Imagine living with an aching thumb day in and day out. The pain can be so bad, you can't use your hand and it keeps you up at night.
An ongoing study at Hospital for Special Surgery in Manhattan aims to find out if injections of a medication already approved to treat knee arthritis can provide pain relief for the thumb, as well. The hospital continues to seek people with painful thumb arthritis for the study. The medication is provided free of charge.
Long Island resident Susan Frey, whose arthritis in her thumb has gotten progressively worse over the past two years, enrolled in the study to seek relief. "I can't lift my grandchildren, it's difficult to button my clothing, my whole hand gets swollen," she said. "I have no strength to grip, I can't even open a plastic bag."
The study, funded by the National Institutes of Health and the Arthritis Foundation, is looking for adults with osteoarthritis, a wear-and-tear disease different from rheumatoid arthritis. Degeneration of the cartilage in the thumb is a common problem in older adults that can significantly affect their quality of life, according to Dr. Lisa Mandl, the rheumatologist at Hospital for Special Surgery leading the study.
Dr. Mandl is studying whether two injections of a medication called Synvisc into the joint, where the thumb meets the wrist, can alleviate pain and restore function.
In 2004, Dr. Mandl and colleagues conducted a preliminary study of Synvisc to relieve thumb arthritis pain in 32 patients. "In the first study, we saw a significant decrease in pain," she said. "That's why we decided to go forward with a much larger double-blind, placebo-controlled trial and applied for funding from the NIH and the Arthritis Foundation. Genzyme Biosurgery is supplying the medication free of charge."
Dr. Mandl is seeking to recruit a total of 213 patients who will be randomly assigned in equal numbers to one of three groups. The first group will receive Synvisc, a second group will receive a cortisone shot and the third group will receive a local anesthetic. Patients will be followed for six months to see how they do.
Osteoarthritis of the thumb can cause severe pain and is more common in women than men. A full 30 percent of women age 65 to 74 are estimated to have arthritis in their thumb, and 80 percent of women will have it once they turn 80.
"Often, this type of arthritis is the only problem in very active, healthy people," Dr. Mandl notes. "They wake up at night, they can't work, they can't pick up a pen. It disproportionately ruins their life. If we had a good treatment that didn't have side effects, their lives would improve dramatically."
Other treatments, such as ibuprofen, can have side effects or don't work for many patients. "We've had patients with terrible pain who are desperate. One woman started to cry when she learned she did not qualify for the study," Dr. Mandl said. When conservative treatments fail to provide relief, the next step is surgery.
Adults over 45 with painful thumb arthritis may be candidates for the trial. They will be screened by a study questionnaire, hand x-ray and hand exam. All medication will be provided free of charge. "An advantage for all study participants is that at the end of six months, everyone is eligible to receive Synvisc free of charge, provided they complete the study," Dr. Mandl says.
Anyone who would like more information about the study is invited to call the clinical research coordinator at 212-774-2960.