Prolotherapy Versus Steroids for Thumb Carpo-metacarpal Joint Arthritis

NCT ID: NCT00685880

Last Updated: 2012-08-30

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

2 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-05-31

Study Completion Date

2010-07-31

Brief Summary

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Arthritis of the base of the thumb is a common debilitating problem. It is believed that laxity (loosening) of the joint leads to worsening arthritis in this joint. This can be treated by securing the joint surgically or symptoms can be treated with hand therapy and/or injection of corticosteroids. Recently prolotherapy (sugar water) has been shown to decrease looseness of joints and also be helpful for hand and knee arthritis. We hypothesize that prolotherapy injections for thumb arthritis will be equally or more beneficial to the patients than steroids.

Detailed Description

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Dextrose prolotherapy has been shown to decrease anterior cruciate ligament (ACL) laxity and decrease knee joint pain. Similar to ACL laxity leading to knee osteoarthritis, laxity of the "beak" ligament can lead to worsening thumb CMC osteoarthritis. We hypothesize that dextrose intra-articular prolotherapy will have similar results in treating the pain and instability related to symptomatic thumb CMC osteoarthritis. This will be a prospective randomized double blind comparison study comparing Celestone to Dextrose intra-articular injections as adjuncts to hand therapy for the treatment of symptomatic thumb CMC osteoarthritis. Twenty patients will be randomized to each treatment arm to provide enough power to show a 20% change in visual analogue scale (VAS) for pain to be significant. We will utilize the ultrasound guided injection protocol described by the co-investigators for both treatment arms to ensure proper placement of the respective solutions. We will measure various grip strengths, and VAS pain scales prior to the first injection, prior to the second injection at 6 weeks and at the final visit at 6 months. A telephone follow-up with pain scale will be administered at 3 months. A Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire measuring upper extremity functional impairment will be obtained at initial and final visits.

Conditions

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Thumb Carpometacarpal Joint Osteoarthritis

Keywords

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thumb carpo metacarpal joint osteoarthritis prolotherapy intra articular steroid hand therapy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

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Prolotherapy group

Subjects randomized to this arm will receive injection(s) of 10% dextrose solution in the affected thumb joint.

Group Type EXPERIMENTAL

Prolotherapy (10% dextrose solution)

Intervention Type DRUG

Dextrose diluted with sterile water.

Corticosteroid Group

Subjects randomized to this arm will receive injection(s) of betamethasone solution in the affected thumb joint.

Group Type ACTIVE_COMPARATOR

Betamethasone

Intervention Type DRUG

CELESTONE® SOLUSPAN® \* (betamethasone injectable suspension) Injectable Suspension is a sterile aqueous suspension containing 3 mg per milliliter betamethasone, as betamethasone sodium phosphate, and 3 mg per milliliter betamethasone acetate. Subjects will receive a 0.25 to 0.5 mL Celestone Soluspan injection.

Interventions

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Prolotherapy (10% dextrose solution)

Dextrose diluted with sterile water.

Intervention Type DRUG

Betamethasone

CELESTONE® SOLUSPAN® \* (betamethasone injectable suspension) Injectable Suspension is a sterile aqueous suspension containing 3 mg per milliliter betamethasone, as betamethasone sodium phosphate, and 3 mg per milliliter betamethasone acetate. Subjects will receive a 0.25 to 0.5 mL Celestone Soluspan injection.

Intervention Type DRUG

Other Intervention Names

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Celestone Soluspan

Eligibility Criteria

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Inclusion Criteria

* Age \>45
* Ability to make follow-up visits over the 6 month protocol
* Ability to give informed consent
* Eaton grade 2-3 thumb carpo-metacarpal joint osteoarthritis with pain over 3/10 on visual analogue scale with symptoms present greater then 6 months.

Exclusion Criteria

* Recent trauma to the hand or wrist or fractures eeen on radiographs
* Eaton grade 1, or 4 joints affected
* Metabolic bone disease
* Recent systemic or localized infection (within last 2 weeks)
* History of rheumatologic disease
* Allergies to injected solutions
* Thumb carpo-metacarpal joint injections in the prior 6 months.
Minimum Eligible Age

45 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Mayo Clinic

OTHER

Sponsor Role lead

Responsible Party

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Mayo Clinic

Principal Investigators

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Michael J. Gruba, M.D.

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic Physical Medicine & Rehabilitation Residency

Locations

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Mayo Clinic

Rochester, Minnesota, United States

Site Status

Countries

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United States

References

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Other Identifiers

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07-006348

Identifier Type: -

Identifier Source: org_study_id