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Response to intramuscular methyl prednisolone in inflammatory hand pain: evidence for a targeted clinical, ultrasonographic and therapeutic approach
  1. Zunaid Karim,
  2. Mark A Quinn,
  3. Richard J Wakefield,
  4. Andrew K Brown,
  5. Michael J Green,
  6. Elizabeth M A Hensor,
  7. Philip G Conaghan,
  8. Paul Emery
  1. Academic Unit of Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
  1. Correspondence to:
    Professor P Emery
    Academic Unit of Musculoskeletal Medicine, Second Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; p.emery{at}


Background: Hand pain with stiffness is a common clinical presentation to early arthritis clinics, with outcome varying from resolution to the development of rheumatoid arthritis.

Objective: To assess the response and predictors of response to intramuscular methylprednisolone (MP) and hydroxychloroquine (HCQ) using a standardised treatment protocol.

Methods: Patients with inflammatory hand pain (IHP), defined as predominantly hand pain and morning stiffness of at least 30 min duration, received a standardised assessment prior to receiving intramuscular MP. Response (primary outcome) at 4 weeks was a 50% improvement in symptoms as perceived by the patient; responders who relapsed received repeat intramuscular MP and HCQ.

Results: 102 patients were recruited, of which 21% were rheumatoid factor (RF) positive, 23% had clinical synovitis, 25% had raised C-reactive protein level and 55% had ultrasound-detected synovitis. 73% responded, with associated significant reductions in morning stiffness, Health Assessment Questionnaire, painful and tender joint counts, and visual analogue scores (p⩽0.006 for all). Ultrasound-detected synovitis (p<0.001) and RF (p = 0.04), but not clinical synovitis (p = 0.74), were significantly associated with response to intramuscular MP. 86% who remained on HCQ long term reported a benefit.

Conclusions: Patients with IHP have significant improvement in symptoms and function following intramuscular MP. Further placebo-controlled trials are required to assess the role of intramuscular MP and ultrasonography in managing this patient group.

  • CRP, C-reactive protein
  • EMS, early morning stiffness
  • HAQ, Health Assessment Questionnaire
  • HCQ, hydroxychloroquine
  • IHP, inflammatory hand pain
  • MP, methylprednisolone
  • RA, rheumatoid arthritis
  • RF, rheumatoid factor
  • US, ultrasonography
  • VAS, visual analogue score

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