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Effect of intra-articular corticosteroid injections and inflammation on periarticular and generalised bone loss in early rheumatoid arthritis


Objectives To explore the effect of intra-articular corticosteroid (IAST) injections on bone mineral density (BMD) in the hand and at the metacarpophalangeal (MCP) joints in early rheumatoid arthritis (RA).

Methods In the first 3 months of the study, 19 patients with RA received methotrexate (MTX) alone and 21 received MTX and IAST injections into clinically inflamed joints. In the following 9 months, all patients received MTX+IAST. BMD was assessed at the hand and periarticular regions at MCP joints 2–5 at baseline, 3 and 12 months.

Results In the first 3 months a numerically lower percentage rate of bone loss was seen in MTX+IAST-treated patients compared with MTX-treated patients. This observation was more pronounced at the MCP periarticular regions (eg, partial proximal phalanges: digit 2, −0.45% vs −2.69%, p=0.045; digit 3, −0.34% vs −3.32%, p=0.003; digit 4, −0.39% vs −2.57%, p=0.14; digit 5, −0.59% vs −2.70%, p=0.24) than for the whole hand (−1.53% vs −2.42%, p=0.32). In the 3–12-month period, only minor non-statistically significant differences were seen between the two groups.

Conclusion IAST given over 3 months protects against periarticular bone loss in inflamed finger joints in RA. These data emphasise the importance of suppressing inflammation in patients with active RA to maintain bone health.

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