Methotrexate may improve symptoms in patients with hand osteoarthritis with synovitis, according to a recent study published by Wang et al in The Lancet. Researchers randomly assigned 97 patients aged 40 to 75 years with hand osteoarthritis and grade ≥ 1 synovitis to receive either 20 mg of methotrexate (n = 50) or placebo (n = 47) orally once weekly for 6 months. The primary outcome of the study was pain reduction. Eighty-four percent (n = 42) and 85% (n = 40) of patients in the methotrexate group and placebo group, respectively, provided primary outcome data. Patients who received methotrexate demonstrated a mean change in pain on the 100 mm visual analogue scale of –15.2 mm vs –7.7 mm among those who received placebo. Sixty-two percent (n = 31) of patients who received methotrexate experienced adverse events compared with 60% (n = 28) of those who received placebo. Although the benefit was moderate, the researchers concluded that methotrexate may offer a potentially clinically meaningful effect on reducing pain in patients with hand osteoarthritis with synovitis.