Evaluation of transdermal steroids for trapeziometacarpal arthritis

Abstract

Purpose: One conservative treatment for trapeziometacarpal joint arthritis is the delivery of steroids transdermally. In prior transdermal studies on the elbow and foot, there are mixed reports of success. It appears that the benefits of the treatment might be limited to short-term relief (approximately one week). It was hypothesized that transdermal steroid delivery would yield short-term improvements for trapezial-metacarpal joint arthritis, although these improvements would not persist at later follow-up (3 or 6 months).

Methods: Eighty-four consecutive trapeziometacarpal joints in 62 patients presenting to an orthopedic hand surgeon were randomized to receive either steroid delivery by iontophoresis or phonophoresis or placebo delivery via iontophoresis or phonophoresis. The researchers and patients were blinded as to the treatment assignment. Patients were evaluated before treatment and at 3 follow-up appointments. Subjects were assessed via the Michigan Hand Outcomes Questionnaire, Short Form 12, analog pain score, and provocative and strength testing. The subjects' study group, gender, and arthritic grade were statistically analyzed versus patient-reported and physician-assessed data over the different time points. Following subject recruitment, 17 joints discontinued the study due to joint discomfort, electing for other treatments. Approximately half of the 67 subject joints opted for alternative treatment after the first or second follow-up; 34 subject joints completed all follow-up time points.

Results: There was no significant predictive relationship between the independent variables and their ability to predict the 9 dependent measures of pain, strength, and well-being. There were trends for the pain to decrease over time, although the trends were not uniform between the different pain metrics and groups. The strength for both iontophoresis groups tended to increase over time, whereas the phonophoresis groups tended to decline.

Conclusions: Although there were some trends in the follow-up data, the overall lack of significant differences in the data suggests that transdermal steroid delivery might not be helpful in providing short- or long-term relief of arthritic symptoms.

Type of study/level of evidence: Therapeutic II.