Antibody treatment can be useful in treating erosive hand osteoarthritis, according to research from the VIB-UGent Center for Inflammation Research, Ghent University, and Ghent University Hospital. By using the antibody denosumab, erosive joint injury is prevented, and bone rebuilding occurs. This is the first proof that the disease’s erosive progression can be stopped. The findings are published in Nature Medicine.
The erosive variety of hand osteoarthritis is a prevalent inflammatory form of degeneration that mostly impacts the finger joints. Consequently, there is a significant disease burden associated with this disorder, which leads to increasing deterioration and loss of function. The structural damage in the affected hands is not addressed by current therapies, even though they can reduce symptoms.
However, recent studies indicate that individuals with erosive hand arthritis may also experience other problems. Overall, their bones are thinner, and as the disease worsens, even in the bones and joints that are not immediately impacted by the osteoarthritis, they lose bone and cartilage. Put differently, erosive hand osteoarthritis is a “systemic” bone ailment as opposed to a “local” one.
“The realization that we’re dealing with a systemic disease prompted us to consider that we may need a treatment that is also systemic,” stated Prof. Ruth Wittoek of Ghent University, the study’s first author. Bone loss associated with cancer and osteoporosis are already treated with the antibody denosumab. Denosumab is a fantastic option for treating erosive hand osteoarthritis because it has also been shown to decrease the erosive progression of rheumatoid arthritis, the precursor to inflammatory arthritis.”
Co-first author Prof. Gust Verbruggen of Ghent University continued, saying, “We focused on the impact of denosumab on progression on X-rays in erosive hand osteoarthritis because we anticipated that by using such anti-osteoporotic medication, we could delay the structural progression.”
In a double-blind, randomized, placebo-controlled trial—the gold standard for interventional research—the researchers included 100 patients with erosive hand osteoarthritis to explore the potential of denosumab. The patients were then randomly assigned to either the treatment or placebo group.
The patients were given injections every three months, either with a placebo or 60 mg of denosumab, for 48 weeks. Compared to the placebo group, those who received the antibody after that treatment period had obvious bone remodeling and less new joint erosions. Crucially, there were no additional negative consequences from the antibody treatment.
“We provide a proof-of-concept that denosumab can be a valuable tool in the treatment of erosive hand osteoarthritis and show for the first time that inhibiting structural progression is an achievable goal in this disease,” stated Prof. Dirk Elewaut (VIB-UGent), senior author of the study.
This study shows that by rebuilding bone and preventing joint erosions, denosumab has beneficial benefits on erosive hand osteoarthritis. The idea that erosive hand osteoarthritis is a systemic illness requiring systemic therapy is also supported by this data.
Journal Reference
Ruth Wittoek et al, RANKL blockade for erosive hand osteoarthritis: a randomized placebo-controlled phase 2a trial, Nature Medicine (2024). DOI: 10.1038/s41591-024-02822-0.
