Background/Purpose:  Strontium ranelate (SrRan) has shown the ability to reduce radiological progression of knee osteoarthritis (OA) over 3 years. Patients with knee OA are also frequently affected by hand OA. In this secondary analysis, we assessed the effects of SrRan on radiological and symptom progression of hand OA.

Methods: This international 3-year, randomized, placebo-controlled phase III trial was designed to assess the effect of SrRan 1g and 2g/day compared to placebo on the radiographic progression of knee OA. Main inclusion criteria were symptomatic primary knee osteoarthritis (ACR criteria), a Kellgren-Lawrence (KL) grade II or III, and a joint space width (JSW) between 2.5–5 mm. There were no specific inclusion criteria regarding hand OA. Hand OA radiographic and clinical assessments were secondary outcomes. During the study, baseline and final postero-anterior radiographs of each hand were performed and scored by 2 independent readers, blinded to treatment and time sequence, using KL (range 0-128), Kallman (0-204) and Verbruggen (0-218) scoring methods. Clinical symptoms were assessed at each visit by the Auscan (0-300) and Functional Index for Hand OA (FIHOA) (0-30). Between-group analyses were performed using a general linear model with baseline, center and gender as covariates.

Results: Of the 1669 patients included in the SEKOIA trial, 999 had radiologic hand OA at baseline (73%). 71% were female. Mean age was 64±7 years, body mass index 29.6±4.7 kg/m², and initial knee JSW 3.4±0.8 mm. Hand OA was mild in radiologic severity: KL score 21±13, Kallman score 25±22 and Verbruggen score 14±15. Mean Auscan global score was 96+80 mm and mean FIHOA score was: 4±5.

The radiographic progression of hand OA observed over 3 years was modest in the placebo group with a mean change of 2.4±3.3 for KL score, 3.7±5.3 for Kallman score and 2.0±3.9 for Verbruggen score. There was no difference between the treatment groups for any radiological score. A significantly higher rate of patients reported an improvement of 20% or more in the Auscan pain subscale in the SrRan 2 g group (95% CI [0.1; 16.3]; p=0.047) compared to placebo.

In erosive patients (≥2 erosive joints, N=71), a significant improvement of KL score (p=0.031) in the SrRan 2 g compared to placebo was observed. In symptomatic patients (FIHOA >5 and pain within the 48 hours prior to the visit, N=126), a trend toward a higher improvement of KL score was noted in the SrRan 2 g group compared to placebo (p=0.079)

Conclusion: Overall, mild hand OA patients showed a very slow radiological progression, with no between-group difference over 3 years. However, in subgroup analyses, a slight beneficial effect of strontium ranelate 2g could be observed on pain and a positive effect on the change in KL score was suggested in the more severe hand OA patients. These results encourage conducting a specific trial in hand OA in the next future.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-strontium-ranelate-on-hand-osteoarthritis-analysis-of-data-from-the-sekoia-trial/