RESEARCH - Changes of cartilage and bone markers after intra- articular steroids with and without postinjection rest in RA

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Ann Rheum Dis. 2005 Apr 20; [Epub ahead of print]

Changes of cartilage and bone markers after intra- articular glucocorticoid

therapy with and without postinjection rest in rheumatoid arthritis

patients.

Weitoft T, Larsson A, Saxne T, Ronnblom L.

Section of Rheumatology, Sweden.

BACKGROUND: Joint immobilization improves the therapeutic effect of

intra-articular glucocorticoid injection for knee synovitis. This may be due

to retarded steroid resorption by immobilization, a procedure that also

could influence cartilage and bone metabolism. OBJECTIVES: To evaluate

changes in cartilage and bone turnover after intra-articular glucocorticoid

treatment for knee synovitis with and without postinjection rest. METHODS:

Twenty patients with rheumatoid arthritis and knee synovitis were randomised

to 24-hour bedrest or to normal activity after intra-articular

glucocorticoid treatment. Serum and urine markers of cartilage and bone

turnover were studied for two weeks. Cartilage oligomeric matrix protein

(COMP) was used as a marker of cartilage turnover, osteocalcin as marker of

bone formation and deoxipyridinoline (DPD) as marker of bone resorption.

RESULTS: After the glucocorticoid injection COMP levels decreased in both

groups (p<0.001), but significantly more in resting patients. Serum

osteocalcin levels decreased significantly (p<0.001) without any difference

between the groups. DPD was unchanged in both groups.

CONCLUSION: In this study intra-articular glucocorticoid therapy for knee

synovitis reduced serum COMP, which suggests that such treatment may have a

cartilage protective effect. The slightly larger decrease of serum COMP in

the resting group may in part be due to lower clearance of COMP from the

joint cavity. Serum osteocalcin was temporarily reduced, indicating a

reversible suppression of bone formation.

PMID: 15843449

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