Background Intra-articular therapy has a long history in treating inflamed arthritis, especially mono-oligoarthritis. Many different compounds are used. Since 1970's, a number of short-term studies have demonstrated Intra-articular administration of MTX can inhibit toxic oxygen metabolite release, lymphocyte proliferation and production of tumour necrosis factor alpha (TNF-a), interleukin (IL)-6 and IL-8 on the synovial membrane. The therapy of MTX i.a. was gradually used in JIA, RA, PsA and knee synovitis with possibly favorable results and rare negative side effects. In the MTX/GS injection, we use not only MTX but also a large volume of 10% glucose solution (GS) to release adhesive tissue by fluid tension and ease joint pain which already was shown benefit to improve metabolism environment in joint cavity. In order to provide clinicians with the highest level of evidence and evaluate the efficacy and safety of this intra-articular therapy, we conducted a 24-week trial in 90 ankylosing spondylitis (AS) patients with single knee synovitis from Nov. 2006 to Mar. 2012.
Objectives To evaluate efficacy and safety of intra-articular therapy with methotraxate in large volume of 10% glucose injection in ankylosing spondylitis (AS) patients with knee synovitis.
Methods AS patients with knee synovitis (n=90) were randomly divided into three groups. 50 patients in MTX/GS group were treated with intra-articular injection of MTX (15 mg) in 10% Glucose solution (20ml) every week for 8 times, while 20 patients in GS group with intra-articular injection of 10% Glucose solution (20ml) every week for 8 times, and 20 patients in control group without injection. All the patients received ibuprofen sustained release tablets 0.3 twice dialy and sulfasalazine 1g twice daily. Same dose of MTX (15 mg once weekly) were given orally to the patients in GS group and control group. At the beginning of the treatment and after 4, 8 and 24 weeks, all the patients underwent a clinical evaluation, measuring maximal angle of knee movement, knee pain with visual analogscale (VAS), swelling with joint circumference, global assessment (ASA20, PGA, BASMI, BASDAI, BASFI). Erythrocyte edimentation rate (ESR) and C-reactive protein were tested.
Results Joint pain, range of joint movement, circumference of swollen joint, ESR, CRP, patient's global assessment (PGA) in MTX/GS group are significantly improved after 4 weeks of treatment in comparison with baseline and other groups at same time point (P<0.01-0.05). Adverse reactions in MTX/GS group were less than other groups. No serious adverse events occurred in all the patients. Axial symptoms were no significant difference in three groups. At all time point, MTX/GS group had better improvement in ASA20, BASMI, BASFI than other groups without statistic difference. No serious adverse events occurred in all the patients. Adverse reactions in MTX/GS group were less than other groups.
Conclusions Compared to MTX orally taken, the repeated intra-articular injections of MTX glucose solution can suppress knee synovitis earlier and safely in AS patients. The intra-articular therapy of MTX/GS is another option in refractory monoarthritis.
Iagnocco A, Cerioni A, Coari G et al. Intra-articular methotrexate in the treatment of rheumatoid arthritis and psoriatic arthritis: a clinical and sonographic study. DClin Rheumatol. 2006 Mar;25(2):159-63.
Disclosure of Interest None declared