Background Intra-articular (IA) corticosteroids injections are used in mono- or oligoarthritis in rheumatoid arthritis (RA) and other aseptic inflammatory joint diseases. IA triamcinolone hexacetonide (TH) is used most often as a supplement to systemic anti-inflammatory therapy.
Objectives To compare the clinical and ultrasound (US) morphology responses to TH injection, to determine whether US morphology can predict the maintenance of therapeutic response, and its correlations with inflammatory arthritis outcome measures.
Methods 37 intra-articular (16wrist, 6MCP, 10PIP, 2elbow, 2TT, 1MTP) US guided injections of TH were performed in 27 patients with inflammatory arthritis: 15 had RA, 9 PsoA, 2 AS and 1 JIA. Every patient was evaluated 5 times: at baseline (immediately before injection), 2 weeks, and 1, 3 and 6 months. At baseline, 1, 3 and 6 months a trained rheumatologist assessed clinical, laboratory and functional data, namely number of swollen and tender joints, range of articular movement (flexion plus extension), visual analogic scale (VAS) for pain, score for disabilities of the arm, shoulder and hand (DASH), and clinical rating system for the ankle and hindfoot scores, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP). A rheumatologist with training on US performed standard examinations. A semi-quantitative score was used for Doppler and B-mode synovitis, effusion and synovial hypertrophy. Exclusion criteria were increasing number and/or dosage of disease modifying anti-rheumatic drugs (DMARD) during the follow-up.
Results Mean age and mean disease duration was 56.1±15.1 and 10.7±8.3 years, respectively. Median ESR was 19 (P2511.5;P7524) mm/h, and mean CRP was 0.71 (P250.37;P751.5) mg/dl. Clinical, functional and US data are summarized in table 1. At 6 months the patients with joint effusion had a tendency to have higher level of ESR. The presence of effusion, B-mode and Doppler synovitis were related with a trend to increased ESR and CRP at 3 and 6 months, with no statistically significant differences. During the follow-up period sixteen percent of patients met the exclusion criteria.
Conclusions All patients showed significant improvement after TH injection. However, half of the patients maintained subclinical synovitis detected by US parameters, and sixteen percent of patients had to increase the number and/or dosage of DMARD.
Disclosure of Interest None Declared