Evaluation of Transdermal Steroids for Trapeziometacarpal Arthritis

Patrick Atkinson; Rajeev Jain; Elizabeth Jain; A. George Dass; Otto Wickstrom; Norman Walter

doi:10.1016/j.jhsa.2010.02.013

Evaluation of Transdermal Steroids for Trapeziometacarpal Arthritis

Patrick Atkinson, Rajeev Jain, Elizabeth Jain, A. George Dass, Otto Wickstrom, Norman Walter

Kettering University

Research output: Contribution to journal › Article › peer-review

Abstract

<p> <h3> Purpose </h3> <p id="x-x-simple-para0030"> One conservative treatment for trapeziometacarpal joint <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/arthritis" title="Learn more about Arthritis from ScienceDirect's AI-generated Topic Pages"> arthritis </a> is the delivery of steroids transdermally. In prior <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/transdermal" title="Learn more about Transdermal from ScienceDirect's AI-generated Topic Pages"> transdermal </a> 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). <h3> Methods </h3> <p id="x-x-simple-para0035"> Eighty-four consecutive trapeziometacarpal joints in 62 patients presenting to an orthopedic hand surgeon were randomized to receive either steroid delivery by <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/iontophoresis" title="Learn more about Iontophoresis from ScienceDirect's AI-generated Topic Pages"> iontophoresis </a> or <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/phonophoresis" title="Learn more about Phonophoresis from ScienceDirect's AI-generated Topic Pages"> phonophoresis </a> 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, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/short-form-12" title="Learn more about Short Form 12 from ScienceDirect's AI-generated Topic Pages"> Short Form 12 </a> , 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. <h3> Results </h3> <p id="x-x-simple-para0040"> 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. <h3> Conclusions </h3> <p id="x-x-simple-para0045"> 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. </p> </p> </p> </p></p>

Original language	American English
Journal	The Journal of Hand Surgery
Volume	35
DOIs	https://doi.org/10.1016/j.jhsa.2010.02.013
State	Published - Jun 1 2010

Keywords

Arthritis
CMC Joint
Steroid
Transdermal
TMC Joint

Disciplines

Biomedical Devices and Instrumentation
Biomedical Engineering and Bioengineering
Engineering
Molecular, Cellular, and Tissue Engineering

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10.1016/j.jhsa.2010.02.013License: CC BY

https://www.sciencedirect.com/science/article/pii/S036350231000184X

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@article{4a2a0189af344cbaa71314f77372da1a,

title = "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. ",

keywords = "Arthritis, CMC Joint, Steroid, Transdermal, TMC Joint",

author = "Patrick Atkinson and Rajeev Jain and Elizabeth Jain and Dass, {A. George} and Otto Wickstrom and Norman Walter",

year = "2010",

month = jun,

day = "1",

doi = "10.1016/j.jhsa.2010.02.013",

language = "American English",

volume = "35",

journal = "The Journal of Hand Surgery",

}

TY - JOUR

T1 - Evaluation of Transdermal Steroids for Trapeziometacarpal Arthritis

AU - Atkinson, Patrick

AU - Jain, Rajeev

AU - Jain, Elizabeth

AU - Dass, A. George

AU - Wickstrom, Otto

AU - Walter, Norman

PY - 2010/6/1

Y1 - 2010/6/1

N2 - 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.

AB - 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.

KW - Arthritis

KW - CMC Joint

KW - Steroid

KW - Transdermal

KW - TMC Joint

UR - https://digitalcommons.kettering.edu/mech_eng_facultypubs/61

UR - https://www.sciencedirect.com/science/article/pii/S036350231000184X

U2 - 10.1016/j.jhsa.2010.02.013

DO - 10.1016/j.jhsa.2010.02.013

M3 - Article

VL - 35

JO - The Journal of Hand Surgery

JF - The Journal of Hand Surgery

ER -

Evaluation of Transdermal Steroids for Trapeziometacarpal Arthritis

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Keywords

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