Imperial awarded £2.2m to lead landmark trial for hormone therapy in hand osteoarthritis

This major clinical trial will investigate whether hormone replacement therapy (HRT) can reduce hand pain in post-menopausal women with hand osteoarthritis.

The study called HOPE-E2 will be led by Dr Fiona Watt, Clinical Associate Professor in Rheumatology in the Department of Immunology and Inflammation.

Osteoarthritis of the hand is one of the most common forms of arthritis, with changes in various finger and thumb joint tissues often leading to disabling symptoms, including hands feeling painful and stiff, and affecting hand function. The condition is most common in women over the age of 50 and currently has no drug therapies that change the course of the disease.

While there has been promising research indicating that a decline in the level of sex hormones seen around menopause could contribute to the development and progression of hand osteoarthritis, the potential therapeutic role of HRT has not been evaluated in a full trial.

Dr Fiona Watt said: “Hand osteoarthritis affects millions of men and women in the UK and can have a devastating long-term impact on daily activities, ability to work and quality of life. While there is mounting evidence that hormonal changes could play a role in the condition, this has never been tested in a definitive clinical trial. Our HOPE-E2 study team aims to provide robust evidence on whether HRT could offer a new treatment for post-menopausal women living with painful hand osteoarthritis.”

Exploring the role of hormones in osteoarthritis

This research will test whether a hormone treatment delivered through the skin, called transdermal oestradiol, can reduce hand pain compared with a placebo treatment. It builds on the success of the HOPE-e study, also led by Dr Watt, which demonstrated that a larger definitive trial was feasible and acceptable to women with hand osteoarthritis. 

The trial has been funded by the UK government agency NIHR and is a result of continuing close multidisciplinary collaboration between Imperial College London including its Imperial Clinical Trials Unit, and colleagues from the Universities of Leeds, Keele, Oxford and Hertfordshire, with advice from its public contributors. 

The trial project begins in October 2026 and will run for 43 months, with participant recruitment expected to start in mid-2027.

If successful, the study could open a door to an entirely new approach to managing hand osteoarthritis for this important subgroup with the condition, expanding currently limited treatment options. It also aims to improve our understanding of the role of sex hormones in osteoarthritis symptoms and disease as a whole.