RESEARCH - Polyarticular steroid injection versus systemic administration in RA

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J Rheumatol. 2005 Sep;32(9):1691-8.

Polyarticular corticosteroid injection versus systemic administration in

treatment of rheumatoid arthritis patients: a randomized controlled study.

Furtado RN, Oliveira LM, Natour J.

From the Rheumatology Division, Universidade Federal de Sao o, Sao

o, Brazil.

OBJECTIVE: To study the effectiveness and side effects of polyarticular

corticosteroid injection compared to systemic administration in patients

with rheumatoid arthritis (RA), and to examine the differential response to

injection among joints. METHODS: Sixty-nine RA patients presenting with 6-12

swollen joints were enrolled to participate in a randomized trial consisting

of polyarticular injection in 6-8 swollen joints of intraarticular (IA)

triamcinolone hexacetonide (IA group) or intramuscular (IM) mini-pulse

therapy with triamcinolone acetonide in equivalent doses (IM group). Blind

examination at baseline (T0), Weeks 1 (T1), 4 (T4), 12 (T12), and 24 (T24)

postintervention included American College of Rheumatology improvement

criteria ACR20%, 50% and 70%, visual analog scale for articular pain, pain

on movement, joint count, range of motion, morning stiffness, quality of

life (Medical Outcome Study Short Form-36), use of nonsteroidal

antiinflammatory drugs and oral corticosteroid, blood pressure, adverse

effects, calls to the physician, and hospital visits. RESULTS: Significantly

better results were observed for IA compared to IM patients as follows:

ACR20% (61.7% vs 28.5% at T1; 73.5% vs 42.8% at T4), ACR50% (29.4% vs 5.7%

at T1; 44.1% vs 20% at T4), ACR70% (11.7% vs 0% at T1), patient's evaluation

of disease activity, lower tender joint count, lower blood pressure, lower

number of adverse effects, calls to the physician, and hospital visits (p <

0.05). Less significant adrenocorticotropic hormone reduction was observed

for IA group at T4 and T12 (p < 0.05). Elbows and metacarpophalangeal joints

had the best response to corticosteroid injection.

CONCLUSION: In the short term, polyarticular IA injection was better than IM

corticosteroid, as shown by ACR improvement criteria and number of adverse

effects.

PMID: 16142862

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6142862 & dopt=Abstract

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