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Abstract
Objective: Areas of tender cutaneous or subcutaneous thickening (“rheumatic patches”) have been described in patients with osteoarthritis (OA): these are frequently proximal to the affected joint, on the limb or in paraspinal areas. Uncontrolled observations have suggested that injection of these patches with saline or a solution of sodium salicylate can result in a significant improvement in symptoms in the joint itself. The aim of this pilot study was to determine if a large, fully-controlled trial of the therapy is justified, and to obtain preliminary data in order to design such a trial.
Design: 48 patients, with OA of the 1st carpo-metacarpal (CMC) joint (“thumb” -16), knee (12) or neck (20), were randomised to receive injections of 0.5% sodium salicylate or normal saline. After six weeks’ observation, they were given up to 6 weekly injections into rheumatic patches, and followed for 12 weeks, further injections being given after six weeks if appropriate.
Results: All groups of patients showed a significant improvement in all outcome measures at the first assessment following the initial course of injections. For instance, median subjective pain scores for all patients treated with salicylate fell from 5.50 to 2.35; respective figures for saline-treated patients were 6.15 and 2.85. In most patients the improvement was well-maintained for the next 12 weeks. This was reflected in a reduction in oral medication. There was no significant difference between the salicylate- and saline-treated groups in the initial response. However, there was a trend for salicylate-treated patients to sustain their improvement better over the following six weeks. For instance, patients with OA of the thumb treated with salicylate showed no change in median pain score (2.1); those treated with saline showed a worsening from 3.3 to 4.3 (p< 0.05). Overall the saline-treated patients required a greater mean number of subsequent injections in the assessment period (0.33) than the salicylate-treated patients (0.12).
Conclusions: The data in this pilot study indicate that injection of rheumatic patches with salicylate or saline results in major improvement in OA, and suggest that this may be better sustained when salicylate is used. Larger trials of this therapy are justified.
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