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THU0211 Combination of Intra-Articular Steroid Injection and Etanercept More Effective Than Etanercept in Rapid Radiographic Progression Patients with Rheumatoid Arthritis: A Randomized, Open Label, X Ray Reader Blinded Study
  1. K. Kume1,
  2. K. Amano1,
  3. S. Yamada1,
  4. T. Kanazawa1,
  5. H. Ohta1,
  6. K. Hatta1,2
  1. 1Rheumatology, Hiroshima Clinic, hiroshima
  2. 2Rheuamatology, Hatta Clinic, Kure, Japan

Abstract

Background Treatment of rheumatoid arthritis (RA) should aim at full remission. However, recent publications described rapid radiographic progression (RRP) existed despite initial biologics and methotrexate combination therapy in early RA. In RRP, initial biologics and methotrexate might be inadequate.

Objectives To compare remission and radiographic non-progression in RRP patients treated with etanercept(ETN) or with infliximab plus intra-articular steroid injection.

Methods We designed a single-blind(X ray reader and assessment physician), randomized controlled trial. We screened 52RRP (CRP> 35mg/L, and ACPA+) early (disease duration<6 months) RA patients for inclusion. 36 were randomly allocated ETN group (E group) or ETN plus intra-articular steroid injection group (E plus I group). All patients were taking methotrexate (from 12 to 22mg a week). For I plus I group, palpate examinations of both MP and PIP joints, wrists, elbows, shoulders, and knees were performed every 4 weeks. If swollen joints were existed, intra-articular steroid injections were intensified in each swollen joints.Co-primary endpoints were proportion of patients showing clinical remission (SDAI <3.3) and radiographic non-progression (Δ modified total Sharp score ≤0.5) at 52 weeks. Analysis was by intention-to-treat with last observation carried forward to missing data.

Results The characteristics of each group at baseline were not significantly different. Clinical remission at 52weeks was achieved by more patients in the E plus I group (29%) than in the E group (21%) (p<0.05). Radiographic non-progression at 52 weeks was achieved by more patients in the E plus I group (31%) than in the E group (22%) (p<0.05).

Conclusions Results of this reveal that combination of intra-articular steroid injection and ETN can achieve a high clinical and radiological remission rate in early RRP RA.

References

  1. Effectiveness of initial treatment allocation based on expert opinion for prevention of rapid radiographic progression in daily practice of an early RA cohort. Durnez A, et al. Ann Rheum Dis. 2011 Apr;70(4):634-7. Epub 2010 Dec 21.

  2. A matrix risk model for the prediction of rapid radiographic progression in patients with rheumatoid arthritis receiving different dynamic treatment strategies: post hoc analyses from the BeSt study. Visser K, et al. Ann Rheum Dis. 2010 Jul;69(7):1333-7. Epub 2010 May 24.

  3. A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritis. Vastesaeger N, et al. Rheumatology (Oxford). 2009 Sep;48(9):1114-21. Epub 2009 Jul 9. Review.

Disclosure of Interest None Declared

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