title: Intra-articular glucocorticoid injections decrease the number of steroid hormone receptor positive cells in synovial tissue of patients with persistent knee arthritis.
abstract: OBJECTIVE
  To explore changes in the number of steroid hormone receptor positive cells in synovial tissue (ST) after intra-articular glucocorticoid injection, to correlate these changes with changes in clinical variables, and to evaluate whether the number of steroid hormone receptor positive cells predicted the clinical response to glucocorticoid injection.
  
  
  METHODS
  Fourteen patients with persistent knee arthritis despite at least two previous injections in an outpatient setting received an intra-articular injection with glucocorticoids, followed by 3 days of admission with bed rest. Clinical efficacy was assessed at 6 and 12 weeks. ST biopsies were performed 2 weeks before and 12 weeks after the injection. The presence of different cell types (T cells, macrophages, fibroblast-like synoviocytes) and numbers of glucocorticoid, androgen and oestrogen α and β receptor positive cells were evaluated by histochemistry.
  
  
  RESULTS
  Patients showed, despite previous failures, good clinical response to glucocorticoid injection, with significant improvement in erythrocyte sedimentation rate, visual analogue scale (VAS) for pain, and joint disability score. The number of steroid hormone receptor positive cells decreased markedly (p<0.05 for all four receptors). The decrease in oestrogen receptor α positive cells correlated significantly with the improvement in VAS for pain and joint disability score. The number of glucocorticoid, androgen and oestrogen α and β receptor positive cells before injection did not predict the effect of treatment.
  
  
  CONCLUSIONS
  Intra-articular glucocorticoid injections followed by bed rest for persistent arthritis are clinically effective and significantly decrease the number of steroid hormone receptor positive cells in ST. The relevance of the latter needs further study.
authors.affiliation: Department of Rheumatology & Clinical Immunology (F02.127), University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. m.c.vandergoes@umcutrecht.nl
authors.forename: Marlies C
authors.initials: MC
authors.lastname: van der Goes
authors.forename: Rainer H
authors.initials: RH
authors.lastname: Straub
authors.forename: Marion J G
authors.initials: MJ
authors.lastname: Wenting
authors.forename: Silvia
authors.initials: S
authors.lastname: Capellino
authors.forename: Johannes W G
authors.initials: JW
authors.lastname: Jacobs
authors.forename: Zalima N
authors.initials: ZN
authors.lastname: Jahangier
authors.forename: Luise
authors.initials: L
authors.lastname: Rauch
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: Floris P J G
authors.initials: FP
authors.lastname: Lafeber
mesh_terms: D005260:Female; D005347:Fibroblasts / Q000187:drug effects; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007150:Immunohistochemistry; D007270:Injections, Intra-Articular; D007719:Knee Joint; D008264:Macrophages / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy* / Q000378:metabolism; D010147:Pain Measurement; D011987:Receptors, Steroid; D013583:Synovial Membrane / Q000166:cytology / Q000187:drug effects* / Q000378:metabolism; D013601:T-Lymphocytes / Q000187:drug effects; D014221:Triamcinolone / Q000008:administration & dosage
chemical_list: D005938:Glucocorticoids; D011987:Receptors, Steroid; D014221:Triamcinolone