A Phase 4 interventional study of Injection of triamcinolone acetonide into the CMC-1 joint and Multimodal Occupational therapy for CMC-1 joint OA in Osteoarthritis Thumb, sponsored by Diakonhjemmet Hospital. Active, not recruiting at 6 sites in Norway. Open to participants aged 40 Years to 85 Years. Per ClinicalTrials.gov, last updated 2026-11-02.
Sponsored by Diakonhjemmet Hospital · Phase 4, Interventional, and Treatment
A placebo-controlled randomized controlled trial exploring the effect of intraarticular steroids, saline or an occupational therapy intervention in inflammatory carpometacarpal-1 osteoarthritis
The primary aim of the PICASSO trial is to examine the efficacy and safety of intraarticular corticosteroid injections and a multimodal occupational therapy intervention in patients with CMC-1 OA (Phase 1). By comparing available non-pharmacological and pharmacological treatments head-to-head, our results will be of interest to the range of health professionals who are involved in the management of CMC-1 OA patients. By including patients who are likely to benefit from the intervention (painful and inflammatory CMC-1 OA), appropriate dosage of drug and ultrasound-guided injections, our trial is more guarded against possible false negative results than previous studies. We will also explore predictors for treatment effects. Due to the heterogeneous presentation of OA, it is unlikely that one treatment will fit all, and treatment should be tailored to the patients´ clinical presentation. Second, we will explore the long-term safety of IACS, and whether the occupational therapy intervention can prevent or halt CMC-1 subluxation (Phase 2).
10,054 studies on the registry are indexed under Pain; 1,649 are open to participants now.
This study's planned enrollment of 354 is above the median of 66 across 8,493 interventional studies indexed under Pain.
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- Adult (40-85 years of age) men and women
In target CMC-1 joint:
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.
Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.
Vaccines made with a weakened form of the germ, such as measles–mumps–rubella (MMR), chickenpox and yellow fever. They can be risky when the immune system is weakened. Flu injections are not live; the nasal flu spray is.
Corticosteroids (steroids)
Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.
Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hypersensitivity
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Excipients
The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Live vaccines
Vaccines made with a weakened form of the germ, such as measles–mumps–rubella (MMR), chickenpox and yellow fever. They can be risky when the immune system is weakened. Flu injections are not live; the nasal flu spray is.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
A single ultrasound-guided intraarticular injection of 0.50 ml of 40 mg/ml triamcinolone acetonide at baseline. A smaller dosage can be considered if there is increased resistance during injection. The same injection procedure will be repeated after 12 weeks if there is pain (NRS≥3) and inflammation (grey scale synovitis grade 1-3) present in the CMC-1 joint.
Drug: Injection of triamcinolone acetonide into the CMC-1 joint
A single ultrasound-guided intraarticular injection of 0.50 ml of sodium chloride 9 mg/ml at baseline. A smaller dosage can be considered if there is increased resistance during injection. The same injection procedure will be repeated after 12 weeks if there is pain (NRS≥3) and inflammation (grey scale synovitis grade 1-3) present in the CMC-1 joint.
Drug: Placebo
Patient education, instructions about hand exercises and training in the Happy Hands app. Administration of day and night orthosis. The Happy Hands app involves a 12 week intervention.
Behavioral: Multimodal Occupational therapy for CMC-1 joint OA
intraarticular injection with triamcinolone acetonide
Also known as: Kenacort-T 40 mg/ml
Patient education, instructions about hand exercises, orthosis and training
Intraarticular injection with saline
Also known as: Sodium chloride 9 mg/ml
Pain during activities in thumb base joint
Change in thumb base joint pain during activities last 24 hours on a 0-10 Numeric Rating Scale (NRS). 0 being no pain and 10 being the worst pain imaginable.
Time frame: 4 and 12 weeks
Pain during activities in thumb base joint
Change in thumb base joint pain during activities last 24 hours on a 0-10 Numeric Rating Scale (NRS). 0 being no pain and 10 being the worst pain imaginable.
Time frame: All visits
Pain at rest in thumb base joint
Change in thumb base joint pain at rest last 24 hours on a 0-10 Numeric Rating Scale (NRS). 0 being no pain and 10 being the worst pain imaginable.
Time frame: Week 00, 04, 12, 24, 104
Pain during activities in finger joints
Change in finger joint pain during activities last 24 hours on a 0-10 Numeric Rating Scale (NRS). 0 being no pain and 10 being the worst pain imaginable.
