Re: RESEARCH - A two-year trial of IM depot steroids in patients with RA who have shown an incomplete response to DMARDs

[Guest guest]

,

I know so many people that get depomedrol shots routinely. I hope

doctors read this article and reconsider how often these steroid

injections are given. If pain management in RA was better, the need

for steroids would be reduced.

a

a

On Mar 14, 2005, at 4:24 PM, wrote:

> The ls of the Rheumatic Diseases

> 2005 March 10

>

>

> A two-year randomised controlled trial of IM depot steroids in

> patients with

> established rheumatoid arthritis who have shown an incomplete

> response to

> disease modifying anti-rheumatic drugs

>

>

> Choy EH, Kingsley GH, Khoshaba B, Pipitone N, DL.

> King's College London, United Kingdom.

>

>

> OBJECTIVES: In rheumatoid arthritis, intramuscular (IM) pulsed

> depomedrone

> expedites the immediate response to disease modifying anti-rheumatic

> drugs

> (DMARDs). Though IM depomedrone is also widely used to treat disease

> flares

> in DMARD-treated patients, its effect on radiological progression has

> not

> been assessed. We therefore undertook a 2-year prospective randomised

> controlled trial to evaluate the benefits of 120mg IM depomedrone

> versus

> placebo in established RA patients whose disease was inadequately

> controlled

> by existing DMARDs. METHODS: Patients were assessed using the

> ILAR/WHO core

> data set, disease activity score (DAS28), X-rays of hands and feet

> scored by

> Larsen's method and bone densitometry. RESULTS: 291 RA patients were

> screened, 166 were eligible and 91 consented and were randomised.

> Disease

> activity improved more rapidly in the steroid-treated patients

> compared to

> placebo but after 6 months no difference remained. There was also a

> small

> but significant reduction in erosive damage in the steroid group

> compared to

> placebo. There was a significant excess of adverse reactions in the

> steroid-treated group (55 versus 42), especially those traditionally

> related

> to steroids (15 versus 2) including vertebral fracture, diabetes and

> myocardial infarction. Hip bone density fell significantly in

> steroid-treated but not placebo patients.

>

>

> CONCLUSIONS: IM depomedrone gave a short-term benefit in disease

> activity

> and a small reduction in bone erosion at the cost of a significant

> increase

> in adverse events. Despite the initial benefit of IM depomedrone, when

> patients respond suboptimally to a DMARD, they should not be given

> long-term

> additional steroids but should be treated with alternative or

> additional

> DMARDs.

>

>

> PMID: 15760929

>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

> cmd=Retrieve & db=PubMed & list_uids=15760929 & dopt=Abstract

>

>

>

>

> Not an MD

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

>

>

>

[Guest guest]

,

I know so many people that get depomedrol shots routinely. I hope

doctors read this article and reconsider how often these steroid

injections are given. If pain management in RA was better, the need

for steroids would be reduced.

a

a

On Mar 14, 2005, at 4:24 PM, wrote:

> The ls of the Rheumatic Diseases

> 2005 March 10

>

>

> A two-year randomised controlled trial of IM depot steroids in

> patients with

> established rheumatoid arthritis who have shown an incomplete

> response to

> disease modifying anti-rheumatic drugs

>

>

> Choy EH, Kingsley GH, Khoshaba B, Pipitone N, DL.

> King's College London, United Kingdom.

>

>

> OBJECTIVES: In rheumatoid arthritis, intramuscular (IM) pulsed

> depomedrone

> expedites the immediate response to disease modifying anti-rheumatic

> drugs

> (DMARDs). Though IM depomedrone is also widely used to treat disease

> flares

> in DMARD-treated patients, its effect on radiological progression has

> not

> been assessed. We therefore undertook a 2-year prospective randomised

> controlled trial to evaluate the benefits of 120mg IM depomedrone

> versus

> placebo in established RA patients whose disease was inadequately

> controlled

> by existing DMARDs. METHODS: Patients were assessed using the

> ILAR/WHO core

> data set, disease activity score (DAS28), X-rays of hands and feet

> scored by

> Larsen's method and bone densitometry. RESULTS: 291 RA patients were

> screened, 166 were eligible and 91 consented and were randomised.

> Disease

> activity improved more rapidly in the steroid-treated patients

> compared to

> placebo but after 6 months no difference remained. There was also a

> small

> but significant reduction in erosive damage in the steroid group

> compared to

> placebo. There was a significant excess of adverse reactions in the

> steroid-treated group (55 versus 42), especially those traditionally

> related

> to steroids (15 versus 2) including vertebral fracture, diabetes and

> myocardial infarction. Hip bone density fell significantly in

> steroid-treated but not placebo patients.

>

>

> CONCLUSIONS: IM depomedrone gave a short-term benefit in disease

> activity

> and a small reduction in bone erosion at the cost of a significant

> increase

> in adverse events. Despite the initial benefit of IM depomedrone, when

> patients respond suboptimally to a DMARD, they should not be given

> long-term

> additional steroids but should be treated with alternative or

> additional

> DMARDs.

>

>

> PMID: 15760929

>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

> cmd=Retrieve & db=PubMed & list_uids=15760929 & dopt=Abstract

>

>

>

>

> Not an MD

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

>

>

>

[Guest guest]

----- Original Message -----

From: " a " <a54@...>

> I know so many people that get depomedrol shots routinely. I hope

doctors read this article and reconsider how often these steroid

injections are given. If pain management in RA was better, the need

for steroids would be reduced.

I had one last Monday and already need another one. How often can we have

them?

Nina

[Guest guest]

----- Original Message -----

From: " a " <a54@...>

> I know so many people that get depomedrol shots routinely. I hope

doctors read this article and reconsider how often these steroid

injections are given. If pain management in RA was better, the need

for steroids would be reduced.

I had one last Monday and already need another one. How often can we have

them?

Nina