Background Recently, in the RA treatment, clinical remission had been a realistic target by methotrexate and biologics. Moreover, strict remission criteria such as Boolean index or SDAI<3.3 had been advocated. But in clinical scene, RA patients often achieve DAS remission or low disease activity (LDA) but not met the strict remission criteria because of persisted small number of swollen and tenderness joints. Intra-articular steroid injection is recommended only for RA patients with small number of swollen joints, but there is few reports mention about its efficacy, durability, relation between disease activity and findings of ultrasonography.
Objectives The aim of this study was evaluating the effect of intra-articular steroid injection with clinical measure and ultrasonography focused on its efficacy and sustainability in the RA patients their internal treatment is considered to be enough to control their disease activity.
Methods 16cases of RA patients who received intra-articular steroid injection to their small number of swollen joints in our clinic from April 2009 to September 2012 were recruited. After intra-articular injection of triamcinolone acetonide and lidocaine to power doppler (PD) positive swollen joint, durability of effect were evaluated with ultrasonography (US), and disease activity were evaluated with composite measures and biochemical markers in every 4 to 8 weeks ambulatory visits.
Results Injected joint were knee:1, shoulder:1, elbow:2, wrist:5, MCP:3 and PIP:4 respectively. Mean followed up period was 11.1 (2.5-40) months. The characteristic data is shown in Table1. After injection, remission and LDA rate was significantly increased in each composite measures as showed in Figure1. CRP titer was also significantly improved from 0.32±0.33 to 0.09±0.10mg/dl. Gray scale grading and PD signal grading were significantly improved and preserved during observation period. In 2cases, PD signal were relapsed at 4 month after injection, but stayed in Grade1 without additional treatment. Serum MMP-3 level was significantly decreased by injection, and it was preserved until last observation as showed in Figure2.
Conclusions Frequent intra-articular steroid injection should be avoided because of its harmful effect on joint. But for the RA patients achieved clinical remission or LDA, this double edged sword might be a useful application to achieve and maintain strict remission state. And if internal treatment succeeded to keep the disease activity at low, single time intra-articular injection may provide lasting swelling free joint.
Disclosure of Interest D. Kato: None Declared, T. Kojima Speakers bureau: Mitsubishi Tanabe Pharma Corporation, Takeda Pharma Corporation, Eisai Pharma Corporation, Chugai Pharma Corporation, Abbott, Bristol-Myers Squibb and Pfizer., K. Funahashi: None Declared, T. Takemoto: None Declared, Y. Yoshioka: None Declared, T. Watanabe: None Declared, N. Takahashi: None Declared, Y. Hattori: None Declared, M. Hanabayashi: None Declared, N. Ishiguro Speakers bureau: Mitsubishi Tanabe Pharma Corporation, Takeda Pharma, Corporation, Eisai Pharma Corporation, Chugai Pharma Corporation, Abbott, Bristol-Myers Squibb and Pfizer.
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