title: Safety of intra-articular injection of etanercept in small-joint arthritis: an uncontrolled, pilot-study with independent imaging assessment.
abstract: This study was conducted to test the safety of intra-articular tumor necrosis factor alpha (TNF-alpha) antagonists in small joints with arthritis. A dose of 2-8 mg etanercept was given intra-articularly guided by ultrasonography (US) in 26 patients with a flare of arthritis in a particular joint (16 wrists, two elbows, two ankles, six finger joints). Primary end points were imaging analyses by independent investigators: US-Doppler measurements were performed in all patients before and after the injection and MRI before and after were obtained in nine patients. The only adverse event was a case of swelling of the hand lasting 2 days after a wrist injection. Two patients had a supplementary glucocorticoid injection and were excluded from efficacy analysis after 4 days and 3 weeks, respectively. VAS for pain decreased after 1 week in 23 of 25 patients (median 0.62), and after 1 month in 14 of 24 patients (median 0.60). No significant changes were seen in erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). On MRI, all nine cases tested had a reduction in synovial thickness (P=0.008) and US Doppler signals diminished after treatment (resistance index (RI) P=0.02, pixels P=0.09). In conclusion, intra-articular injection of etanercept gave no noticeable adverse events.
authors.affiliation: The Parker Institute, Frederiksberg Hospital, Copenhagen, DK-2000, Denmark. henning.bliddal@fh.hosp.dk
authors.forename: Henning
authors.initials: H
authors.lastname: Bliddal
authors.forename: Lene
authors.initials: L
authors.lastname: Terslev
authors.forename: Etienne
authors.initials: E
authors.lastname: Qvistgaard
authors.forename: Peter v d
authors.initials: Pv
authors.lastname: Recke
authors.forename: Christian C
authors.initials: CC
authors.lastname: Holm
authors.forename: Bente
authors.initials: B
authors.lastname: Danneskiold-Samsoe
authors.forename: Anette
authors.initials: A
authors.lastname: Savnik
authors.forename: Søren
authors.initials: S
authors.lastname: Torp-Pedersen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000473:pathology; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001168:Arthritis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000473:pathology; D000068800:Etanercept; D005384:Finger Joint / Q000000981:diagnostic imaging / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage* / Q000009:adverse effects*; D007270:Injections, Intra-Articular; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010865:Pilot Projects; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D014033:Toe Joint / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept