Painful Inflammatory Carpometacarpal-1 Osteoarthritis Treated With Intraarticular Steroids, Saline or an Occupational Therapy Intervention: the PICASSO Trial

What this Trial Is About

Researchers are exploring the effects of intraarticular corticosteroid injections, saline injections, and a multimodal occupational therapy intervention in people with inflammatory carpometacarpal-1 osteoarthritis (CMC-1 OA). This trial, known as the PICASSO trial, aims to compare these pharmacological and non-pharmacological treatments head-to-head for efficacy and safety, focusing on patients with painful and inflammatory CMC-1 OA. The study will also investigate predictors of treatment effects and explore long-term safety and whether the occupational therapy can prevent or stop joint subluxation. Participants will be randomly assigned to one of three groups: a corticosteroid injection group receiving a single ultrasound-guided injection of triamcinolone acetonide at baseline with a possible repeat at 12 weeks if pain and inflammation persist; a placebo group receiving a saline injection under the same conditions; or an occupational therapy group involving patient education, hand exercises, training using the Happy Hands app, and use of day and night orthosis over a 12-week period. Dosage may be adjusted if resistance is noted during injections. During the study, participants will be assessed for pain during thumb activities at 4 and 12 weeks as the primary outcome. Additional evaluations include pain at rest and during activities in finger joints, hand function indexes, disease activity reports, joint tenderness, grip strength, medication use, ultrasound assessments, and safety monitoring up to 104 weeks. The study uses ultrasound guidance, questionnaires, and clinical exams to monitor disease progression and treatment effects, with follow-ups continuing for up to two years.

Intraarticular Steroids, Saline and Occupational Therapy in People With CMC1 Osteoarthritis