Efficacy and safety of combining intra-articular methylprednisolone and anti-TNF agent to achieve prolonged remission in patients with recurrent inflammatory monoarthritis (original) (raw)
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ISRN rheumatology, 2013
Our aim was to evaluate the effectiveness of tumour necrosis factor (TNF) inhibitors as add-on therapy for knee synovitis that did not respond to disease-modifying antirheumatic drugs (DMARDs) and other standard treatments in patients with peripheral spondyloarthritis (SpA). We retrospectively studied 27 SpA patients, in whom an anti-TNF agent was added for active peripheral arthritis with knee synovitis refractory to DMARDs and treatment with low-dose oral corticosteroids and/or nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular (IA) corticosteroids. As response of knee synovitis, were considered the absence of swelling, tenderness, and decreased range of movement in the clinical examination, after 4 months of anti-TNF therapy. In twenty-four (88.9%) of the patients there was response of knee synovitis. No statistical differences in gender (P = 0.53), age (P = 0.88), disease subtype (P = 0.22), and pattern of arthritis (P = 0.20) between knee synovitis responders and...
Reumatologia/Rheumatology
In knee osteoarthritis (KOA), synovial inflammation is linked with pain, swelling and structural abnormalities. Intra-articular corticosteroids (IACS) have been considered for pain relief in subjects who are non-responders to standard therapy. However, the results vary across different studies. This review aims to determine efficacy of IACS in KOA by review of the existing data. In several randomized controlled trials (RCTs), meta-analyses and uncontrolled studies a single IACS resulted in pain relief from 1 to a few weeks. In a few studies repeated IACS every three months provided a longer duration of pain relief and functional improvement in a proportion of patients. Baseline synovitis was predictor of treatment response in some but not all studies. Based upon the existing data, IACS provides a short-term pain relief in a proportion of patients. Given, anti-inflammatory properties of IACS, it is likely to be more effective in subgroups of KOA who display inflammatory phenotype.
2010
very early inflammatory polyarthritis (IP) with a 3-week course of intramuscular (IM) methylprednisolone acetate may postpone the need for disease-modifying antirheumatic drugs (DMARDs) and prevent IP from evolving into rheumatoid arthritis (RA). duration) were randomised to receive three injections of either 80 mg IM methylprednisolone acetate or placebo, given at weekly intervals. Assessments were monthly until 6 months after the first injection, and then concluded at 12 months. The primary outcome was the need to start DMARDs by the 6-month assessment. Secondary outcomes included disease activity and final clinical diagnosis by the rheumatologist at 12 months. PATIENTS AND METHODS Study design and patients This randomised, double-blind, placebo-controlled, multicentre trial examined the effect of IM glucocorticoids in patients with very early IP. General practitioners in the region of 23 participating hospitals were asked to refer patients aged 18 or older who had IP with symptom duration of 4-10 weeks to the rheumatology outpatient clinic. Patients had to have tenderness and soft tissue Objective To evaluate whether treating patients with Methods Patients with very early IP (4-10 weeks' Results Patients in the placebo group (76%) were more Conclusion Treatment of patients with very early IP with
International Journal Of Public Health Excellence, 2022
Rheumatoid Arthritis (RA) is an autoimmune disease characterized by inflammation of the joints. The selection of corticosteroids with broad indications is used as an adjunct therapy because of its anti-inflammatory activity and immune suppression. The research aimed to determine the efficacy and safety profile of corticosteroids in rheumatoid arthritis patients. The method used was a literature review with a narrative review design based on inclusion and exclusion criteria through the PubMed and Google Scholar databases. The results showed that the Prednisone group with varying doses of 5 mg; 6.25 mg; 10 mg gave better efficacy than the placebo group or Methotrexate monotherapy against disease activity with the DAS28 parameter. Prednisone safety was observed from the side effects, hypertension; hyperglycemia and adverse events, headache; reported diarrhea. The review show that the use of Prednisone tab 10 mg/day provided the best efficacy in the first 3 months (p<0.001) with the DAS28 parameter which achieved the greatest clinical remission. The side effects of Prednisone could not be concluded between the effect of dose and the level of drug safety.
