Botulism Toxin Injection as a Treatment for Arthritis of the Basal Thumb Joint

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01045694
Recruitment Status : Terminated (Unable to acquire additional funding needed to continue this study.)
First Posted : January 11, 2010
Results First Posted : July 13, 2017
Last Update Posted : October 6, 2017
Information provided by (Responsible Party):
University of Missouri-Columbia

Brief Summary:
Basal arthritis of the thumb is a common condition with increased prevalence in post-menopausal women, obese persons, and the elderly. Surgical options are varied and efficacious, but not all patients are candidates for surgery. The successes and pitfalls of previous, similar trials are carefully considered in the creation of our own. Though steroid injection is the standard of care in basal joint arthritis, current data does not support its efficacy beyond placebo effect. No trial has yet examined the efficacy of botulinum toxin type A (BTX-A) injection into the basal thumb joint nor compared it to steroid. Since efficacy of steroid is questionable at best, our hope is that BTX-A injection of the basal joint might be the next great tool in treating this common, debilitating disease.

Condition or disease Intervention/treatment Phase
Arthritis Multiple Joint Drug: Botulinum Toxin Type A Drug: Steroid - Triamcinolone Acetonide Drug: Lidocaine Phase 4

Detailed Description:

Purpose: Basal joint arthritis, or carpometacarpal (CMC) osteoarthritis, of the thumb is very common, particularly in the elderly. Morbidities include pain, decreased range of motion, and decreased strength. Nonsurgical treatments for CMC arthritis include oral analgesics, splinting, and steroid injection. In multiple recent trials, botulinum toxin A (BTX-A) injection has been shown to be an efficacious nonsurgical option for osteoarthritis of large joints, including those that have failed steroid injections. To our knowledge, the efficacy of BTX-A injection in thumb CMC arthritis has not been examined.

Methods: Patients with a clinical and radiographic diagnosis of basal joint arthritis who are appropriate and willing candidates for injection therapy will be selected. The primary symptom indicating need for injection would be pain not controlled with more conservative measures (e.g. nonsteroidal anti-inflammatory drugs (NSAIDs), splinting, physical therapy, etc.) Weakness and impaired functioning are also considered. Exclusion criteria will include any injection within the last 12 months or surgical treatment. All patients will undergo Eaton staging radiographically prior to treatment. Informed consent will be obtained and patients will be randomly assigned to one of three groups. One group will receive BTX-A injections, the second group will receive triamcinolone plus lidocaine injections, and the third group will receive saline plus lidocaine injections of the thumb CMC joint. Prior to treatment, patients' baseline function will be assessed with pinch, grip, and range of motion measurements, and the affect of their disease will be measured with a visual analog pain scale and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Pain scales and DASH questionnaires will be completed at twenty-four hours, ten days, twelve weeks, six months, and one year after treatment. Pain scales will be recorded for average pain and maximum pain. Clinical evaluations with pinch, grip, and range of motion measurements will occur ten days, twelve weeks, six months, and one year after treatment. All patients will be asked to return when sufficient symptoms recur to warrant further treatment.

Expected Results: We hypothesize that BTX-A injection will have equal or better efficacy than steroid injection for the treatment of basal joint arthritis.

Expected Conclusion: No study to date has examined BTX-A as a treatment for basal joint arthritis. Some patients are not surgical candidates and are reliant on non-surgical treatments for pain control and maintenance of function. BTX-A has shown to be effective in treating osteoarthritis of larger joints that undergo frequent use, including cases resistant to steroid injections. The basal thumb joint also undergoes frequent use and is often resistant to steroid injection. We believe that BTX-A will provide another efficacious non-surgical option for treatment of the CMC joint of the thumb. We estimate that the study will require approximately three to four years to achieve adequate patient numbers for each group.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 8 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Botulinum Toxin Versus Steroid Injection for Basal Joint Arthritis of the Thumb: a Randomized, Double Blind, Placebo-controlled Clinical Trial
Study Start Date : March 2011
Actual Primary Completion Date : August 2012
Actual Study Completion Date : October 2015

Arm Intervention/treatment
Experimental: Botulinum Toxin Type A
Arm investigates the efficacy of Botulinum Toxin A injection for the treatment of basal thumb joint arthritis
Drug: Botulinum Toxin Type A
One-time injection of 50 units of Botulinum Toxin A suspended in 2 mL of normal saline, with approximately 1 mL injected or sufficient quantity to fill joint capsule
Other Names:
  • Botox Cosmetic
  • Botox

Active Comparator: Steroid - Triamcinolone Acetonide
Arm uses the standard of care - Steroid injection - as an active comparator to the experimental injection of Botulinum Toxin A for the treatment of basal thumb joint arthritis
Drug: Steroid - Triamcinolone Acetonide
Single injection of 1 - 3 mL of 40mg/mL Triamcinolone acetonide solution
Other Name: Kenalog-40

Placebo Comparator: Lidocaine
Arm uses plain lidocaine injection to serve as a baseline for evaluating the efficacy of Botulinum toxin as compared to steroid injection for the treatment of basal thumb joint arthritis.
Drug: Lidocaine
Single injection of 1 - 3 mL of 2% Lidocaine
Other Name: Xylocaine

Primary Outcome Measures :
  1. Pain [ Time Frame: twenty-four hours, ten days, twelve weeks, six months, and one year ]

Secondary Outcome Measures :
  1. Range of Motion [ Time Frame: twelve weeks, six months, and one year ]
  2. Strength [ Time Frame: twelve weeks, six months, and one year ]

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Radiographic evidence of basal joint arthritis
  • Associated symptoms of basal joint arthritis including:
  • Pain
  • Decreased range of motion
  • Decreased thumb strength

Exclusion Criteria:

  • Persons under the age of 18
  • Women who are currently pregnant
  • Incompetent persons or persons otherwise incapable of effectively communicating the subjective experience of pain
  • Prior surgery on the joint
  • Injection in the last 12 months

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01045694

United States, Missouri
University of Missouri
Columbia, Missouri, United States, 65212
Sponsors and Collaborators
University of Missouri-Columbia
Principal Investigator: Stephen H. Colbert, MD University of Missouri-Department of Surgery-Division of Plastic Surgery

Responsible Party: University of Missouri-Columbia Identifier: NCT01045694     History of Changes
Other Study ID Numbers: 1146517
First Posted: January 11, 2010    Key Record Dates
Results First Posted: July 13, 2017
Last Update Posted: October 6, 2017
Last Verified: September 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by University of Missouri-Columbia:
Carpometacarpal Joints
Basal thumb joint arthritis
Trapeziometacarpal arthritis

Additional relevant MeSH terms:
Joint Diseases
Musculoskeletal Diseases
Botulinum Toxins
Botulinum Toxins, Type A
Triamcinolone hexacetonide
Triamcinolone Acetonide
Triamcinolone diacetate
Anesthetics, Local
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents
Anti-Arrhythmia Agents
Voltage-Gated Sodium Channel Blockers
Sodium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Acetylcholine Release Inhibitors
Cholinergic Agents
Neurotransmitter Agents
Anti-Inflammatory Agents
Hormones, Hormone Substitutes, and Hormone Antagonists