Changes of cartilage and bone markers after intra-articular glucocorticoid treatment with and without postinjection rest in patients with rheumatoid arthritis
- 1Section of Rheumatology, Department of Internal Medicine, Gävle Hospital, Gävle, Sweden
- 2Department of Medical Science, Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden
- 3Department of Rheumatology, Lund University Hospital, Lund, Sweden
- 4Department of Medical Science, Section of Rheumatology, Uppsala University Hospital
- Correspondence to:
Dr Tomas Weitoft
Section of Rheumatology, Department of Internal Medicine, Gävle Hospital, 801 87 Gävle, Sweden;
- Accepted 13 April 2005
- Published Online First 20 April 2005
Background: Joint immobilisation improves the therapeutic effect of intra-articular glucocorticoid injection for knee synovitis. This may be due to retarded steroid resorption by immobilisation, a procedure that also could influence cartilage and bone metabolism.
Objective: To evaluate changes in cartilage and bone turnover after intra-articular glucocorticoid treatment for knee synovitis with and without postinjection rest.
Methods: 20 patients with rheumatoid arthritis and knee synovitis were randomised to 24 hour bed rest or to normal activity after intra-articular glucocorticoid treatment. Serum and urine markers of cartilage and bone turnover were studied for two weeks. Cartilage oligomeric matrix protein (COMP) was used as a marker of cartilage turnover, osteocalcin as marker of bone formation, and deoxipyridinoline (DPD) as marker of bone resorption.
Results: After the glucocorticoid injection COMP levels decreased in both groups (p<0.001), but significantly more in resting patients. Serum osteocalcin levels decreased significantly (p<0.001) without any difference between the groups. DPD was unchanged in both groups.
Conclusions: Intra-articular glucocorticoid treatment for knee synovitis reduced serum COMP, which suggests that such treatment may have a cartilage protective effect. The slightly larger decrease of serum COMP in the resting group may reflect a lower clearance of COMP from the joint cavity. Serum osteocalcin was temporarily reduced, indicating a reversible suppression of bone formation.
Published Online First 20 April 2005