Background Rheumatoid arthritis (RA) and Spondyloarthropathies (SpA) are the commonest chronic inflammatory arthritides and intra-articular corticosteroid therapy is commonly used to control flares in one or few joints. However, it is surprising that despite more fifty years of experience with intra-articular corticosteroids use and evidence to attest their usefulness, evidence in the form of controlled trials to evaluate individual agents and their comparison remains sparse.
Objectives To compare the efficacy of intra-articular injection of methylprednisolone acetate with triamcinolone acetonide in treatment of acutely swollen knee joint in patients with chronic arthritis (RA and SpA) over a follow up period of 24 weeks using time to relapse and patient reported outcomes between the two groups.
Methods Patients with RA/SpA and swollen knee joint were recruited in this double-blind, randomized controlled trial. They were randomized in 1:1 ratio to receive either intra-articular methylprednisolone acetate (80 mg) or triamcinolone acetonide (80 mg) and followed up over a period of 24 weeks with follow-up visits at 4,12 and 24 weeks. Patients continued to take their DMARDs and other medications, with the dose of oral corticosteroids kept ≤7.5 mg/day prednisolone or equivalent. At each visit, relapse in the target joint was assessed using clinical measures, which included joint tenderness and swelling. Numerical rating scales for joint swelling and pain in the target joint, disease activity (using DAS28 (3)/BASDAI) and functional status assessment using the Health assessment questionnaire (HAQ) were secondary outcomes.
Trial #CTRI 006187.
Results This study included 100 patients of RA and SpA (RA:SpA=89:11,M:F=24:76) with mean age being 41.9 (± 25.2) years and mean disease duration 5.38 years. Among these, 50 patients each received intra-articular methylprednisolone 80 mg or triamcinolone acetonide 80 mg. After 24 weeks follow-up, there was no significant difference in the relapse rate or time to relapse between the two groups, each group having 9 relapses (relapse rate in the two groups was 18.4% vs.18.8%) with an average time to relapse of 6.44 (±8.24) weeks and 7.44 (±9.74) weeks in methylprednisolone and triamcinolone groups (p=0.991). Reduction in NRS-pain was 5.50 and 5.38 and in NRS-swelling was 5.52 and 5.45 respectively in methylprednisolone and triamcinolone groups at 24 weeks. The reduction in DAS28 at 24 weeks was 1.78 in both the groups. There was no significant difference in functional status between the two groups, the average reduction in HAQ scores being 0.85 and 0.86 in methylprednisolone and triamcinolone groups respectively
Conclusions Our study suggests that there is no significant difference between intra-articular methylprednislone and triamcinolone in terms of efficacy.
Pyne D,Ioannou Y,Mootoo R,et al.Intra-articular steroids in knee osteoarthritis:a comparative study of triamcinolone hexacetonide and methylprednisolone acetate,Clin Rheumatol.2004;23:116–205
Centeno LM,Moore ME,Preferred intra-articular corticosteroids and associated practice:a survry of members of the American College of Rheumatology,Arthritis Care Res.1994;7:151–155
Disclosure of Interest None declared