Response of symptoms and synovitis to intra-muscular methylprednisolone in osteoarthritis of the hand: an ultrasonographic study.
OBJECTIVE
To examine the relationship between ultrasound (US)-detected synovial pathology in hand OA and the clinical response to parenteral corticosteroids.


METHODS
People with symptomatic OA of the hand completed questionnaires [visual analogue scale (VAS) pain, Australian Canadian Osteoarthritis Hand Index and VAS global] and underwent an US examination of both hands prior to receiving an i.m. dose of methylprednisolone. Four- and twelve-week assessments were performed to assess therapeutic response.


RESULTS
Thirty-six subjects with established OA were enrolled. Twenty-four (67%) subjects met the primary end-point of a 20% reduction in VAS pain, 25 (69.4%) met the Osteoarthritis Research Society International response criteria at 4 weeks. Overall in the group, there was a reduction in levels of pain in the most painful joint, pain in all joints and in global disease activity at 4 weeks (P < 0.001, P < 0.001 and P < 0.001, respectively). Reduction in symptoms was not associated with a statistically significant reduction in US-detected synovial hypertrophy or power Doppler signal.


CONCLUSIONS
In this observational study, parenteral corticosteroids were associated with a statistically significant reduction in symptoms, but no statistically significant reduction in US-detected synovial inflammation. The latter finding may, however, reflect the relatively low levels of synovial inflammation detected ultrasonagraphically in hand joints.
Keen
Helen I
HI
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
Wakefield
Richard J
RJ
Hensor
Elizabeth M A
EM
Emery
Paul
P
Conaghan
Philip G
PG
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D010146:Pain; D012720:Severity of Illness Index; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014463:Ultrasonography
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone