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Effect of intra-articular corticosteroid injections and inflammation on periarticular and generalised bone loss in early rheumatoid arthritis
  1. Glenn Haugeberg1,
  2. Sarah Morton2,
  3. Paul Emery3,
  4. Philip G Conaghan3
  1. 1Department of Rheumatology, Sørlandet Hospital, Kristiansand, Norway
  2. 2Balmore Park Surgery, Caversham, UK
  3. 3Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
  1. Correspondence to Professor Philip G Conaghan, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; p.conaghan{at}leeds.ac.uk

Abstract

Objectives To explore the effect of intra-articular corticosteroid (IAST) injections on bone mineral density (BMD) in the hand and at the metacarpophalangeal (MCP) joints in early rheumatoid arthritis (RA).

Methods In the first 3 months of the study, 19 patients with RA received methotrexate (MTX) alone and 21 received MTX and IAST injections into clinically inflamed joints. In the following 9 months, all patients received MTX+IAST. BMD was assessed at the hand and periarticular regions at MCP joints 2–5 at baseline, 3 and 12 months.

Results In the first 3 months a numerically lower percentage rate of bone loss was seen in MTX+IAST-treated patients compared with MTX-treated patients. This observation was more pronounced at the MCP periarticular regions (eg, partial proximal phalanges: digit 2, −0.45% vs −2.69%, p=0.045; digit 3, −0.34% vs −3.32%, p=0.003; digit 4, −0.39% vs −2.57%, p=0.14; digit 5, −0.59% vs −2.70%, p=0.24) than for the whole hand (−1.53% vs −2.42%, p=0.32). In the 3–12-month period, only minor non-statistically significant differences were seen between the two groups.

Conclusion IAST given over 3 months protects against periarticular bone loss in inflamed finger joints in RA. These data emphasise the importance of suppressing inflammation in patients with active RA to maintain bone health.

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Footnotes

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the University of Leeds.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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