New, less expensive treatment for arthritis

WABC-TV--New York—December 5, 2012

There is a common painful condition that affects women as young as their mid-thirties. Arthritis in their thumb. But now there is a less expensive way to treat it that will help many patients. Dr. Jay Adlersberg has the latest on the new treatment.

Dr. Jay Adlersberg: The less expensive treatment is a cortisone shot but there is a new product called hyaluronic acid or HA, which works well for knee arthritis. It's expensive but some local researchers wondered if it were better than cortisone for an arthritic hand joint, especially the thumb.

Just taking off a bottle cap is tough for Mary Ann Oklesson.

Mary Ann Oklesson: When I go like this just to try and open it, I can't and it hurts.

Dr. Adlersberg: Mary Ann has had severe arthritis for 10 years at the base joint of her thumb and at the wrist. It is the most common place for painful osteoarthritis in the hand. She took part in the study injecting one of these three drugs into the joint.

Mary Ann: Whatever they gave me helped. The results seem to last about a year.

Dr. Adlersberg: Mary Ann had a cortisone or steroid injection. In the study comparing an injection of cortisone called Kenalog, an artificial joint fluid called hyaluronic acid, or HA, or a simple shot of novocaine. Researchers found that all worked about the same, but cortisone, the cheapest, worked better that HA, the most expensive.

Dr. Lisa Mandl: It was statistically, mathematically better and led to clinically meaningful improvement compared to the HA. In other words, patients did actually feel better on the steroid compared to the HA.

Dr. Adlersberg: Mary Ann and the other patients were compared six months after their injections. This is an x-ray of Mary's thumb. Here are two relatively normal joints with about a thirty-second of an inch of space between the bones. This is the bad joint. There is no space left. It's bone on bone rubbing--that's very painful. For arthritic pain, and any finger joint, cortisone has a long track record, not the same for HA or novocaine. But repeated shots of cortisone may damage joints over time, not so with HA or novocaine. Which one to use?

Dr. Mandl: I think it's going to be a discussion between the doctor and the patient--what's going to be best for you.

Dr. Adlersberg: Surgery to replace the thumb joint is very effective but means time off from activities and a lot of rehabilitation. You might wonder if an HA shot or a simple shot of novocaine would work as well as cortisone for arthritis on the other joints of the hand. The answer is maybe, but it hasn't been studied yet.