Have you utilized denosumab in treatment of erosive hand osteoarthritis?

I have not prescribed denosumab for patients with erosive hand osteoarthritis. While the 2024 double-blind placebo-controlled trial suggested that this RANK ligand inhibitor may have structure-modifying effects by inducing remodeling and preventing new erosions, the phase 2a study of 100 patients did not demonstrate any symptomatic benefit in pain or disability by the primary outcome measures at 48 weeks (Wittoek et al., PMID 38361122). While the open-label extension to 96 weeks suggested some c...

No, I have not incorporated denosumab into my routine practice for erosive hand osteoarthritis.

I found the Nature Medicine study (Wittoek et al., PMID 38361122) to be very interesting and well conducted, with convincing biological rationale and encouraging structural signals. However, at this stage, I personally do not feel that the available data are sufficient to change my clinical practice, particularly given the modest clinical effects and the remaining uncertainty regarding long-term benefi...

It is my first choice if the patient has erosive hand OA and osteopenia or osteoporosis; however, insurance will not approve Prolia for EOA as it is not FDA-approved, despite some positive signs in clinical trials. We need more studies in EOA and CPPD (mimicker for SNRA: hint RA wrist or MCP only, proceed with caution), even rheumatology anecdotal use of DMARD: hydroxychloroquine, methotrexate, etc, has no clear clinical trial data for guidelines. I think we can all some EOAs or CPPD have a more...

I agree. My concern is also the fracture risk. However, there is another issue. What is referred to as erosive osteoarthritis actually appears to be calcium pyrophosphate deposition disease, and hydroxychloroquine appears an effective treatment.