M, Harris PG, Bureau NJ, Gaudreault N, Patenaude N. Biopsychosocial factors associated with pain severity and hand disability in trapeziometacarpal osteoarthritis and non-surgical management. J Hand Ther. 2023 Jul-Sep;36(3):647-657. doi: 10.1016/j.jht.2022.10.001. Epub 2023 Mar 12. — View Citation
Hamasaki T, Laprise S, Harris PG, Bureau NJ, Gaudreault N, Ziegler D, Choiniere M. Efficacy of Nonsurgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review. Arthritis Care Res (Hoboken). 2020 Dec;72(12):1719-1735. doi: 10.1002/acr.24084. Epub 2020 Nov 7. — View Citation
Loudon K, Treweek S, Sullivan F, Donnan P, Thorpe KE, Zwarenstein M. The PRECIS-2 tool: designing trials that are fit for purpose. BMJ. 2015 May 8;350:h2147. doi: 10.1136/bmj.h2147. No abstract available. — View Citation
Meenagh GK, Patton J, Kynes C, Wright GD. A randomised controlled trial of intra-articular corticosteroid injection of the carpometacarpal joint of the thumb in osteoarthritis. Ann Rheum Dis. 2004 Oct;63(10):1260-3. doi: 10.1136/ard.2003.015438. — View Citation
Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR Jr, Yanke AB, Cole BJ. The Therapeutic Effect of Intra-articular Normal Saline Injections for Knee Osteoarthritis: A Meta-analysis of Evidence Level 1 Studies. Am J Sports Med. 2017 Sep;45(11):2647-2653. doi: 10.1177/0363546516680607. Epub 2016 Dec 27. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Rate of participant recruitment | The number of participants recruited per week, divided by those assessed for eligibility and those included | Through study completion (estimated time, 1 year) | |
Other | Rate of participants completing the initial assessment | The number of participants completing initial assessments, divided by those recruited | Through study completion (estimated time, 1 year) | |
Other | Rate of participants receiving the injection | The number of participants receiving the injection, divided by those recruited | Through study completion (estimated time, 1 year) | |
Other | Rate of participants completing the follow-ups | The number of participants completing the follow-ups at 1, 3, and 6 months, divided by those recruited | Through study completion (estimated time, 1 year) | |
Other | Success of blinded procedures for patients | Success of blinded procedures for patients will be investigated by asking them to guess which treatment they will have received via the post-injection questionnaire. Three response categories for treatment guess are 'corticosteroid injection', 'saline injection', or 'I don't know', after the last follow-up). | 1, 3, and 6 months after receiving the injection | |
Other | Success of blinded procedures for clinicians | Success of blinded procedures for physicians will be by asking them by email after the injection to guess which treatment they administered. Three response categories for treatment guess: 'corticosteroid injection', 'saline injection', or 'I don't know'. | Up to 24 hours after each injection | |
Other | Hospital Anxiety and Depression Scale | 14-item questionnaire to assess anxiety and depression symptoms among non-psychiatric patients. It generates an Anxiety score and a Depression one from 0 to 21 where a higher score indicates greater distress. Anxiety Scores = 10 and Depression Scores = 7 are considered clinically significant. | Baseline, 1, 3, and 6 months after injection | |
Other | Adverse events | Side effects will be reported systematically by using a questionnaire with 5 items assessing the presence, type, frequency, severity and duration of injection-related adverse events. | 24 hours after the injection and at 1-month, 3-month- and 6-month post-injection. | |
Primary | Trapeziometacarpal pain intensity | Three types of pain intensity (current, on the average in the last 7 days, at its worst in the last 7 days) will be measured using a 0-10 rating scale (0 = no pain and 10 = worst pain possible) | Baseline, 1, 3, and 6 months after injection | |
Secondary | QuickDASH questionnaire (short version of the 30-item Disabilities of the Arm, Shoulder and Hand). | 11-item questionnaire assesses the level of physical function and symptoms among patients with upper limb musculoskeletal condition. The total score ranges from 0 to 100 and the higher it is, the more disabled is the patient. | Baseline, 1, 3, and 6 months after injection |
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