Time frame: Week 00, 04, 12, 24, 104
Pain at rest in finger joints
Change in finger joint pain in rest last 24 hours on a 0-10 Numeric Rating Scale (NRS). 0 being no pain and 10 being the worst pain imaginable.
Time frame: Week 00, 04, 12, 24, 104
AUSCAN (Australian/Canadian hand index)
Change in Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain, stiffness and function subscales. Sum scores for pain (range: 0-20), stiffness (range: 0-4) and function (range: 0-36) can be calculated with higher scores representing worse health.
Time frame: Week 00, 04,12, 24 and 104
OMERACT-OARSI criteria responders
Number of OMERACT-OARSI criteria responders
Time frame: Week 00, 04, 12, 24, 104
MAP-Hand
Change in measure of activity performance of the hand
Time frame: Week 00, 04,12, 24 and 104
Patient-reported overall disease activity
Change in patient-reported overall disease activity in hands last 24 hours on a 0-10 Numeric Rating Scale (NRS). 0 being no disease activity and 10 being the worst disease activity imaginable.
Time frame: Week 00, 04, 12, 24, 104
Assessor-reported overall disease activity
Change in assessor-reported overall disease activity in hands on a 0-10 Numeric Rating Scale (NRS). 0 being no disease activity and 10 being the worst disease activity imaginable.
Time frame: Week 00, 04, 12, 24, 104
Pain in finger joints (hand figure)
Change in pain in finger joints last 24 hours (hand figure)
Time frame: Week 00, 04, 12, 24, 104
Grip strength
Change in grip strength
Time frame: Week 00, 04, 12, 24, 104
Use of analgesics
Change in use of analgesics
Time frame: Week 00, 04, 12, 24, and 104
Use of NSAIDs
Change in use of non-steroidal anti-inflammatory drugs (NSAIDs)
Time frame: Week 00, 04, 12, 24, and 104
Arthritis self-efficacy scale
Change in arthritis self-efficacy scale. The response categories are 10-100 with 10 points increment between each response category. A sum score is created based on the average of the five questions. Higher scores represent better self-efficacy.
Time frame: Week 00, 04, 12, 24, 104
Patient satisfaction
Number of responders regarding self-reported perceived effect of treatment (yes/no). Patient satisfaction will be assessed with a question about whether the participants believe that they have had effect of the received treatment.
Time frame: Week 04, 12
EuroQol 5 dimensions 5-levels (EQ-5D-5L)
Change in EuroQol 5 dimensions 5-levels (EQ-5D-5L). The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. On the EQ-VAS the participant is instructed to self-rate their health on a 0-100 scale, where 0=worst health and 100=best health.
Time frame: Week 00, 04, 12, 24,104
Tender hand joints
Change in number of tender hand joints
Time frame: Week 00, 04, 12, 24, 104
Swollen hand joints
Change in number of swollen hand joints
Time frame: Week 00, 04, 12, 24, 104
Ultrasound synovitis in the CMC-1 joint
Change in ultrasound synovitis in the CMC-1 joint
Time frame: Week 00, 04,12, 24, 104. Will also be assessed in relation to additional injections in Phase 2.
Synovitis in the CMC-1 joint
Change in MRI synovitis in the CMC-1 joint on contrast-enhanced MRI
Time frame: Week 00, 04
Bone marrow lesions in the CMC-1 joint
Change in bone marrow lesions in the CMC-1 joint on contrast-enhanced MRI
Time frame: Week 00, 04
Structural progression
Change in structural progression by Kellgren-Lawrence
Time frame: Week 00, 104
Osteophytes
Change in osteophytes by OARSI atlas
Time frame: Week 00, 104
Joint space narrowing
Change in joint space narrowing by OARSI atlas
Time frame: Week 00, 104
Subluxation of the CMC-1 joint
Change in subluxation of the CMC-1 joint
Time frame: Week 00, 104
Adverse events
Number of adverse events
Time frame: Week 00, 04, 12, 24, 104. Will also be assessed in relation to additional injections in Phase 2.
Serious adverse events
Number of serious adverse events
Time frame: Week 00, 04, 12, 24, 104. Will also be assessed in relation to additional injections in Phase 2.
Withdrawals because of adverse events
Number of withdrawals because of adverse events
Time frame: Week 04, 12, 24, 104. Will also be assessed in relation to additional injections in Phase 2.
Use of healthcare services
Questions about use of healthcare services
Time frame: Week 00, 12, 24, 104
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
This study is active, not recruiting, as verified in Oct 2026. You cannot join it, but the record below documents what was studied.
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Diakonhjemmet Hospital