Intra-articular corticosteroid for knee osteoarthritis
Cochrane Database of Systematic Reviews, 2015
Background Knee osteoarthritis is a leading cause of chronic pain, disability, and decreased quality of life. Despite the long-standing use of intraarticular corticosteroids, there is an ongoing debate about their benefits and safety. This is an update of a Cochrane review first published in 2005. Objectives To determine the benefits and harms of intra-articular corticosteroids compared with sham or no intervention in people with knee osteoarthritis in terms of pain, physical function, quality of life, and safety. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE (from inception to 3 February 2015), checked trial registers, conference proceedings, reference lists, and contacted authors. Selection criteria We included randomised or quasi-randomised controlled trials that compared intra-articular corticosteroids with sham injection or no treatment in people with knee osteoarthritis. We applied no language restrictions. Data collection and analysis We calculated standardised mean differences (SMDs) and 95% confidence intervals (CI) for pain, function, quality of life, joint space narrowing, and risk ratios (RRs) for safety outcomes. We combined trials using an inverse-variance random-effects meta-analysis. Main results We identified 27 trials (13 new studies) with 1767 participants in this update. We graded the quality of the evidence as 'low' for all outcomes because treatment effect estimates were inconsistent with great variation across trials, pooled estimates were imprecise and did not rule out relevant or irrelevant clinical effects, and because most trials had a high or unclear risk of bias. Intra-articular corticosteroids appeared to be more beneficial in pain reduction than control interventions (SMD-0.40, 95% CI-0.58 to-0.22), which corresponds to a difference in pain scores of 1.0 cm on a 10-cm visual analogue scale between corticosteroids and sham injection and translates 1 Intra-articular corticosteroid for knee osteoarthritis (Review)
Arthritis Care & Research, 1994
Objective. To determine which intraarticular steroids are used by rheumatologists and whether this use and associated practice vary with time and place of training. Method. American College of Rheumatology members were mailed questionnaires that focused on steroid use in the adult knee. Results. The steroids favored by the respondents were methylprednisolone acetate [MPA), preferred most by those trained in the eastern U.S.; triamcinolone hexacetonide [TH), preferred by those trained in the Midwest and Southwest; and triamcinolone acetonide FA), preferred by those trained in the West. Only TH was chosen primarily because of efficacy. Regardless of concentration, respondents used 1 ml of steroid. Most (especially those recently trained) combined steroid with local anesthetic. Post-injection instructions varied: 29% did not restrict weight-bearing; 8% recommended limited weight-bearing for 1 week or more. Conclusion. MPA, TH, and TA were favored. Associated techniques varied, based in part on where and when training took place. Research is needed to provide a more rational basis for clinical practice.
Clinical and experimental rheumatology
To compare the efficacy and safety of intraarticular glucocorticoid injection to its systemic use for treatment of knee synovitis in rheumatoid patients. A randomized double-blind controlled study was conducted including 60 patients with RA. Patients were randomized to receive either a single intraarticular knee injection with triamcinolone hexacetonide 60 mg (3 ml) and xylocaine chloride 2% (1 ml) associated to a single intramuscular injection of 1 ml of xylocaine chloride 2% (IAI group) or 1 ml of xylocaine chloride 2% by intraarticular injection and a intramuscular injection of triamcinolone acetonide 60 mg (3 ml) and xylocaine chloride 2% (1 ml) (IM group). All patients were blindfolded for the procedure. Evaluations were performed at baseline and 1, 4, 8 and 12 weeks post-intervention. The following instruments were used: VAS for knee pain, as primary outcome, VAS for knee morning stiffness and edema; the ACR 20, 50 and 70% improvement criteria; knee circumference and goniometr...